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Preparing the Rapid Assessment Team for Clinical Emergencies utilizing Clinical Simulation

Preparing the Rapid Assessment Team for Clinical Emergencies utilizing Clinical Simulation. Belinda Lechtenberg RN, BSN, CCRN, PCCN . Things We Already Know: Rapid Assessment Team Function . These three problems often lead to failure to rescue. Failures in planning

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Preparing the Rapid Assessment Team for Clinical Emergencies utilizing Clinical Simulation

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  1. Preparing the Rapid Assessment Team for Clinical Emergencies utilizing Clinical Simulation Belinda Lechtenberg RN, BSN, CCRN, PCCN

  2. Things We Already Know: Rapid Assessment Team Function These three problems often lead to failure to rescue. • Failures in planning • Includes assessments, treatments, goals • Failure to communicate • Patient-to-staff, staff-to-staff, staff-to-physician, etc. • Failure to recognize a problem

  3. Clinical Instability Prior to Arrest • 70% (45/64) arrests with evidence of respiratory/neurologic deterioration within 8 hours (Schein, Chest 1990; 98: 1388-92) • 66% (99/150) abnormal signs and symptoms within 6 hours of arrest and MD notified 25% of cases (25/99)(Franklin, Crit Care Med;1994;22: 224-247)

  4. Clinical Instability Prior to Arrest Warning signs within 6 hours of event: • MAP <70 or >130 mmHg • Heart rate <45 or >125 per minute • Respiratory rate <10 or >30 per min • Chest pain • Altered mental status

  5. What difference can an RAT make? • Literature Review: Other hospitals that have implemented such programs have reported • 50% reduction of codes • 12 – 30% reduction in hospital mortality • 46-70% reduction in “failure to rescue” • Improved staff satisfaction and recruitment with presence of “support team”

  6. What difference can an RAT make? • 50% reduction in non-ICU arrests (Buist, BMJ 02) • Reduced post-operative emergency ICU transfers (44%) and deaths (37%) (Bellomo, CCM 04) • Reduction in arrest prior to ICU transfer (4 % v 30 %) (Goldhill, Anest 99)

  7. What Is the Role of the RAT? • Assess • Stabilize • Assist with communication • Educate and support • Assist with transfer, if necessary

  8. Background:What is a Rapid Assessment Team? Why a Clinical Emergencies Class? • A Rapid Assessment Team (RAT) – was developed to prevent deaths in patients who are progressively failing outside the ICU • At IBMC the RAT team was established and guidelines set in place for a RAT call but no real education took place for the requestors or responders to the RAT call. • It become apparent to leadership after surveys of the nursing staff had been completed that the staff had no real understanding of what constituted a RAT call or what a clinical emergency looked like that required a RAT call, members were not clear about their function at the RAT call and guidelines had not been established for training of the team. • The results of the surveys were presented to nursing leadership as well as the Code Blue committee and as a result a Clinical Emergencies class became part of the nursing orientation process and all new nurses required to attend the class and all existing staff encouraged to attend.

  9. Clinical Emergencies Course Design • Nursing Staff • Criteria for calling • Notification process • Communication and teamwork skills • SBAR, Assertiveness / Critical Language • Appropriate expectations • Importance of calling even when unsure • Non-judgmental, non-punitive nature of the RAT • Have information available for RAT (chart, medication administration record, etc.) • Role as a member of the team

  10. Providing Education:Criteria for Callingthe RAT • Evaluating nurse will utilize the established DUCS criteria in assessment of the patient DUCS Initial Review • Heart Rate > 120 or < 50 • Systolic Blood pressure <90 • Respiratory Rate <10 or > 30 • Abnormal mental status • Oxygen saturation < 90% despite oxygen therapy

  11. Criteria for Callingthe RAT DUCS secondary review • Staff member is worried about the patient • Acute change in HR to <50 or >120 • Acute change in SBP to <90 • Acute change in respiratory rate to <10 or >30 • Acute change in oxygen saturation to <90% despite oxygen therapy • Acute change in mental status (conscious state) • Acute change in Urine output to <50 ml in 4 hours

  12. Clinical Emergencies Course Design • The Clinical Emergencies Course is designed utilizing teaching methods for the adult learner • One of the methods utilized is Clinical Simulation • The following demonstration is a GI bleed scenario that involves recognition of a clinical emergency, utilizing resources, calling the RAT and function of the team at the RAT call.

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