1. ACT (Assessment Consultation Team) Outcome – To rescue patients by providing early and rapid intervention – Promote improved outcomes Reduced cardiac and/or respiratory arrests Reduced or more timely transfers to ICU Reduced emergent intubations Reduced number of deaths Reduced overall length of stay (LOS), etc.

2. ACT Members Critical Care RN (ICU) Respiratory Therapist Primary Care Nurse

3. ACT Goal Provide a multidisciplinary assessment team to implement early assessment and rapid intervention Provide care in collaboration with the primary care provider to promote effective efficient patient management – Improved patient outcomes

4. ACT Availability ACT will be available 24/7 to all patient care areas excluding: – ICU – CVICU – ED – L&D – NICU – Pediatric Patients – OR Areas – PACU

5. Criteria For Calling ACT Acute or trending change in HR Acute or trending change in BP Acute or trending change in Respiratory Status Acute change in LOC (Level of Consciousness) Acute Bleeding Failure to respond to current treatment for acute problem/symptom Staff member concerned/worried about the patient

6. Activating ACT Pager (327-9111) – Enter phone extension at the location May call the ICU immediately after paging if necessary (ext. 6600) ACT response time goal – Five minutes

7. Critical Care RN Responsibilities Review/Clarify situation, background and assessment of the patient Collaborate with primary care nurse in reassessment of patient Institute interventions as per approved protocol or through verbal physicians orders Speak with physician as necessary about situation and evaluation of patient for any further orders Assure family/significant others are updated Assist/facilitate with transfer to higher level of care if indicated

8. Respiratory Therapist Responsibilities Provide Respiratory Assessment Implement treatment per approved protocol as determined through assessment findings in collaboration with ACT RN and Primary Care Nurse Notify physician for further orders as needed Assist with facilitation of transfer to higher level of care if indicated

9. ACT Protocol (Respiratory) Initiate Pulse Oximetry Start 02 @ 2-4 L/m if Sp0 2 < 90% – Goal 90-92% or 88-89% if known C0 2 retainer Stat neb tx with 0.5cc Albuterol/2.5cc NS – May add 0.5mg Atrovent if indicated ABG’s for respiratory distress or  Sp0 2 Place oral or nasopharyngeal airway & suction PRN if airway compromised Initiate BI-PAP per RT Protocol if pH 7.2-7.3

10. Primary Care Nurse Assist with patient assessment Provide current and historical information on patient status Provide reason/concern for activating ACT Assist in obtaining necessary equipment or medications Remain with patient and ACT until patient stable or relieved of their responsibility

11. Documentation ACT Response Record – Completed per Nursing Staff Respiratory Therapy documentation – Via Computer

12. Designated ACT Therapist Most senior therapist in ICU – Page will come across the 327-7975 ICU pager Must be validated in intubation

13. Code Gray Code Gray has been incorporated with ACT – ACT RN will initiate Code Gray if indicated ACT RN and Therapist will already be at bedside

14. ACT Trial January 30 th 2006 Trial Areas – Respiratory Stepdown – Family Practice – Medical Stepdown