Who You’ll Hear
Kati Kleber, MSN RN CCRN-K – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, speaker
Melissa Stafford, BSN RN CCRN SCRN – Highly experienced and currently practicing nationally certified neurocritical care nurse
Elizabeth Mills, BSN RN CCRN – Highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center
What You’ll Learn
- What a Rapid Response Team is
- Good times to call the Rapid Response Team
- Possibly unnecessary times to call
- Things you should do when you call the RRT
When Nurses Should Call the Rapid Response Team Show Notes
What is a Rapid Response Team (RRT)?
- Recognize patients who could be in potential distress or risk for decline
- Help facilitate interventions to prevent the decline or transition them to a higher level of care
- Team members that show up
- Hospitalist or Advanced Practice Provider (PA or APRN)
- Critical Care RN
- Respiratory Therapist
- Follow set protocols to provide stat treatment
- Move patients to higher level of care if needed
- Are essential to preventing Code Blues
Good times to call an RRT
It is important to recognize signs of decline early before it becomes an emergency. You don’t have to know what exactly is going on, but you can detect something is wrong and get another set of eyes on the patient to help figure it out.
- Neuro changes
- Can be subtle!
- Changes in alertness and orientation
- Slurred speech or new difficulty swallowing
- Sensory or motor changes, especially unilateral
- Time is brain. Calling an RRT can get the physician to examine the patient now and get them to CT stat.
- Can be subtle!
- Respiratory changes
- Many RRTs are called due to changes in oxygen requirements
- Respiratory changes can precede an adverse event by up to 8 hours
- Don’t only focus on oxygen saturation. A patient can maintain adequate O2 sats with compensatory mechanisms, but they cannot compensate forever and that’s when they start crashing.
- Pay attention to work of breathing
- Depth of respirations– able to take deep breaths? Or only breathing shallow?
- Accessory muscle use– use of abdominal muscles to facilitate each breath? Any retractions visible between ribs or at clavicle?
- Ability to carry conversation– pausing to catch breath between sentences?
- Shortness of breath with exertion– more difficult now than this morning?
- Positioning– no longer able to breathe if laying down flat (keep in mind what is this patient’s normal)?
- Listen to lung sounds!
- Usually, a patient doesn’t crash immediately— not a light switch flipping off.
- Often it’s a slow progression over the course of hours where we as nurses need to recognize those early signs of deterioration.
- PAUSE and think of how this patient has looked over the course of your shift. How do they compare now to your initial assessment several hours ago?
- If the situation is non-urgent, it may be appropriate to call the Rapid Response RN and ask for them to come take a look at the patient so that the patient is on their radar. They can help you think through what might be happening and additional things to be watching out for.
You can also call an RRT if you’re not getting a prompt response from the provider and the patient is deteriorating. Rather than paging, waiting for the call back, paging again, waiting for orders, etc. this facilitates a rapid response to the situation by getting the right people and resources to the bedside.
Unnecessary times to call
If you think you need to call, call. Better to be safe. If it turns out that wasn’t quite appropriate, when all is said and done, ask questions to the Rapid Response Team and learn from it.
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- A blood sugar less than 70 mg/dL can cause neuro changes.
- If your patient is having neuro changes, grab a blood sugar real quick.
- Symptomatic hypoglycemia can be scary, but if you have a hypoglycemia protocol in place it is something you can handle without calling a Rapid Response.
- It’s a rhythm change and the rate on the monitor maybe be fluctuating rapidly.
- It’s important to assess the patient and ask how they feel. Are they symptomatic?
- If asymptomatic, manage by communicating with provider in standard fashion.
- It is unacceptable for the primary RN to be made to feel bad for calling a Rapid Response.
- That culture breeds distrust and leads RNs to be hesitant to call a Rapid Response.
- This is about patient safety and you are advocating for your patient.
- However, if the Rapid Response RN is short with you or demanding in the moment, that is most likely them being assertive and managing the situation, not them having any sort of issue with you as a nurse.
Things you should do once you call the RRT
- Stay with your patient!
- You are the story teller for what is going on with this patient so you need to be there when the Rapid Response Team arrives.
- Ask your teammates to grab you supplies so you can stay at the bedside.
- Get a full set of vital signs and a blood sugar while you are waiting for the Rapid Response Team to arrive.
- Document, document, document!
- What necessitated the call?
- What orders were implemented?
- Make sure your charting reflects your concern for the patient and why the Rapid Response needed to be called.
- Calling an RRT facilitates quick clinical decision making when a patient is deteriorating.
- It is better to call and it turns out to be unnecessary, than not call and have the patient have a poor outcome.
- Check to see if your institution has a rapid response policy that outlines specific instances when a rapid response should be called. Go ahead and print that bad boy out to have as a quick reference.