1. RAPID RESPONSE TEAMS:
IMPROVING PATIENT
OUTCOMES ON SURGERY AND
MEDICAL UNITS
NUR6403 NON-THESIS PROJECT
FOR THE MASTER OF SCIENCE IN NURSING ADMINISTRATION
JAMES NICHOLS, B.S.N.
SPRING 2016

2. STATEMENT OF PURPOSE
• The purpose of this project is to determine if
implementing a rapid response team (RRT) at
a Magnet designated urban hospital will
improve patient outcomes in a medical
surgical environment.

3. RESEARCH QUESTION
• Will the implementation of a RRT on medical
surgical units at a Magnet designated urban
hospital improve patient outcomes for at risk
patients as measured by shorter patient
hospital stays, reduction in patients requiring
increased level of care, and increased level of
patient functionality at discharge?

4. INTRODUCTION
• Rapid response teams (RRTs) made up of
highly skilled nurse specialists are being
implemented in the United States in an effort
to lead to more positive hospital patient
outcomes in cases of patient health downturn
events which is any event that puts the patient
at risk of death or a reduction in short or long
term level of functionality.

5. SIGNIFICANCE OF THE PROBLEM TO
NURSING PRACTICE
• Between 44,000 and 98,000 hospital patients die
each year because of medical errors or oversights
(Evans, 2013).
• RRTs are one intervention used to try to lower these
numbers (Evans, 2013).

6. SIGNIFICANCE OF THE PROBLEM TO
NURSING PRACTICE (CONT.)
• The increasing acuity of patients on surgical and
medical floors combined with the continuing
staffing limits make the safeguarding of patients a
more challenging issue as time goes by.

7. LITERATURE REVIEW - CLINICAL OUTCOME
• Pham, Pfoh, Sydeney, Weavers and Winters (2013) in a systematic
review of 44 studies found a decrease in cardiac arrests but found
no decrease in hospital mortality after implementation of a RRT.
• Fikkers, Mintjes, Schoohoven, Simmes and Van der Hoven (2012)
found in a university medical center a 50% reduction in cardiac
arrest and unexpected deaths after implementation of a RRT.
• Berg, Jain Nallmouthu and Sasson (2010) in a systematic review of
18 studies found a reduction in cardiac arrests with no increase in
survival rates for these same patients.

8. THEORY OF CARE - ADMIRAL ABDALLAH’S THEORY OF
NURSING FOCUSING ON 21 NURSING PROBLEMS
• Problem 3. To insure safety through the prevention of accident,
injury and other trauma and through prevention of the spread
of infection.
• Problem 5. Maintain supply of oxygen to the body cells. Provide
respiratory therapy by the RRT if needed.
• Problem 8. Maintain electrolyte and fluid balance. Initiation of
fluid bolus or blood administration if needed by the RRT.

9. THEORY OF CARE - ADMIRAL ABDALLAH’S THEORY OF
NURSING FOCUSING ON 21 NURSING PROBLEMS (CONT.)
• Problem 9. To recognize the physiological responses of the body
to diseases condition. To watch for changes in skin color, mental
status and other signs of change by both the primary care RN
and later the RRT.
• Problem 10. To facilitate and maintain the regulatory mechanism
and functions. Monitoring both the vital signs and the patient’s
mental status by both the primary care RN and later by the RRT.

10. FRAMEWORK – IOWA MODEL OF EVIDENCE BASED
PRACTICE
• The Iowa Model of Evidence Based Practice explores each stage of health care
delivery from the overall infrastructure to the provider and to the patient
(Dontje, 2007).
• Population – Patients on medical surgical unit of hospital suffering downturn in
health condition
• Intervention – Rapid Response Team (RRT) at discretion of general surgical
nurse responsible for patient or per preset protocol based on vital statistics
• Control – Code White Response in crisis (Deployment of ER Resident, Resp.
Tech, House Manager, Critical Care Nurse and Pharmacist)
• Outcome – Change in percentage of patients requiring increase in level of care,
change in patient level of function at discharge, change in mortality / morbidity

11. METHODOLOGY
• Setting - In order to prove the desirability of a RRT
the implementation of a RRT will be undertaken on
the medical surgical floors of a Magnet certified
urban hospital.
• Target population will be medical surgical patients
of a Magnet urban hospital who face a patient
health downturn.

12. METHODOLOGY - ETHICS
• The hospital institutional review board (IRB) will approve
this project before implementation as data will be
collected to measure the outcomes.
• Patient confidentiality and privacy will be protected by
removing all identifiable information from any data used
in this study.
• Approval by the Magnet hospital’s nursing congress will be
needed.
• Approval by the medical board and executive board of the
Magnet hospital will be needed.

13. METHODOLOGY - DATA COLLECTION/INSTRUMENTS-
• Rapid response team records will be completed both by the
activating nurse with as much information filled out as possible
before the RRT team arrives and by the designated RRT team
member during the event.
• Feedback to RRT forms filled out by the medical surgical nurses on
the units after the event serves many purposes facilitating the
after action reporting process, enhancing the quality control,
encouraging the improvement effort and providing information for
comparison-analysis purposes.
• Information on transfers to the ICU units from general surgery and
information regarding activation of code whites for two years
before the implementation of the RRT.

14. IMPLEMENTATION - TEAM DEVELOPMENT
• Team members will consist of a advanced practice nurse
(APN), a trauma certified RN, & a respiratory therapist.
• Member training will consist of six weeks training with
currently operating RRT.
• Self-Selection of team members with ongoing deselection
option by 2 of 3 members will be implemented.

15. IMPLEMENTATION - COMMUNICATION
• Connecting switchboard, units, physician, contact
number, intensive care units, pharmacist and all
other resources needed quickly and efficiently
• Text based for Health Portability and Privacy Act
compliance with hands free vocal option during
codes
• Redundant for optimal function in emergency
situations i.e. natural disasters such as floods and
tornadoes

16. IMPLEMENTATION - EDUCATION
• All hospital employees
• Focus on activation number, when to activate &
expectations of RRT program
• Multimedia for optimization of learners preferred
form of training. i.e. video, handouts, recordings
from multiple points of access
• Signs in all rooms and public areas in Spanish and
English explaining RRT system and providing phone
number

17. CALL RRT – RAPID RESPONSE TEAM 9111 OR 552-
9111
• If Family or Staff see a patient in distress, pain
or suffering any of the below symptoms.
• Respiratory Distress
• Change in Mental Status
• Tachycardia (Beats/Minute)
• Bradycardia (Beats/Minute)
• Chest Pain
• Seizures
• Color change
• Agitation
• Limb weakness or smile drop
Example of Sign
for display.
Bright, bold
color.
Information
simple and easy
to read.
Both Spanish
and English

18. CALL RRT – RAPID RESPONSE TEAM 9111
OR 552-9111
• If Family or Staff see a patient in distress, pain or suffering any of the below symptoms call
• Respiratory Distress (Breaths / Minute) Less than 10 or Greater than 30
• Change in Mental Status Sudden decrease in Level of Consciousness
• Tachycardia (Beats/Minute) Greater than 130
• Bradycardia (Beats/Minute) Less than 40
• Blood Pressure SBP Less than 90 or greater than 180
• Chest Pain Complaint non traumatic chest pain
• Seizures Sudden or extended or prolonged
• Pulse ox (SPO2) Less than 92%
• Color change
• Agitation
• Limb weakness or smile droop
• Nurse intuition
Example of resource
card to be kept behind
each employees badge.

19. IMPLEMENTATION - EDUCATION
Proposed Activation Protocol for RRT
• Respiratory Distress (Breaths / Minute) <10 or > 30
• Sudden Decrease in Level of Consciousness or increased
agitation
• Tachycardia (Beats/Minute) > 130
• Bradycardia (Beats/Minute) <40
• Blood Pressure SBP < 90 or > 180
• Pulse ox (SPO2) < 92%

20. IMPLEMENTATION - EDUCATION
Proposed Activation Protocol for RRT
• Chest Pain complaint non traumatic
• Seizure sudden or extended or prolonged
• Color change
• Limb weakness or smile droop
• Nurse intuition

21. IMPLEMENTATION - CONTINUITY OF CARE
• The primary care team should remain actively
engaged in the continued care of the patient
working in conjunction with the RRT to ensure that
the patient’s and families’ wishes are followed
(Berrios et al. 2014) .

22. IMPLEMENTATION - CONTINUITY OF CARE (CONT.)
• One on one educational events with the RRT
members and unit level staff would be beneficial in
building a team “spirit de corp” between the two
groups and help to reinforce the essential nature of
the medical surgical nurse in the RRT intervention.

23. IMPLEMENTATION - DOCUMENTATION SYSTEM
• Rapid response team records will be completed both by
the activating nurse with as much information filled out as
possible before the team arrives and by the designated
team member during the event.
• Feedback to RRT forms serves many purposes facilitating
the after action reporting process, enhancing the quality
control, encouraging the improvement effort and
providing information for comparison-analysis purposes.
• Information on transfers to the ICU units from general
surgery and information regarding activation of code
whites for two years before the implementation of the
RRT.

24. IMPLEMENTATION - DOCUMENTATION SYSTEM
•
Example of
Rapid
Response
Team
Record to
be filled
out by both
activating
and RRT
designated
record
keeper.

25. IMPLEMENTATION - SAFETY HUDDLE
• A safety huddle should be held immediately after
the event and include all personnel available. The
safety huddle will allow for an open discussion of
what went correctly, what could have been done
better, equipment needs, concepts for
improvement, needed training and will allow for
psychological closure with a healing moment for
those involved.

26. IMPLEMENTATION-DOCUMENTATION SYSTEM•
• Feed back to RRT (Appendix C)
• Thank you for calling the RRT
• The RRT is here for you. If there is anything we can do to improve our response, we need and welcome
your input
• Please take a few minutes to answer our questions below
• Did the team arrive promptly?
• Yes No
• Was the RN/RT efficient and respectful?
• Yes No
• Did you feel the patients’ needs were addressed appropriately?
• Yes No
• Did you feel supported by the RRT?
• Yes No
• Would you call the RRT?
• Yes No
Example of
Feedback to
RRT form to
be filled out
after the
event by floor
nurses and
MD’s.

27. IMPLEMENTATION - DEBRIEF
• In the case of a patient death or critical change in
patients’ health status called a sentinel event a
debrief chaired by the chief nursing officer with all
involved parties needs to be held to quickly
determine what changes need to be made to
improve patient safety and unit efficiency (Roberts,
2005).

28. CONCLUSION – PROJECTED OUTCOMES
• Decreased morbidity and mortality from cardiac
events.
• Increased patient safety in form of reduced
increases in level of patient care, decreased
morbidity, decreased mortality and decreased
number of days in hospital.
• Increased admissions to intensive care units.

29. CONCLUSION – PROJECTED OUTCOMES
• Increased patient functionality at discharge.
• Revenue neutral implementation cost. i.e. The
increased cost of $28 per patient will be offset by
increased admissions to intensive care units which
have a higher daily reimbursement rates per
patient.
• Increased nursing satisfaction and more effective
communication in nursing corp.

30. CONCLUSION – AREAS FOR FUTURE STUDY
• Effectiveness of communications between the medical
surgical patient, the physician and the RRT team should
be studied and areas of improvement defined.
• Expansion of the study to other sites to confirm findings
and generalizability of findings will also be needed.

31. REFERENCE
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35. REFERENCE (CONT.)
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