1. Rapid Response Team Training for Lead RNs
Explanation of why team is in italics- the importance of teamwork, communication, and collaboration, etc…

2. The Rapid Response Team is lead by nurses and includes:
Staff RN’s, MA’s, RN Managers, RN Supervisors, and RN Relief Supervisors.
All staff RN’s and MA’s will complete training on how to assess a patient, visitor, or employees medical needs, how to activate and communicate with the Rapid Response Team, and roles within the team.
RN Managers, RN Supervisors, Relief RN Supervisors, and a small group of staff RN’s will receive further training on nursing clinical assessment skills, developing a plan of care (POC) with the unit staff and LIP, and communication within the team.

3. Objectives for this training:
For all Lead Registered Nurses (RNs) to describe and be able to implement the new Rapid Response Team (RRT) policy with fellow RNs and MTs.
For all Lead RNs to be able to define their role and responsibilities and be able to lead and direct the rest of the RRT members to perform necessary tasks to ensure we are providing high quality coordinated care.
To ensure all Lead RNs are comfortable and competent performing a basic nursing assessment and formulating a plan of care with a Licensed Independent Practitioner (LIP) using the ISBAR format when a RRT is activated.
RRT committee- Any other objectives?

4. Why do we have a Rapid Response Team at Bradley Hospital?
It is strongly encouraged by the Joint Commission to have a medical response team available to respond to the medical needs of our patients, employees, and visitors.
Better utilization of Bradley Hospital and community resources.
The most important reason: it improves care and safety.

5. Bradley Hospital’s Rapid Response Team
Goals:
To provide early intervention and assessment of patients, staff, and employees with changing clinical needs prior to activating the East Providence EMS for non-cardiopulmonary or life threatening events.
2. To reduce the number of Code Blues called for non-life threatening emergencies.
To decrease the number of unplanned transfers to a higher level of care.

6. Rapid Response Team Policy
The purpose of the Rapid Response Team is to quickly respond to the medical needs of patients, visitors, and employees and develop a plan of care appropriate for their current physiologic status.
The Rapid Response Team was developed to provide support and guidance to Registered Nurses and the rest of the health care team through interdisciplinary collaboration with the goal of improving care and safety.

7. Code Blue v. RRT activation
Non- Life Threatening Events (when to call a RRT) below are examples but not limited to…
Life Threatening Events (Call a Code Blue)
-Cardiopulmonary Arrest
actively performing CPR
or rescue breathing
- Cardiac or Respiratory Distress with unstable VS
-Severe Bleeding
-First time Seizure- (not usually life threatening but most likely patient will be transferred for further testing.)
- Uncertainty of severity of the individual’s clinical status
-Changes in physiologic status that aren’t in the life threatening column.
-Fainting/passing out VS stable
-Seizure- known seizure history
-Trauma/Acute Injury (non-life threatening)
-Head trauma s/p fall (as long as patient’s VS are stable, they are A&O, and there is no sign of skull fracture or bleeding.)
- Reported ingestion with changes in vital signs or neurologic status.

8. The Pediatric Assessment Triangle
-This basic assessment uses only visual and auditory clues, requires no equipment, is non-invasive, non-threatening, and takes seconds to perform.
-Is a guide to nursing assessment of a client, visitor, or staff with acute medical needs.
-Was developed to standardize the initial assessment of infants and children (mos- 18yo) for all levels of health care providers.

9. Roles and Responsibilities of Rapid Response Team Members:
The RRT team has 5 to 6 members depending on the location of the event
and will include:
Lead RN:
Responsible for ensuring coordination of team members and their delegated roles.
Functions as team lead, completes nursing physical assessment, reviews vital signs, reviews pertinent medication orders, and labs prior to contacting the appropriate LIP.
Communicates pertinent information and develops a POC with the Pediatric Team, Attending, DOC, or EMS using the Identification, Situation, Background, Assessment, Recommendations (ISBAR) format.
Communicates POC with the unit RN and provides education regarding patient’s condition and expected outcomes.

10. Roles and Responsibilities of Rapid Response Team Members cont. :
The Lead RN is responsible for leading a quick debriefing session after all RRT activations and providing feedback to team members regarding areas of strengths and areas for continued improvement.
The Lead RN ensures all documents including the Rapid Response /Code Blue Document and debriefing forms are completed and submitted.
Patient RRT/code blue form is submitted to Pediatric department to be scanned into patient medical record. Debriefing to be sent to pediatric department.
Visitor RRT/code blue form submitted to Pediatric department. Debriefing to be sent to Pediatrics.
Employee (original) RRT/code blue documents sent to Employee Health Dept and copy goes to Pediatric department. Debriefing sent to Pediatrics.

11. Roles and Responsibilities of Rapid Response Team Members :
*These are general guidelines, RN’s and MA’s may need to complete varying roles depending on the location, nature of event, etc.*
Unit RN or first RN to arrive:
Identify medical concerns and perform initial nursing assessment.
Stay with the patient until the RRT arrives.
Help patient into a comfortable position.
Assure all vital signs are completed once equipment is available.
Assess need for blood glucose check and pulse oximetry, if needed delegate task to another RN.
Assign a RN to gather any medical information needed from Lifechart.
Delegate needed tasks to other RN’s as they arrive including documenting.
Share pertinent information with RRT Lead RN.

12. Roles and Responsibilities of Rapid Response Team Members cont. :
RRT Children’s RN (1st and 2nd shift)
Assist RN 1 as needed when equipment arrives.
RRT Harbor and CADD RN’s (1st and 2nd shift)
Respond with medication kit, Pulse Oximeter, and Glucometer
Assist RN 1 as needed.
Children’s and Bay MA’s (1st and 2nd shift)
Respond with code kit
Help with crowd control
CADD MA to respond to code called
1) Provide support as needed

13. Communication using the ISBAR Process
Identification- identify the patient with name, age, sex, and date of admission and related diagnosis.
Situation- What is the situation you are calling about?
Briefly state the problem, when it occurred/started, and how severe it is.
Background- pertinent information related to the situation should be provided. It may include:
List of current medications, allergies, and relevant labs and their results.
Most recent vital signs.
Any other relevant clinical information.

14. Communication with LIP using the ISBAR Process cont’d.
Assessment- what is your assessment of the situation?
Is this an emergent or life threatening situation?
Recommendation- What are your recommendations or what would you like to see happen?
1. What is your proposed plan for nursing care?
2. Does the patient need to be seen now?
3. Do you need any new orders or changes in current orders?

15. Prior to Rapid Response Team Conclusion:
The RRT will conduct a debriefing to ensure all team members understand and agree with the patient/visitor/employee’s status, the proposed plan of care if activated for a Bradley Hospital patient, and the rapid response team process.
Rapid Response Team member’s will complete and sign the Debriefing Form and Rapid Response /Code Blue Documentation that will be used for tracking and evaluating this process.
Once completed, a copy of the Rapid Response/Code Blue Document should be forwarded to the Pediatric Department along with the Debriefing Form, it will then be scanned into pt’s medical record.

16. Prior to Rapid Response Team Conclusion cont’d:
If the RRT was activated for an employee, the original Rapid Response / Code Blue Document must be forwarded to EOHS and a copy forwarded to Pediatrics.
If a RRT was activated for a visitor, both forms shall be completed and forwarded to Pediatric Department.
If responding to the needs of a visitor a Safety Net event report must be completed.
Be sure the patient and their family are updated on the plan of care and report any noted concerns to the appropriate LIP.

17. Debriefing:
Why?
The debriefing process will give the opportunity to discuss individual and team performance, identify strengths, areas for improvement, and develop a plan for continued improvement.
It only needs to be 3-5 minutes long, long enough to review relevant events and observed teamwork behaviors.
Shared understanding has been shown to positively affect team performance.
It is critical to the experiential learning process, allowing one to use lessons learned to improve response in later events.

18. Debriefing cont’d:
It is important to focus on a few important areas for discussion and continued improvement.
The Lead RN will be expected to encourage team membership contribution and participation.
It is the Lead RN’s responsibility to focus the discussion on teamwork process.
The goal of discussion is to provide examples of how team members may be able to alter specific behavior in the future.
Feedback provided will be used by the RRT committee for continued evaluation and improvement.

19. Updates:
There is a new section added to the debriefing form that indicates specific follow up that requires management attention. Please be sure to include specific details for this follow up to occur.
RRT/Code Blue form have been combined and are now available on one document. Refer to document for instructions.

20. Process & policy change: emergency medication kit/medication admin to staff/visitor.
In the event a medical code is called for a visitor, the code team will complete an initial assessment and provide appropriate care based on the individual’s clinical status. The following medication CAN be provided to staff or visitor.
One dose of Epinephrine 0.15mg or 0.3mg via Epipen (based on weight/size of visitor) may be administered to a visitor or employee for clinical symptoms consistent with anaphylaxis including but not limited to difficulty breathing, angioedema, flushed or pale skin, sensation of lump in throat, swelling of the tongue, and dizziness as well as reported history of anaphylaxis.
One dose of Glucagon 1mg IM may be administered to a visitor or employee with hypoglycemia as evidenced by blood glucose level of <60 and is unable to take oral glucose replacement.

21. Practice in the Simulation Lab Case 1

22. Case 2

23. Questions? Clarifications?

24. References:
Brownstein, MD, D., Dieckmann, MD, MPH, FACEP, FAAP, D., and Gausche- Hill, MD, FACEP, FAAP, M. (April )The Pediatric Assessment Triangle. Pediatric Emergency Care, volume 26, # 4.
Institute for Clinical Systems Improvement- 4th Edition, July
Newport Hospital, A Lifespan Partner, Rapid Response Team Policy, Section 1370, 10/2010
VHA
Salas, E., Klein, C., King, H., Salisbury, M., Augenstein, J.S., Birnbach, D., Robinson, D.W., & Upshaw, C. ( September, 2008.) Debriefing Medical Teams: 12 Evidence-Based Best Practices and Tips. The Joint Commission Journal on Quality and Patient Safety