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After the Call

Med/surg nurses hold information vital to a patient's outcome in a rapid response.

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Med/surg nurses should be an integral part of hospital Rapid Response Teams (RRTs), but instead often relinquish care of the patient to this expert team when they arrive at the bedside.

The RRT focuses on preventing future deterioration of the patient, quick interventions and transfer to a higher level of care.1 Toward that goal, they are staffed by critical care nurses, a respiratory therapist and usually a physician assistant, resident or physician with critical care expertise.

Another goal for the RRT is "to foster collaboration between critical care nurses and med/surg nurses in the care of patients through assessment, communication, immediate interventions, support and education."1

But although the med/surg nurse at the patient's bedside holds information vital to the outcome, at my institution their interaction with the RRT is minimal.

Evolution of RRTs

The Institute for Healthcare Improvement (IHI) identified the need for the development of the RRT in 2004 as part of its 100,000 Lives Campaign, and are an important component of IHI's 5 Million Lives Campaign.1

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The purpose of this initiative was to rescue distressed patients early, prevent further deterioration, transfer them to a critical care unit and decrease mortality.

Most hospitals report positive results in patient outcomes since the institution of RRTs, and several are profiled in "Improvement Stories" on the IHI website.

But little evidence indicates the goal of collaboration between med/surg nurses and the RRT through communication, support and education has been achieved.

Total team collaboration can only be realized when the med/surg nurse is recognized as an integral RRT member.

Perceptions of RRT Roles

Personal observations from my role as clinical nurse educator provoked me to ask med/surg nurses how they perceived their role in a rapid response.

One nurse felt the event was stimulating and caused her to reflect on her actions prior to the call:

"I wondered if it was something that I did or did not do that caused the patient's deterioration," she remarked. This experienced nurse utilized the rapid response as a learning experience by intently listening to the conversations and interactions of the critical care nurse and physician as they discussed the next course of action.

Not all nurses feel the same as this experienced nurse. Another nurse conveyed these feelings:

"I just get out of the way so they can take over and do their thing." She described her responsibilities as retrieving medications, equipment and other needed items, which are clearly important.

Other nurses expressed similar feelings of having taken a backseat role when the RRT arrives.

Still other nurses stated although they had not participated in many rapid responses, when they did, they were unsure of what they should do when the team arrived.

Additionally, these nurses relayed that some practitioners rolled their eyes and whispered comments like, "Why did they call this?"

Sharing Nursing Expertise

In all of the situations above, it is obvious the med/surg nurse was either unsure of her role or stands aside and lets the team take over.

But as the primary nurse, the med/surg nurse knows the patient best.

Information obtained from the patient's chart including past history, medications and lab values has been researched by the primary nurse.

In addition, assessment of the patient's vital signs and comprehensive examination at the start of the shift along with multiple interactions throughout the day provide baseline information about the patient.

Quick mental reviews of report from the previous shift reveals still more data. Knowing all this valuable information, the nurse cannot remain a silent participant when decisions about the patient need to be made. Best patient outcomes are only realized when information is shared.2

Improving Communication

The SBAR [situation, background, assessment, recommendations] format is employed during a rapid response so that information can be communicated succinctly and quickly.2

Nurses need to practice this format in all communications so it can be easily applied during an emergency situation.

Since physicians communicate in a more bulleted fashion, for instance, using the SBAR format will grab their attention and promote a quicker response to recommendations by med/surg nurses.

Other ways to build confidence and become actively involved in a rapid response is for the med/surg nurse to look to other members of the team as mentors.

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The critical care nurse serves as a role model with her technical expertise and experience in emergency events. Respectful interactions and a willingness to learn can further develop relationships, bridging the gap between critical care and med/surg nurses.

Asking critical care nurses questions about interventions made during the rapid response through debriefing during or after the event are methods that assist the med/surg nurse in a garnering a greater understanding of their decisions.

At the end of this brief encounter, personal reflection and evaluation of the interaction is another way to examine the effectiveness of the communication among team members.

Many hospitals have simulation equipment and use this advanced technology to create rapid response scenarios so nurses can practice their roles during a rapid response.

Even without simulation equipment, role playing sessions can be conducted to increase the comfort level of the med/surg nurse. This provides an opportunity to perform these unfamiliar and infrequent skills in a non-threatening, safe environment.

The incidence of emergency events is unpredictable, but with the use of simulation equipment or role playing and repeated practice sessions with feedback, the nurse will gain experience and increased confidence to actively participate in patient emergencies.

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Golden Opportunity

Med/surg nurses need to embrace each emergency event as a golden opportunity to enhance their knowledge base and draw on the experience of the expert team.

Employing the SBAR format, utilizing critical care nurse mentors and sharpening communication skills through practicing simulated rapid response scenarios will magnifying the role of the med/surg nurse during a rapid response.

Collaborating and sharing knowledge is critically important for best patient outcomes.

Each member of the RRT has a vital part to play in rescuing the patient, but this can only be accomplished when the med/surg nurse is acknowledged as a valuable member of the team.

Gaining confidence to actively participate and refusing to relinquish care during a rapid response assures the med/surg nurse will be recognized as a collaborative team member.

Helen Clements is clinical nurse educator, Manchester Memorial Hospital, Manchester, CT, an affiliate of Eastern Connecticut Health Network.




     

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