The hospital nursing education office trained all nurses on all shifts in a short period of time. All nursing staff were taught to use SBAR (situation, background, assessment, and recommendation) communication and to identify early warning signs.1 The importance of recognizing the early warning signs was stressed during the nursing and physician training sessions. Staff were reassured that they didn’t have to know what was wrong with the patient to know that something was wrong and that help was required.
Publicity was accomplished in a variety of ways. The facility purchased pencils in our official color—lime green—that said “Rapid Response Team X4415.” The duffle was wheeled to all nursing stations so that staff could see it. We also ordered custom green-and-white M&M candy (available at www.mms.com) labeled “RRT X4415” to give as a promotional gift when an RRT was called.
Staffing
One last question remained for our team members: Who would respond to the RRT?
The committee felt strongly that an ICU nurse, an ICU resident, and a respiratory therapist should respond. Many physicians on the team did not want a doctor to respond, mostly due to concerns over chain of command. Who would be responsible for decisions made by the RRT? What if an ICU R2 disagreed with a surgery R4? Could they write a “do not call RRT order?” Nursing, on the other hand, wanted physician response; they wanted to be able to stabilize the patient.
Standardized protocols were discussed, but the team felt that the they would unreasonably delay the start. Radiology, which has no code blue response, volunteered to respond to all calls and hand-deliver the film to a computerized viewing system. The lab volunteered to run all RRT labs—designated with a lime green sticker—as quickly as possible.
The medical staff wanted to pilot the RRT, but because we are a small facility (220 beds) and to avoid confusion we launched the RRT for all inpatients. We went live in October 2005. The original plan was to staff an ICU nurse/RRT position. This RRT RN would relieve ICU nurses for breaks to maintain staffing ratios and provide RRT coverage. Because of the omnipresent nursing shortage, however, the RRT position is often pulled and the charge nurse must cover calls. Nurses sign up for RRT overtime and get pulled for patient care duties.
Mock RRT Calls
We performed three RRT drills to determine problem areas. For the first call, we involved a physician who had been vocal about the need for an RRT. The call was for a patient with shortness of breath. Two problems occurred during this drill: The primary team was never called, and there was no overhead page. So a member of our team worked with the hospital operator on our committee and clarified our protocols.