Emergency Teams at MUSC

1. Emergency Teams at MUSC

2. Several Emergency Teams-one number Mayday-cardiopulmonary arrest or imminent life threatening danger Pharmacy Response Team-for codes in the ICU only on intubated patients Rapid Response Intubation-for urgent intubation in the ICUs only-like calling anesthesia �stat� MET-Medical Emergency Team-responds to deteriorating patients on the general care floors BAT-Brain Attack Team-responds to patients with signs/symptoms of stroke

3. What is a MET? Medical Emergency Team- Responds when the �hospitalized patient has deteriorated... to the point where there is an imminent risk of serious harm�. MET-Rapid Response Team with MD component Responders are a RT, RN and MD from the ICU.

4. MUSC MET-Adults ART team-CCU RNS, the respiratory therapy coordinator and a cardiology fellow cover during the day. Off hours, a medical resident covers for the fellow. Main Hospital Adult Team-MICU RNs, the respiratory therapy coordinator and a pulmonary fellow cover the Main adult hospital. Off hours, a medical resident also covers this team.

5. MUSC MET -Pediatrics There are 2 teams in Children�s. One is based out of the PCICU and services 7CHC with the cardiology fellow. 7A, 7B and 8D are covered by PICU nurses. During the day, the attending responds. At night, it is the PICU resident.

6. How is the MET called? Adult Activation Criteria Staff member is worried about the patient Acute decrease in pulse oximetry saturation to <90% despite O2 fractional inspired oxygen (FiO2) of 50% or greater. (<60% in congenital heart disease. Acute change in conscious state Acute change in urine output Acute vital sign changes as from patient baseline

7. How is the MET called? Pediatric Activation Criteria Staff member is worried about the patient Acute decrease in pulse oximetry saturation to <90% despite O2 fractional inspired oxygen (FiO2) of 50% or greater. (<60% in congenital heart disease. Acute change in conscious state Acute change in urine output Acute vital sign changes as from patient baseline

8. MET Procedure If the patient demonstrates calling criteria, the nurse consults with the primary team about calling a MET. The nurse may call a MET at any time, but should let the house staff know first, if patient status permits. Floor caregiver calls 2-3333 and asks for MET team. Caller also gives name of primary service MD to be called. This MD gets a text page a MET has been called.

9. MET Procedure Floor caregiver gives information to team via SBAR protocol. Floor caregiver remains with the MET team throughout intervention. Standing orders allow RNs/RTs to begin medical treatment if MD is delayed. MET team documents on MET form

10. Mayday, Mayday!!

11. MUHA Mayday Teams -all called by 2-3333 MUH Adult Mayday Team ART Mayday Team Children�s Hospital Mayday Team Rutledge Tower Pediatric Mayday Team Rutledge Tower Adult Mayday Team Institute of Psychiatry Mayday Team CMH Mayday Team BSB Mayday Team Hollings Mayday Team Campus Response Mayday Team

12. How do you call?- if you work on the general floors Call the operator at 2-3333. Information to give: Where you are-exactly! We have a big campus here, so �5th floor� won�t work. Tell the operator the room number and the building. Adult or pediatric. We have several teams here, so they need to know who to call. Your name and call back number, so the operator can confirm someone responded.

13. �For Maydays in the Intensive Care Units, staff will call a Pharmacy Response Team if the patient is intubated. If the patient is not intubated, a full Mayday Team response will be called for.� Call 2-3333, give the name and location of the ICU, your name and call back number and if the patient is adult or pediatric.

14. Pharmacy Response TeamICU, ED and PACU ONLY If the patient is intubated or has a tracheostomy, you may call for the Pharmacy Response Team. This brings the pharmacist with their bag, the HSC (as appropriate) and the chaplain. On the floor, pharmacy responds with the full team, so the Pharmacy Response team is unnecessary

15. Rapid Response Intubation ICU, ED and PACU ONLY If anesthesia is needed for urgent intubation-the patient hasn�t coded, yet-call 2-3333 and ask for the Rapid Response Intubation Team.

16. Remember to call 2-3333 for Maydays and ask for the Stab Team. The Stab team responds to all nursery codes! Stab team consists of Pharmacy Residents/Interns Attending Stab Nurse NNPs Respiratory HSC

17. Remember to Document Have one person be the timekeeper-if you use your watch, the monitor and the wall clock, the times on the sheet will be misleading. Fill out sheet completely-fill it out as you are going along, so that you don�t forget anything. Remember, the code sheet counts as MD orders and the MAR.

19. Team Training Mayday team members are undergoing Team Training. This training decreases the number of people at the bedside and increases efficiency.

20. Mayday Teams-Training

22. MUSC Primary Certified Stroke Center (July 20, 2007 per the Joint Commission ) In an attempt to improve the organization and delivery of care to stroke patients, the Brain Attack Coalition published 2 sets of recommendations, one for primary stroke centers (PSCs) and, more recently, one for comprehensive stroke centers (CSCs). Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke. 2005;36: 1597�1616. A PSC has the personnel, programs, expertise, and infrastructure to care for many patients with uncomplicated strokes, uses many acute therapies (such as intravenous tPA), and admits such patients into a stroke unit. Brain Attack Coalition. Recommendations for the establishment of primary stroke centers. JAMA. 2000;283: 3102�3109.

23. MUSC Primary Certified Stroke Center (July 20, 2007) The CSC is designed to care for patients with complicated types of strokes, patients with intracerebral hemorrhage or subarachnoid hemorrhage, and those requiring specific interventions (eg, surgery or endovascular procedures) or an intensive care unit type of setting. MUSC has the components of a CSC, but the actual certification process has not been implemented by the Joint Commission yet.

24. Time lost = Brain Lost Rapid Assessment for Signs and/or symptoms of stroke with onset (last known at baseline) = 8 hours: 24/7 Emergency response team to ED, adult inpatient areas of main hospital & adult outpatient areas = 15 minute response to ED or bedside Stroke Neurology Resident, Stroke RN If > 8 hours call for Stroke Neurology Consult- If patient wakes up with symptoms then when were they last known without symptoms. Same thing with patients who have had anesthesia for surgery or procedure. Describe the response If > 8 hours call for Stroke Neurology Consult- If patient wakes up with symptoms then when were they last known without symptoms. Same thing with patients who have had anesthesia for surgery or procedure. Describe the response

25. Stroke Warning Signs Is your patient experiencing: Sudden numbness or weakness of face, arm, or leg, especially on one side of the body Sudden confusion or trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Sudden severe headache with no known cause Call 2-3333 and page the MUSC Brain Attack Team to your patient�s bedside. With a Stroke, Time Lost is Brain Lost. If > 8 hours call for Stroke Neurology Consult- If patient wakes up with symptoms then when were they last known without symptoms. Same thing with patients who have had anesthesia for surgery or procedure. Describe the response If > 8 hours call for Stroke Neurology Consult- If patient wakes up with symptoms then when were they last known without symptoms. Same thing with patients who have had anesthesia for surgery or procedure. Describe the response

26. Time lost = Brain Lost If > 8 hours call for Stroke Neurology Consult- If patient wakes up with symptoms then when were they last known without symptoms. Same thing with patients who have had anesthesia for surgery or procedure. Describe the response If > 8 hours call for Stroke Neurology Consult- If patient wakes up with symptoms then when were they last known without symptoms. Same thing with patients who have had anesthesia for surgery or procedure. Describe the response

27. Time lost = Brain Lost Rapid diagnostic evaluation for Signs and/or symptoms of stroke: Labs collected = 10 from time pt presents to ED or response team to patient on floor 24/7 CT/CTP/CTA Scan completed (goal = 25 minutes) from time pt presents to ED or response team to patient on floor EKG, NIH Stroke Scale I-stat creat. are now being done in the ED / Radiology to protect patients with renal problems. If there is any ? We just proceed w/ plain non-contrast CT to r/o ICH I-stat creat. are now being done in the ED / Radiology to protect patients with renal problems. If there is any ? We just proceed w/ plain non-contrast CT to r/o ICH

28. Time lost = Brain Lost Rapid treatment for Signs and/or symptoms of stroke: Hemorrhagic Stroke � Consult Neurosurgery Ischemic Stroke < 3hours from symptoms of stroke with onset (last known at baseline) � tPA considered (goal = 60 minutes from time pt presents to ED or response team to patient on floor to the initiation of the drug Ischemic Stroke < 8 hours from symptoms of stroke with onset (last known at baseline) � Thrombectomy and/or Thrombolysis Neuro-Interventional Radiology

29. JC Requires Documentation on: Dysphagia Screening before any PO Including medication Stroke Specific Education Related to patient specific risk factors See ClinDoc ? Disease Specific Stroke Education Smoking Cessation Admission Assessment Disease Specific Stroke Education

30. BAT & Team Support Neuro-Intensivist Stroke Neurologist Stroke Program Nurse NSICU Charge RN Chest Pain Center/DDC ICU Charge RN Neurology House-Staff Support staff on pager: Neurosurgery - Neuro- Interventional Radiology ED Operations Coordinator - Pharmacy - HSC - ATC

31. REMEMBER TIME MATTERS AND BRAIN IS MATTER OF TIME Lost time = lost cells =lost function= protect the punundrumLost time = lost cells =lost function= protect the punundrum