1. Lighthouse Development Team
Rapid Response Team

2. Opportunities
Most hospitalized patients with cardiac arrest have abnormal physiological values recorded in the hours preceding the event
A patient’s baseline condition begins to deteriorate a mean of 6.5 hours before an unexpected critical event or actual cardiac arrest (5)
Schein et al found that 70% of patients show evidence of respiratory deterioration within 8 hours of arrest (6)
At a minimum, the measurement of key clinical indicators must be obtained accurately and recorded with appropriate frequency (7)
Communication of patient deterioration can be improved and physician notification of patient’s condition worsening may only occur in 25% of cases
Ongoing program management and performance improvement is essential to the sustainability of RRT’s
(5) Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction
of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. Br Med J. 2002;324:
(6) Schein. Chest. 1990;98:
(7) ILCOR Consensus Statement. Recommended Guidelines for Monitoring, Reporting, and Conducting Research on Medical
Emergency Team, Outreach, and Rapid Response Systems: An Utstein-Style Scientific Statement.
(8) Franklin. Crit Care Med. 1994;22:

3. RRTModule Overview
The following slides show examples of the proposed online documentation and communication screens to be displayed within the patients electronic medical record.
Summaries and executable knowledge shown are populated and triggered by electronic clinical documentation.

4. Review Patient
Mews/Pews scoring assessments are collected leveraging existing electronic nursing clinical documentation.
Diagnostic results are collected and displayed in the clinical repository.
If any result/assessment is out of set parameters, alerts are triggered.
Process Recommendations:
Standardize Triggering Criteria and Protocol
Daily RRT Rounding
Executable Knowledge:
Rule: MEWS/PEWS Scoring/notification
RRT Patient Screening/Scoring:
Bedside Clinician: Document Clinical Assessment
MEWS/PEWS
Summary View :
Review physiologic parameters
RRT Dashboard:
Facilitate daily rounding
Amend/filter screening criteria
Change parameters to meet patient’s clinical concerns

5. PEWS Documentation

6. PEWS Documentation

7. RRT Execution- Real Time Notification
High Risk Patients
“At Risk Patients” are automatically recognized by the system and are
In need of additional assessment.
In need of additional intervention.
Clinicians are notified in real time
Recognize
Executable Knowledge—Alert when..
Alert/Notify: MEW/PEWS Scoring/notification
“At Risk” Patients: based on worsening trend of scoring criteria
Linked with RRT summary page
Rule: RRT Low Grade Fever Rule
Increase Vital sign assessment Frequency
SBAR MPage: RRT activation criteria
SBAR communication checklist
Ability to active RRT and Notify Physician
Summary View:
Clinical Early Warning
Activating and alerting of RRT events
RRT Dashboard:
Stratified view of risk levels and key indicators

8. RRT Response Executable Knowledge: Respond
Alert/Notifications: RRT Activate
Care Plan:
Suggested with activation
SBAR Summary page:
RRT Intervention/SBAR with “standing orders”
Early Warning/RRT events are recorded
RRT Record
Code Blue Record
Clinician or System Trigger to Activate RRT!
RRT assessment, intervention, and disposition
Option to communicate with attending Physician
Respond

9. RRT Intervention Care Plan/Orderset What gets triggered?
Vital Signs (initially and as indicated)
Blood pressure, heart rate, respiratory rate, temperature, oxygen saturation
Nursing Orders:
P.O.C. Blood glucose, Cardiac monitor
IV Patent IV access IV fluid: Normal saline at _________mL/hour
Respiratory:
Clear and maintain airway, Oxygen therapy to stabilize patient and maintain oxygen of %
via ____nasal cannula ____mask
Ventilation assistance with positive pressure ventilation
Medications
Albuterol _____mg nebulizer as needed for respiratory distress
Nitroglycerin 0.4 mg sublingual for chest pain. May repeat every 5 minutes for total of 3 doses
Naloxone (for narcotic reversal) ( mg) IV IM or subcutaneously as needed for respiratory depression
Flumazenil (benzodiazepine reversal) 0.2 mg IV; may dose every 60 seconds for a total of 4 doses as needed for respiratory depression (maximum is 1 mg)
D50 IV or other hypoglycemic agents
Lab/Diagnostic Tests:
Chest x-ray (AP Portable)
Other imaging studies
EKG
HGB/HCT CBC Glucose Electrolytes (Na+, K+, Cl -,CO2) BUN/Creatinine
Arterial blood gases

10. RRT Execution: Recover Treat and measure
Process Recommendations:
RRT Debriefing: Staff, Patient, Family
Communication Protocol: Physician Notification
Executable Knowledge:
Documentation:
Patient Chart: Rapid Response Team Record /Code Blue
Summary Page: SBAR Documentation
Physician Documentation: RRT Record
Notification:
Physician
Summary View :
Significant Events Component
Communication of event record to care team
Recover
Standardized Documentation of RRT Activities and Outcomes
Communication of patient status with RRT, Staff Nurse, Physician, ICU etc.

11. RRT Dashboard, Summary page and Communcation page
Provides a summary view of all patients that require monitoring.
Available anywhere
Ability to drill down through results
Ability to graph and trend results
Ability to send results to physician – real time.

12. RRT Population Based Dashboard

13. RRT Population Based Dashboard

14. RRT Population Based Dashboard

15. RRT Inpatient View

16. Inpatient Summary

17. RRT Communication Summary SBAR

18. RRT Communication Summary SBAR