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Lighthouse Development Team. Rapid Response Team. Opportunities. Most hospitalized patients with cardiac arrest have abnormal physiological values recorded in the hours preceding the event
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Lighthouse Development Team Rapid Response Team
Opportunities • Most hospitalized patients with cardiac arrest haveabnormal physiological values recorded in the hours precedingthe event • A patient’s baseline condition begins to deteriorate a mean of 6.5 hours before an unexpected critical event or actual cardiac arrest (5) • Schein et al found that 70% of patients show evidence of respiratory deterioration within 8 hours of arrest (6) • At a minimum, the measurement of key clinical indicators must be obtained accurately and recorded with appropriate frequency (7) • Communication of patient deterioration can be improved and physician notification of patient’s condition worsening may only occur in 25% of cases • Ongoing program management and performance improvement is essential to the sustainability of RRT’s (5) Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. Br Med J. 2002;324:387-390 (6) Schein. Chest. 1990;98:1388-1392. (7) ILCOR Consensus Statement. Recommended Guidelines for Monitoring, Reporting, and Conducting Research on Medical Emergency Team, Outreach, and Rapid Response Systems: An Utstein-Style Scientific Statement. (8)Franklin. Crit Care Med. 1994;22:224-247.
RRTModule Overview • The following slides show examples of the proposed online documentation and communication screens to be displayed within the patients electronic medical record. • Summaries and executable knowledge shown are populated and triggered by electronic clinical documentation.
Review Patient • Mews/Pews scoring assessments are collected leveraging existing electronic nursing clinical documentation. • Diagnostic results are collected and displayed in the clinical repository. • If any result/assessment is out of set parameters, alerts are triggered. • Process Recommendations: • Standardize Triggering Criteria and Protocol • Daily RRT Rounding • Executable Knowledge: • Rule: MEWS/PEWS Scoring/notification • RRT Patient Screening/Scoring: • Bedside Clinician: Document Clinical Assessment • MEWS/PEWS • Summary View : • Review physiologic parameters • RRT Dashboard: • Facilitate daily rounding • Amend/filter screening criteria • Change parameters to meet patient’s clinical concerns
RRT Execution- Real Time Notification • High Risk Patients • “At Risk Patients” are automatically recognized by the system and are • In need of additional assessment. • In need of additional intervention. Clinicians are notified in real time • Executable Knowledge—Alert when.. • Alert/Notify:MEW/PEWS Scoring/notification • “At Risk” Patients: based on worsening trend of scoring criteria • Linked with RRT summary page • Rule: RRT Low Grade Fever Rule • Increase Vital sign assessment Frequency • SBAR MPage: RRT activation criteria • SBAR communication checklist • Ability to active RRT and Notify Physician • Summary View: • Clinical Early Warning • Activating and alerting of RRT events • RRT Dashboard: • Stratified view of risk levels and key indicators Recognize
RRT Response • Clinician or System Trigger to Activate RRT! • RRT assessment, intervention, and disposition • Option to communicate with attending Physician • Executable Knowledge: • Alert/Notifications:RRT Activate • Care Plan: • Suggested with activation • SBAR Summary page: • RRT Intervention/SBAR with “standing orders” • Early Warning/RRT events are recorded • RRT Record • Code Blue Record Respond
RRT Intervention Care Plan/OrdersetWhat gets triggered? • Vital Signs (initially and as indicated) • Blood pressure, heart rate, respiratory rate, temperature, oxygen saturation • Nursing Orders: • P.O.C. Blood glucose, Cardiac monitor • IV Patent IV access IV fluid: Normal saline at _________mL/hour • Respiratory: • Clear and maintain airway, Oxygen therapy to stabilize patient and maintain oxygen of % • via ____nasal cannula ____mask • Ventilation assistance with positive pressure ventilation • Medications • Albuterol _____mg nebulizer as needed for respiratory distress • Nitroglycerin 0.4 mg sublingual for chest pain. May repeat every 5 minutes for total of 3 doses • Naloxone (for narcotic reversal) (0.2-0.4 mg) IV IM or subcutaneously as needed for respiratory depression • Flumazenil (benzodiazepine reversal) 0.2 mg IV; may dose every 60 seconds for a total of 4 doses as needed for respiratory depression (maximum is 1 mg) • D50 IV or other hypoglycemic agents • Lab/Diagnostic Tests: • Chest x-ray (AP Portable) • Other imaging studies • EKG • HGB/HCT CBC Glucose Electrolytes (Na+, K+, Cl -,CO2) BUN/Creatinine • Arterial blood gases
RRT Execution: RecoverTreat and measure • Process Recommendations: • RRT Debriefing: Staff, Patient, Family • Communication Protocol: Physician Notification • Executable Knowledge: • Documentation: • Patient Chart: RapidResponse Team Record /Code Blue • Summary Page: SBAR Documentation • Physician Documentation: RRT Record • Notification: • Physician • Summary View : • Significant Events Component • Communication of event record to care team Recover • Standardized Documentation of RRT Activities and Outcomes • Communication of patient status with RRT, Staff Nurse, Physician, ICU etc.
RRT Dashboard, Summary page and Communcation page • Provides a summary view of all patients that require monitoring. • Available anywhere • Ability to drill down through results • Ability to graph and trend results • Ability to send results to physician – real time.
