1. Identifying Early Warning Signs Medical Emergency Team Training

2. What is a MET Team?
Medical Emergency Team (MET) is a multidisciplinary team which purpose is to provide expert assessment, early intervention and stabilization of patients to prevent clinical deterioration or cardiopulmonary arrest.

3. Why do we need a MET Team?
According to the Institute for Healthcare Improvement
48% of all hospital deaths were “unexpected”
All of the patients were admitted to non-ICU setting
When a MET team is implemented
Non-ICU arrests reduced by 50%
Mortality rates reduced by 37-50%

4. Signs of Patient Deterioration
Studies show that 70% of patients show evidence of respiratory deterioration within 8 hours of arrest
66% show abnormal vital signs within 6 hours of arrest and the MD was only notified 25% of the time
Why does this happen?
Failure to adequately plan care
Assessments, goals, placement of the patient at the appropriate level of care
Failure to communicate
Patient to staff
Between healthcare providers
Failure to recognize patient deterioration

5. What is the Role of the MET Team?
The MET team is expected to:
Respond to the location as soon as possible and should be at the bedside within 5 minutes
Perform a thorough assessment to determine patient status
Assist with communication between nursing personnel and the MD using the SBAR format
Support and include the primary RN in all assessments and interventions performed so that he/she may increase his/her level of knowledge
Stabilize or assist with transfer of the patient
Document on the physician’s progress notes the reason and results for the consult, as well as in the nursing notes

6. MET Team Responsibilities Per CHSB Policy
Respond to the MET call location
Perform a thorough assessment
Consult with the assigned nurse throughout the patient care process
Call the attending physician and make recommendations using SBAR
Document on Physician Progress Notes and Nurses Notes utilizing SBAR the reason for the call and the result
RT will perform a thorough respiratory assessment

7. Criteria for Calling the MET at CHSB
Respiratory distress, threatened airway, change in breathing pattern
Acute change in respiratory rate (less than 10 breaths/min or greater than 24 breaths/min)
Acute change in blood pressure (systolic BP less than 90 mmHg)
Acute change in heart rate (less than 50 beats/min or greater than 120 beats/min)

8. Criteria for Calling the MET at CHSB – cont’d
Decreased urine output (less than 50 ml in 4 hours - not on dialysis)
New, repeated, or prolonged seizures
Failure to respond to treatment
Staff “intuition” or concern

9. Criteria For Calling Pediatric MET Response
Altered level of consciousness
Respiratory distress
New onset of seizure
Other Pediatric Considerations
Children’s vital signs vary as the child matures
A single threshold for activation does not exist

10. Composition of the CHSB MET team
ICCU Charge RN
Lead Respiratory Therapist
House Supervisor
ICCU Medical Director
Provide informational assistance
attendance not required
***Adult first responders include the ICU RN and Resp Therapist
***Pediatric first responders include ED RN and Resp Therapist

11. Important MET team traits
Must be available to respond immediately when called
Must be onsite and accessible
Must have critical care skills
Must have good customer service skills
Respond with a smile
“Thank you for calling. How may I help you”
Staff must feel comfortable in order to call
If they feel ridiculed or condescended to they will be reluctant to call

12. Important to Remember
The MET team does not work independently of the patient’s assigned nurse or physician
No Pre-printed orders!
ACLS Guidelines may be followed
Care should be taken to include both the patient’s nurse and the patient’s physician early and throughout the process of caring for the deteriorating patient

13. Activating the MET Team
Due to the nature of the services, the MET Team will respond to all departments with the exception of the following:
Pediatrics – call ED RN (MET may be called for concerns regarding parent/visitor or other adult emergency
Couplet Care – call L&D RN (L&D RN to assist MET Responders)
Children’s Subacute Center – Call 911

14. Activating the MET Team – cont’d
Staff Nurse Calls 1000 to request the MET Team and identify the location
Operator places an overhead page, “MET TEAM TO FLOOR/UNIT ________”
Operator activates pages to the following : ICCU Charge RN, Lead RT, and House Supervisor.

15. Interventions by MET : Registered Nurse
Perform a thorough assessment to determine the status of the patient
A sepsis screening will be performed on all patients
If patient screens positive for sepsis, lactic acid level and blood cultures are drawn
If patient screens positive for sepsis and has a systolic BP of <90 mmHg, the MET RN will administer a 20 ml/kg fluid bolus utilizing normal saline
The MET RN will contact the primary physician and inform him of the positive sepsis screen and obtain orders

16. Interventions by MET : Registered Nurse – cont’d
Consider initiating a 500 ml normal saline bolus for patients with an SBP ≤70 mmHg with signs/symptoms of shock while awaiting physician call back
Evaluate and assess the need to transfer to a higher level of care.
In the event the physician cannot be reached, the MET team has the authority to move the patient to the appropriate level of care
Document on MET documentation for PI/review and fax to House Supervisor

17. Interventions by MET : Respiratory Therapist
Oxygen may be initiated for:
ALOC
Moderate to severe dyspnea
Moderate cyanosis
Pallor
Moderate to severe hypotension
Aerosol bronchodilator therapy may be initiated as defined in RT protocol based on assessment
ABGs may be obtained to assess acid-base balance

18. Interventions by MET : Respiratory Therapist - cont’d
Bag-valve Mask ventilation may be initiated per assessed need:
Respiratory Insufficiency
Alveolar Hyperventilation
Severe Respiratory Distress
Apnea
Intubation may be done for:
Apnea
Severe Respiratory distress
Patient inability to maintain adequate oxygenation or ventilation

19. Responsibility of the Patient’s Nurse
Provide the team with a status report upon team arrival
Make the medical record available
Ensure that any ordered therapy is available on the unit before calling the Team
Assist in transfer of the patient if required.
The accepting RN will check for IV patency or assist with establishing an IV site
Document in the Nursing Notes reason for MET call and patient’s response to the intervention

20. MET Team Responders : What to Avoid
MET Team responders should avoid “lateral violence” or “horizontal violence”
Nurses who overtly or covertly direct their dissatisfaction toward each other, toward themselves, and/or toward those less powerful
Considered behavior of an “oppressed population”
Lateral violence stops nurses from asking questions or seeking help when it is needed out of fear

21. Examples of Lateral Violence
Non-verbal innuendo
Raising eyebrows, face-making
Verbal remarks
Snide comments, abrupt responses
Undermining
Turning away, ignoring questions
Scapegoating
Attributing patient condition to the nurse
Backstabbing
Complaining about the nurse to other individuals

22. Avoiding Lateral Violence
Be cooperative, despite feelings of dislike
Don’t denigrate co-workers to superiors
Don’t engage in negative conversations about co-workers
Don’t criticize another nurse publicly
Look a co-worker in the eye when talking with them

23. MET Process Monitoring
Feed back from the MET team and initiating nurses will be collected and examined using the “MET Documentation Form”
The form includes:
Type of event, location , and patient outcome
Evaluation of MET procedure
Response time
Competency of team members
Availability and functioning of equipment
Accurate completion of forms
Data is evaluated by Code Blue and ICCU subcommittees

24. Responsibility of the Patient’s Nurse
Provide the team with a status report upon team arrival
Make the medical record available
Ensure that any ordered therapy is available on the unit before calling the Team
Assist in transfer of the patient if required.
The accepting RN will check for IV patency or assist with establishing an IV site
Document in the Nursing Notes reason for MET call and patient’s response to the intervention

25. Important to Remember
The MET responders should be on the floor for interventions 30 minutes or less
Collaboration with the physician or triage to a higher level of care will usually be made within 30 minutes
However, patient safety comes first and the MET responders will assist in the safe transport of the patient to a higher level of care if required.