National Nurses United

CE_Nov REV 6/30/11 1:49 PM Page 14 CE Home Study Course Rapid Response Teams Another "Safety" Scheme? I Introduction n 2004 the institute for Healthcare Improvements (IHI) encouraged hospitals in the United States to implement Rapid Response Teams (RRTs), which was one of six life- saving strategies recommended by the IHI to improve patient outcomes. It was part of its 100,000 Lives Campaign. www.ihi.org.Today, more than 2,700 hospitals have joined nationwide and implemented RRT strategies which now have become the standard of care for prevention of avoidable deaths. Proponents of rapid response teams have been given names such as STAR or STAT teams. These teams are composed of clinicians with ICU-level clinical expertise. are admitted on medical-surgical units with less rich RN staffing ratios, being cared for by nurses who do not have demonstrated and validated competencies in providing critical care. According to critics, the deployment of RRTs has created a false sense of security among RNs and patients alike, including the patients' families who are given the RRT's stat Code H number so they can call the team directly. They further question the logic. Who has the responsibility and accountability to identify and recognize the patient's deteriorating condition? Answer: the direct-care RN assigned to the patient, not the RRT team. Who has the responsibility to initiate competent interventions? The answer again is the direct-care RN assigned to the patient, not the RRT team. Early Detection and Early Intervention in order to be able to assess and intervene in a timely manner, there must first be sufficient numbers of direct-care RNs with current demonstrated competency present and available. What is confusing is that the RRT team is touted as the stabilizer of a pre-"forest fire" condition and not the identifier of deteriorating conditions. The requirement is that when a patient's vital signs reaches a close to what is sometimes called a "flat line" or "near miss," then stat page the STAR or similar type of team. Question: Why wait? There seems to be three stages of deterioraThe Latest Safety Scheme tion: (1) subtle decline in the patient's vital signs and status; (2) management consultants, pushing their "safety" schemes, STAR or RRT-team level of deterioration creating a "near miss" situstate that there are various systemic factors that contribute to the ation; and; (3) patient crashed, requiring full resuscitation/ Code variability of the safety of patients in healthcare today: (1) failure in Blue or ending up in a "failure to rescue" situation. planning patient care (including patient assessments, This conjures up another question. Why is there a treatments, identifying and implementing goals); (2) need for an intermediary team? In many instances failure to communicate (patient to direct-care RN, Submitted by the Joint hospitals "break" the "ratios" when the team is shift/transfer report from RN to RN; and RN to MD Nursing Practice deployed. Members of the RRT team may be reports); and (3) failure to recognize deteriorating Commission, DeAnn assigned to provide meals/break relief and are patient condition. McEwen, RN, and instantaneously pulled off, or a 1:1 ICU patient may According to these consultants, the RRT stands to Hedy Dumpel, RN, JD be instantly reclassified as a 1:2 to accommodate the impact this "failure to rescue" state of affairs by idenProvider Approved RRT team. tifying unstable patients and those patients likely to by the California suffer cardiac, respiratory arrest, or some other deadBoard of Registered Current, Demonstrated and ly outcome. The goal is to respond to a "spark" (subNursing, Provider Validated Competency jective patient complaints, signs, and symptoms) #00754 for 2.0 contact hours (cehs). before it becomes a "forest fire" (cardiac or respiratoprior to market-driven corporate healthcare, Recognized by all ry arrests). direct-care RNs, in general, had the required unitstates with the excepCritics of the RRT strategy have argued that this is specific demonstrated and validated competency to tion of Arkansas, just another corporate "penny wise pound foolish" take care of patients who were admitted to the unit. Delaware, Massachuscheme to countermand the "failure to rescue" critiUnits would have a designated Charge Nurse and/or setts, Minnesota, Montana, North Carolina, cism directed towards the hospital industry. Instead Clinical Nurse Specialist (CNS), an expert, who and South Carolina. of placing the patients in a higher level of care based would be available to assist with assessments, proon their severity of illness and acuity, these patients vide consultation, and perform sophisticated and 14 N AT I O N A L N U R S E W W W. N A T I O N A L N U R S E S U N I T E D . O R G JUNE 2011 THELINKE | ISTOCKPHOTO.COM Description. This home study examines the proliferating usage of Rapid Response Teams (RRT), a team of critical care experts established to bring critical care expertise to the patient's bedside, and their relationship to the unit placement of the patient and reductions in the rate of mortality.

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