Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 14: Rapid Response Teams and Transport of the Critically Ill Patient.

Slides:



Advertisements
Similar presentations
Introduction Efficient intra-hospital transport of severe closed head injury and stroke patients requires maintenance of consistent ventilation and oxygenation.
Advertisements

OUR LADY OF LOURDES MEMORIAL HOSPITAL Binghamton, New York Medical Emergency Team MET A Strategy to Reduce Morbidity and Mortality.
Utilization Management. Learning Objectives Upon completion of this section the participant will be able to: Define Utilization Management. Understand.
Cardiac Reperfusion Team Protocol Reduces Door-to-Balloon Time at Hamot Medical Center Antonios D. Katsetos, DO, Thomas Williams, MS, Theresa Kisiel, CRNP,
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission, Discharge, Transfer, and Referrals.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 36 Implementing and Evaluating Care.
1 Code Team Members Roles and Responsibilities Jamileh Mokhtari nori, MSN, PhD candidate Nursing Faculty, Nursing Management Dept., Baqiyatallah Medical.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 06: End-of-Life Issues in Critical Care.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 07: Ethical Issues in Critical Care Nursing.
Preparation for postural drainage
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 05: Relieving Pain and Providing Comfort.
Implementation Chapter Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Purposes of Implementation  The implementation.
PROGRESSIVE PATIENT CARE.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1 Overview of Nursing Process, Clinical Reasoning, and Nursing Practice.
RENI PRIMA GUSTY, SK.p,M.Kes
Pre-operative Assessment and Intra operative Nursing Role
M Purpose Improvement Tools/Methods Limitations / Lessons Learned Results Process Improvement Improving Hospital-Acquired Pressure Ulcers at Discharge.
DUCS and RATS INTEGRIS Health.
 Who Physicians from  Anesthesia  Medicine (on call MICU and cardiology teams)  Surgery Nursing  House supervisor  ACLS trained nurse from CCU/CTICU.
Lighthouse Development Team
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 40 Nursing Care of the Child With a Cardiovascular Disorder Maternity and.
Conscious Sedation.
Rapid Response Team Patty Gessner, RN MSN Alexian Brothers Medical Center.
Question Are Medical Emergency Team calls effective in reducing cardiopulmonary arrest rates in the general medical surgical setting? Problem The degree.
Bergeron et al., First Responder, 7 th Edition © 2005 by Pearson Education, Inc. Upper Saddle River, NJ Introduction to EMS Systems CHAPTER 1 Unit 1 Preparatory.
Trauma Services Backboard Removal Project. First off, we need a volunteer please……
Catholic Medical Center Rapid Response Teams
Stroke and Code Brain Attack “Act Fast When the Brain Attacks”
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 9 Continuity of Care.
 Emergency  Defined as an unexpected serious occurrence that may cause injuries that require immediate medical attention  Time becomes a critical factor.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10Safety Concerns in Healthcare.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 19: Community Preparedness: Disaster and Terrorism.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Textbook for Nursing Assistants Chapter 14: Admissions, Transfers, and Discharges.
Rapid Response Team. What is a Rapid Response Team? A Rapid Response Team or RRT, is a working team of clinicians who bring critical care expertise to.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins MS 1 Program Group 3-30 Chapter 03: The Nursing Process.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1 Nursing Diagnoses: Issues and Controversies.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 8 Healthcare Delivery Systems.
Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 18: Design Considerations for Healthcare Information Systems Chapter 18:
Current EMS System. Define and enumerate the general principles of the current EMS system, its various component and various rule of each and every component.
Pre-Operative and Post-Operative Care
Slide 1 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing.
EMERGENCY PLAN Trained Personnel –Credentials 1st Aide CPR ATC EMT MD –Emergency Care Equipment Field Kits Splint Bags Stretcher Biohazard.
The Postanesthesia Care Unit Ahmad abu assa. PACU Recovery from anesthesia can range from completely uncomplicated to life-threatening. Must be managed.
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Operations.
Limmer, First Responder: A Skills Approach, 7 th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 1 Introduction to the EMS System.
Ms. Christine Loyle, B.A. Program Coordinator/Analyst Tripler Army Medical Center Honolulu, HI Rapid Response Team Training for Activators - Staff, Patient,
1 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Documentation of Patient Assessment.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 06The Nursing Process in Mental Health Nursing.
Chapter 7 Emergency Plan and Initial Injury Evaluation.
Responding to Medical Emergencies PO Learning Objectives  The Physical Therapy Technician will respond to medical emergencies in the physical.
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 33 Trauma Overview.
Rapid Response Martin Bower Richelle Cisco Jerrica Crandall.
11 WAYS TO DECREASE DOOR TO NEEDLE TIME YOU CAN DO IT FASTER Jeff Nickel, MD FACEP ED Medical Director Parkview Regional Medical Center.
Annual Clinical Competency. 2 PURPOSE of Emergency Care Guidelines To provide a standardized response in the event of emergency care situations.
ACT (Assessment Consultation Team) Outcome – To rescue patients by providing early and rapid intervention – Promote improved outcomes Reduced cardiac and/or.
Question Are Medical Emergency Team calls effective in reducing cardiopulmonary arrest rates in the general medical surgical setting? Problem The degree.
Introduction to EMS Systems Chapter 1. Components of Emergency Medical Services (EMS) System  Care begins at the emergency scene  Formal transfer of.
EMT/ Paramedic 8.1 Research Paramedic as a career.
Pre-operative Assessment and Intra operative Nursing Role
Rapid Response Team RRT
CPR and Automated External Defibrillation (AED)
Program Coordinator/Analyst Tripler Army Medical Center
Continued Scene Assessment
The Emergency Medical Treatment and Active Labor Act
Chapter 14 Implementation.
Anatomy of a Rapid Response Team Call
Objectives of patients flow map
Chapter 71 Emergency Nursing
Chapter 5 Patient Assessment
Presentation transcript:

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 14: Rapid Response Teams and Transport of the Critically Ill Patient

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Rapid Response Team (RRT) Calling Criteria

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Example of a Rapid Response Team Protocol See Figure 14-1.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Gaining Administrative Buy-in When Developing a RRT Institute for Health Care Improvement findings support RRT as a way to decrease length of stay and save costs. Chart audits of in-hospital arrests and events leading to arrests support the need for RRT. Need support from administration so ICU nurses on RRT are freed up to make calls as needed

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Team Structure of RRT Members: experienced ICU nurse and others (respiratory therapist, nurse practitioner, hospitalist or intensivist, physician assistant) Members must be ready to go to the emergency immediately. Members must be onsite. The critical care nurse must be willing to respond and educate.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication Tools and Protocols Used By RRT Protocol provides guidelines to ensure each member understands and performs assigned duties. Communication tools provide rapid report and ability to audit for continuous improvement. –SBAR (situation, background, assessment, recommendation)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Training for RRT Policies and protocols for RRT ACLS training and training in triage Roles and responsibilities of each team member and the staff nurse Use of communications tools, such as SBAR Chain of command When palliative care is appropriate

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Training for Staff About Using RRT Policy and procedure for using RRT Staff nurse responsibilities Reminders on what to do when an emergency occurs (badge reminders, pocket cards, etc.)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Calling Criteria and the Mechanism to Activate the RRT System Make sure calling criteria are readily available to all staff (badge reminders, pocket cards, posters, sticker on every medical record or Kardex). Make sure the activation number is also available on all of the information above.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Feedback Mechanisms For Continuous Improvement of RRT Establish tracking mechanism to determine RRT effectiveness –Patient outcomes (chart audits) –Satisfaction surveys from staff using RRT

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation of RRT Effectiveness Codes per 1,000 discharges Codes outside the ICU Number of times the RRT system was used and the number of admissions to ICU, number of hospital days

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins SBAR Communication Tool See Box 14-3.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Interfacility Transfer Algorithm See Figure 14-2.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Advantages and Disadvantages of Ground Versus Air Transport AdvantagesDisadvantages Ground transportCarry more equipment and staff No weight restrictions Longer estimated time of arrival (ETA) Hard to provide interventions on bumpy road Air transportShorter ETA Crew has specialized training Weight limitations Less staff and equipment Weather and altitude restrictions

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The critical care nurse is preparing for the arrival of a patient via ground critical care transport. Which of the following should the nurse consider first when setting up for the transfer? A. The time the patient is not in the hospital B. Travel time needs to be considered as top priority C. Equipment and supplies the patient will need D. Arrival time of the family

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Equipment and supplies the patient will need Rationale: The transport team will take back their equipment, and the equipment may be different from the facility’s, so the nurse needs to be prepared for the switchover. This is a top priority in the choices provided. The other statements are important for determining issues such as how much time the nurse has to prepare for the patient, and making sure to include the patient’s family on their arrival after settling in the patient. The patient is in a mobile critical care unit, so out-of- hospital time is less of an issue.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Emergency Medical Transfer Active Labor Act Flowchart See Figure 14-3.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Factors of an Effective Interfacility Transfer Determine benefits versus risks of the transfer Determine appropriateness of accepting facility Provide interfacility transfer report Evaluate transfer process for continuous quality improvement

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 1 A 44-year-old man needs to be flown to a level I trauma center to undergo surgery and further stabilization. Phase 1: What role should the ED physician and RN provide in terms of notifying and gaining acceptance from the receiving facility and completing the institution’s transfer list? Phase 2: What items from the chart and tests should the RN get ready? What should the RN include in the transfer report to the transport team and the RN at the receiving facility?

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 1 (cont.) Phase 3: What should the transport RN and team do during this phase? What role should the RN at the receiving facility play to prepare for the patient? Phase 4: What steps should the transport team take during the turnover process at the receiving facility? What steps should the RN at the receiving facility take during this phase? Phase 5: What continuous quality indicators should be considered during this phase for the transport team, the receiving facility, and the facility that sent the patient?

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Guidelines for Accompanying Personnel for Interfacility Transfer

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Equipment Necessary for Interfacility Transport Airway and ventilation/resuscitation equipment ACLS medications Monitor/defibrillator/external pacemaker IV pumps and tubing Equipment for stabilization of neck and spine Equipment to monitor vital signs Communication equipment

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 2 A 64-year-old patient in the cardiac care unit develops sustained ventricular tachycardia with a weak thready pulse and hypotension. The dysrhythmia is not responding to medications and only temporarily responds to cardioversion. The electrophysiologist wants to perform electrophysiology studies in the cardiac cath lab, which is seven floors down, and the patient may need a implantable defibrillator. 1.What are the indications for intrafacility transport? 2.What process should be used during the transport?

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The nurse is preparing a patient for air transport to another facility. The client is diagnosed with an inferior wall MI and has a history of vertigo. The nurse should: A. Provide a transdermal scopolamine patch B. Remove the nasogastric tube C. Position the patient supine and raise the legs on a pillow to take pressure off the abdomen D. Provide oxygen by a tight-fitting mask

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Provide a transdermal scopolamine patch Rationale: The transdermal scopolamine patch will lower the risk for motion sickness. The patient needs to be side-lying and the head of the bed needs to be elevated. The oxygen needs to be provided in a less confining manner, such as a nasal cannula, so if the patient vomits, there is less risk of aspiration. The patient has a nasogastric tube in place to decompress the stomach and lessen the risk for aspiration, so the tube needs to stay in place during the transport.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following trauma patients is not a candidate for high-altitude air transport to the level I trauma center? A. A patient requiring neurosurgical intervention B. A patient who was deep sea diving, hit a reef, and was buddy breathing and has decompression sickness C. A patient with an open pelvic fracture who received 7 units of packed red blood cells to stabilize BP D. A patient bitten by a rattlesnake; ground travel time is 60 minutes

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. A patient who was deep sea diving, hit a reef, and was buddy breathing and has decompression sickness Rationale: High-altitude flying will worsen the decompression sickness. In decompression sickness, nitrogen bubbles are trapped in the bloodstream and could lead to an air embolus. The patient would need either ground transport or low-altitude transport (<1,000 feet) to a trauma center with a hyperbaric chamber for treatment. The other three patients could benefit from the speed of air transport.