Presentation on theme: "OUR LADY OF LOURDES MEMORIAL HOSPITAL Binghamton, New York Medical Emergency Team MET A Strategy to Reduce Morbidity and Mortality."— Presentation transcript:
OUR LADY OF LOURDES MEMORIAL HOSPITAL Binghamton, New York Medical Emergency Team MET A Strategy to Reduce Morbidity and Mortality
Our Lady of Lourdes Memorial Hospital Our Lady of Lourdes Hospital is a 267 bed acute care, community, not-for-profit healthcare facility which provides a full spectrum of inpatient, ambulatory and emergency services. Our Lady of Lourdes Hospital is a 267 bed acute care, community, not-for-profit healthcare facility which provides a full spectrum of inpatient, ambulatory and emergency services.
Medical Emergency Team PURPOSE: The Medical Emergency Team is available to provide consultation and assistance to non-critical care nursing staff in the identification and triage of potentially life threatening conditions. The Medical Emergency Team is available to provide consultation and assistance to non-critical care nursing staff in the identification and triage of potentially life threatening conditions.
Medical Emergency Team Cardiac arrests in hospitals are usually preceded by signs of clinical instability that typically begin 6-8 hours prior to arrest. Risk of death with in-hospital cardiopulmonary arrest is reported in the literature as between 50% and 80%.
Medical Emergency Team MET Members: ACLS RN (ICU – 1st Responder. If unable to respond, ICU RN will call ER or Seton 1 Telemetry) Respiratory Therapist Clinical Manager Primary Registered Nurse on patient unit MET responds with a Life-Pak
Medical Emergency Team CRITERIA: HAVE A CONCERN- Something’s just not right HAVE A CONCERN- Something’s just not right Acute symptomatic change in respirations, respiratory distress or threatened airway ( 30) OR Change in breathing pattern Acute symptomatic change in respirations, respiratory distress or threatened airway ( 30) OR Change in breathing pattern Acute symptomatic change in heart rate( 130), refer to baseline Acute symptomatic change in heart rate( 130), refer to baseline Acute change in oxygen saturation, <90% despite oxygen Acute change in oxygen saturation, <90% despite oxygen
Medical Emergency Team Acute symptomatic change in blood pressure, refer to baseline Acute symptomatic change in blood pressure, refer to baseline Chest pain Chest pain Acute change in level of consciousness (LOC) Acute change in level of consciousness (LOC) Decrease in urinary output; <50 ml in 4 hours without history of renal dysfunction Decrease in urinary output; <50 ml in 4 hours without history of renal dysfunction Failure to respond to treatment Failure to respond to treatment New, repeated or prolonged seizure New, repeated or prolonged seizure
Our Process to Initiate MET Call is placed to ICU, stating “This is a MET call”. ICU RN gets brief overview of reason for call. ICU pages Respiratory Therapist to make them aware of MET call and location. If ICU RN unable to respond, Telemetry Unit is notified. If Telemetry Unit RN is unable to respond, ICU RN notifies Emergency Department RN to respond.
SBAR Communication S – Situation B – Background A – Assessment R - Recommendation
SBAR Definition: SBAR is a situational briefing tool that logically organizes information so that it can be transferred to others in an accurate and efficient manner.
SBAR Fosters critical thinking skills Eliminates information getting lost in translation Saves time Develops RN / RT assertive behavior Individuals speaking up and stating their information with appropriate persistence until there is a resolution, all done in the interest of better patient care
SBAR SBAR – SITUATION “I am” (name and unit) “I am calling about” (patient’s name and room number) “The problem that I am calling about is” (state the problem)
SBAR SITUATION - example “This is Joe, a nurse on Seton 3, calling about your patient Mrs. Gaige in Room 3606 bed 2. The problem that I am calling you about is her new complaint of dyspnea and increasing respiratory rate.”
SBAR SBAR – BACKGROUND State admission diagnosis and date of admission Give brief synopsis of hospital course and treatment to date Give vital signs including SpO2 and physical assessment pertinent to the problem
SBAR BACKGROUND _ EXAMPLE Mrs. Gaige was admitted 3 days ago with pneumonia.She’s been on Levaquin and improving each day, no more fever and less cough and sputum. Now her vital signs are RR=32 P=86, BP= 90/60, T=100.1 and SpO2= 88% on 2L. Her breathing looks labored and she has new crackles in the right lower lobe.”
SBAR SBAR – ASSESSMENT Give your impression of the present situation. A diagnosis is not necessary If the situation is unclear, at least try to indicate what body system is involved State how severe the problem seems to be If appropriate, state the problem could be life threatening
SBAR ASSESSMENT EXAMPLE “I think Mrs. Gaige could be developing worsening pneumonia in the right lower lobe.” “I think Mrs. Gaige could be developing worsening pneumonia in the right lower lobe.”
SBAR SBAR – RECOMMENDATION Give the physician your recommendations for the interventions that you think should be done, based on your assessment
SBAR RECOMMENDATION – EXAMPLES “I have called the MET.” “I think that you should come see the patient now.” “I think that you need to discuss code status with the family.” “I think the patient needs a portable chest xray and blood cultures.
SBAR BEFORE YOU CALL THE PHYSICIAN: Have the patient’s chart, MAR and I & O sheet Have today’s labs Review the most recent progress note Review the nursing notes for past shift Know the patient’s code status
SBAR What can you expect from MET? Experienced ACLS team members and the primary care nurse working collaboratively to assist with the assessment of your patient A comprehensive and complete assessment of your patient Early intervention to slow or prevent clinical deterioration Critical Care at the bedside Preventing Failure to Rescue Decrease hospital morbidity and mortality
Testing MET Team developed a policy for MET, which enabled MET to perform stat EKG and ABG, without obtaining physician order first. Team developed an SBAR tool to guide primary nurse through call to primary physician. We began testing MET on the 11PM to 7AM shift in October 2004. MET members from ICU and Telemetry went unit to unit and presented a powerpoint education face to face with staff. SBAR Communication Technique incorporated into education. Developed an evaluation tool to monitor the MET calls.
Testing MET Presented Medical Emergency Team to our Medical Executive Committee (MEC). MEC voiced concern that there might be a delay in notifying the physician. We advised that the physician should be called sooner than later if units called with established MET criteria. ICU began to get calls on the day shift in early November. Team began to develop a plan to educate day shift and evening shift on MET. Presented to Nursing Unit Educators, who then educated their units on MET.
Testing MET MET and SBAR presented at orientation. SBAR tool made into pads that are located at nursing station near phone. Reordered through our copy center. MET available all 3 shifts as of 12/23/04.