Team Rapid

The Hospitalist. 2006 August;2006(08):

August 1, 2006 | The Hospitalist

Medications were to be verbally ordered by the doctor, then read back and verified by the nurses documenting and administering for the RRT. For the most part, medication orders were restricted to what was carried in the RRT bag. The document was eventually copied three times: The original was placed in the chart, one copy was sent to the pharmacy for a record of medication, and the other was saved for QI. The primary team was expected to write a note in the chart’s disposition and time of disposition were to be included in this message.

Summary: Lessons Learned

Our experiences at OV-UCLA taught us a few lessons about putting together an effective RRT. These suggestions should be useful to any facility implementing a similar program.

Spend time with the chiefs of service at your facility and make your case for the RRT;
Establish a chain of command;
Decide ahead of time how you will staff the RN position;
Remember to market the RRT. You might use pencils, candy, stickers for the phones, and positive feedback;
Arrange mock RRT calls to evaluate gaps and problems;
Give feedback whenever possible;
Collect data on calls and codes; and
Review codes to see if any opportunities to call the RRT were missed. Again, give feedback.

Creating an RRT is hard work and requires a high level of dedication, as well as a great deal of communication and cooperation among staff members. Given the promising results and positive feedback that facilities are experiencing, however, it seems that time and effort might just be a small price to pay.

Equipment

The OV-UCLA equipment team had one important question to answer: What supplies did we need at the bedside?

Although equipment and medications are readily available outside the ICU, the team didn’t want to spend time looking for equipment during an RRT call. “I don’t want a quick RRT call to evolve into a three-hour scavenger hunt,” says one team member.

Because OV-UCLA does not have a 24-hour pharmacist, the group felt it essential to bring medications to the bedside to avoid delays. Our solution to this potential problem was simple. The medication box is prepared by the pharmacy and sealed with one expiration date. Once the box is opened, it is exchanged for a new sealed box. The team chose a rolling duffle to store and transport the supplies, which are compartmentalized into the following sections: infection control, medications, airway and respiratory, IV access and blood draw, and IV start. Medications include respiratory treatments, antibiotics, furosemide, nitroglycerin, metoprolol, heparin and low molecular weight heparin, naloxone, ephedrine, dopamine, glucose, glucagons, and so on. The bag is restocked upon its return to the ICU.

Because of the stress involved in maintaining emergency equipment, we opted to call the supplies a “convenience bag.” This label ensured that only the sealed medication box would require a mandatory check; the rest of the equipment would be monitored on a more informal basis. Because all equipment is available on every floor, and because any RRT call can be converted to a code blue, the team felt that this was reasonable. The committee also purchased a five-pound patient monitor that has a screen for a cardiac tracing, a pulse oximeter, a noninvasive blood pressure monitor, and a temperature probe. This monitor fits easily in a pocket of the duffle.

Education and Publicity

How would staff know to call the RRT? The OV-UCLA team, anticipating that the majority of RRT calls would be activated by the primary RNs, decided that educating all nursing staff was essential.