OUR LADY OF LOURDES MEMORIAL HOSPITAL Binghamton, New York

1. OUR LADY OF LOURDES MEMORIAL HOSPITALBinghamton, New York Medical Emergency Team MET A Strategy to Reduce Morbidity and Mortality

2. Our Lady of Lourdes Memorial Hospital Our Lady of Lourdes Hospital is a 267 bed acute care, community, not-for-profit healthcare facility which provides a full spectrum of inpatient, ambulatory and emergency services.

3. Medical Emergency Team PURPOSE: The Medical Emergency Team is available to provide consultation and assistance to non-critical care nursing staff in the identification and triage of potentially life threatening conditions.

4. Medical Emergency Team • Cardiac arrests in hospitals are usually preceded by signs of clinical instability that typically begin 6-8 hours prior to arrest. • Risk of death with in-hospital cardiopulmonary arrest is reported in the literature as between 50% and 80%.

5. Medical Emergency Team • MET Members: • ACLS RN (ICU – 1st Responder. If unable to respond, ICU RN will call ER or Seton 1 Telemetry) • Respiratory Therapist • Clinical Manager • Primary Registered Nurse on patient unit • MET responds with a Life-Pak

6. Medical Emergency Team CRITERIA: • HAVE A CONCERN- Something’s just not right • Acute symptomatic change in respirations, respiratory distress or threatened airway (<8 or >30) OR Change in breathing pattern • Acute symptomatic change in heart rate(<40 or >130), refer to baseline • Acute change in oxygen saturation, <90% despite oxygen

7. Medical Emergency Team • Acute symptomatic change in blood pressure, refer to baseline • Chest pain • Acute change in level of consciousness (LOC) • Decrease in urinary output; <50 ml in 4 hours without history of renal dysfunction • Failure to respond to treatment • New, repeated or prolonged seizure

8. Our Process to Initiate MET • Call is placed to ICU, stating “This is a MET call”. • ICU RN gets brief overview of reason for call. • ICU pages Respiratory Therapist to make them aware of MET call and location. • If ICU RN unable to respond, Telemetry Unit is notified. If Telemetry Unit RN is unable to respond, ICU RN notifies Emergency Department RN to respond.

9. SBAR Communication • S – Situation • B – Background • A – Assessment • R - Recommendation

10. SBAR Definition: • SBAR is a situational briefing tool that logically organizes information so that it can be transferred to others in an accurate and efficient manner.

11. SBAR • Fosters critical thinking skills • Eliminates information getting lost in translation • Saves time • Develops RN / RT assertive behavior • Individuals speaking up and stating their information with appropriate persistence until there is a resolution, all done in the interest of better patient care

12. SBAR SBAR – SITUATION • “I am” (name and unit) • “I am calling about” (patient’s name and room number) • “The problem that I am calling about is” (state the problem)

13. SBAR SITUATION - example • “This is Joe, a nurse on Seton 3, calling about your patient Mrs. Gaige in Room 3606 bed 2. The problem that I am calling you about is her new complaint of dyspnea and increasing respiratory rate.”

14. SBAR SBAR – BACKGROUND • State admission diagnosis and date of admission • Give brief synopsis of hospital course and treatment to date • Give vital signs including SpO2 and physical assessment pertinent to the problem

15. SBAR BACKGROUND _ EXAMPLE • Mrs. Gaige was admitted 3 days ago with pneumonia.She’s been on Levaquin and improving each day, no more fever and less cough and sputum. • Now her vital signs are RR=32 P=86, BP= 90/60, T=100.1 and SpO2= 88% on 2L. • Her breathing looks labored and she has new crackles in the right lower lobe.”

16. SBAR SBAR – ASSESSMENT • Give your impression of the present situation. A diagnosis is not necessary • If the situation is unclear, at least try to indicate what body system is involved • State how severe the problem seems to be • If appropriate, state the problem could be life threatening

17. SBAR ASSESSMENT EXAMPLE “I think Mrs. Gaige could be developing worsening pneumonia in the right lower lobe.”

18. SBAR SBAR – RECOMMENDATION • Give the physician your recommendations for the interventions that you think should be done, based on your assessment

19. SBAR RECOMMENDATION – EXAMPLES • “I have called the MET.” • “I think that you should come see the patient now.” • “I think that you need to discuss code status with the family.” • “I think the patient needs a portable chest xray and blood cultures.

20. SBAR BEFORE YOU CALL THE PHYSICIAN: • Have the patient’s chart, MAR and I & O sheet • Have today’s labs • Review the most recent progress note • Review the nursing notes for past shift • Know the patient’s code status

21. SBAR What can you expect from MET? • Experienced ACLS team members and the primary care nurse working collaboratively to assist with the assessment of your patient • A comprehensive and complete assessment of your patient • Early intervention to slow or prevent clinical deterioration • Critical Care at the bedside • Preventing Failure to Rescue • Decrease hospital morbidity and mortality

22. Testing MET • Team developed a policy for MET, which enabled MET to perform stat EKG and ABG, without obtaining physician order first. • Team developed an SBAR tool to guide primary nurse through call to primary physician. • We began testing MET on the 11PM to 7AM shift in October 2004. • MET members from ICU and Telemetry went unit to unit and presented a powerpoint education face to face with staff. • SBAR Communication Technique incorporated into education. • Developed an evaluation tool to monitor the MET calls.

23. Testing MET • Presented Medical Emergency Team to our Medical Executive Committee (MEC). • MEC voiced concern that there might be a delay in notifying the physician. • We advised that the physician should be called sooner than later if units called with established MET criteria. • ICU began to get calls on the day shift in early November. • Team began to develop a plan to educate day shift and evening shift on MET. • Presented to Nursing Unit Educators, who then educated their units on MET.

24. Testing MET • MET and SBAR presented at orientation. • SBAR tool made into pads that are located at nursing station near phone. Reordered through our copy center. • MET available all 3 shifts as of 12/23/04.

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