Document #: WR

Rapid Response Team (RRT) Policy Northwest Network Effective Date: 2/8/2018 Version #: 2 Document #: WR.387.149 Patient Care Next Review: 2/8/2021 Page #: 1 of 7 SCOPE: All PeaceHealth St. Joseph Center Patient Care Providers and Rapid Response Team. PURPOSE: To deploy trained staff to provide early and rapid intervention at the first sign of change in an adult patient condition. Outcomes may include: Reduction of cardiac and/or respiratory arrests Reduction of mortality Reduction or facilitation of more timely transfers to a higher level or care Consistent recognition of early signs of clinical patient deterioration by clinical staff POLICY Rapid Response Team (RRT) will respond to inpatient areas of St. Joseph Medical Center. Response for offsite PHMG Clinics, Wound Healing Center, Cancer Center, staff should call 911 for assistance. REQUIREMENTS 1. Criteria Guidelines for Initiating the Rapid Response Team: any or all the following criteria meets the guidelines for initiation of Rapid Response. 1.1. Respiratory rate less than 8 or greater than 30 breaths per minute or airway compromise 1.2. Acute change in heart rate less than 40 or greater than 120 beats per minute 1.3. Acute change in SBP less than 90mmHg or greater than 200mmHg 1.4. Persistent change in oxygen saturation less than 90% with supplemental oxygen 1.5. Acute change in urinary output less than 50ml in four hours 1.6. Acute change in level of consciousness, increased restlessness, lethargy or seizure 1.7. Signs or symptoms of stroke 1.8. Signs of sepsis 1.9. Significant bleed 1.10. New onset or unrelieved acute chest pain 1.11. Acute change in patient coloration: Lips, face or limbs pale, dusky or blue 1.12. Drug reaction 1.13. Caregiver has a clinical concern about patient

NWN St. Joseph MC Page: 2 of 7 2. Activation of RAPID RESPONSE TEAM (RRT) 2.1. Any caregiver, visitor or family member may initiate an RRT by: 2.1.1. Calling extension # 5555 and asking the operator to call the rapid response team and giving the patient location. 2.1.2. If at any point the patient becomes unstable and additional staff is needed, a Code Blue should be called per Policy #WR. 387.66 Code Blue, CPR, Code Blue Evaluation- Main Campus. 3. Rapid Response Team Members 3.1. Advanced Cardiac Life Support (ACLS) trained Stat RN 3.2. ACLS trained Respiratory Therapist 3.3. House Supervisor 4. Equipment 4.1. Department monitor 4.2. Portable O2 tank 4.3. Other equipment or supplies requested by STAT RN 5. Rapid Response Team Responsibilities During RRT Activation RRT members will arrive in the called patient location within 5 minutes of receiving notification. 5.1. Primary Nurse will communicate the following in SBAR format: 5.1.1. Current situation 5.1.2. Patient s admitting diagnosis 5.1.3. Vital Signs 5.1.4. Pertinent medications and diagnostic tests 5.1.5. Drug allergies 5.1.6. Code status 5.1.7. Primary Provider 5.2. Primary nurse will remain with the patient and assist the RRT nurse. 5.3. Communicates with family and patient about situation. 5.4. Documents events leading up to the incident in the patient record nurses note.

NWN St. Joseph MC Page: 3 of 7 5.4.1. Records necessary additional information on Nursing Close Observation Record when needed. 5.5. Rapid Response Nurse 5.5.1. Perform a rapid physical assessment. 5.5.2. Notifies provider as soon as possible. 5.5.3. Uses SBAR communication with providers and staff. 5.5.4. Initiate General Rapid Response Team Focused Orders as appropriate. 5.5.5. Communicate with the attending provider regarding the RRT call, interventions and outcomes. 5.5.6. Facilitate transfer to a higher level of care if deemed necessary. 5.5.7. Escalates the Rapid Response to a Code Blue as deemed necessary, (see Rapid Response vs Code Blue job aide). 5.5.8. Pediatric Rapid Response or CBC, the RRT may be called to assist, the role of the RRT in these areas is to provide extra help with specific duties that are with their scope of practice and expertise (e.g. assist with initiating the rapid infuser). 5.6. Rapid Response Respiratory Care Therapist 5.6.1. Perform focused respiratory and airway assessment. 5.6.2. Call for additional Respiratory Care Therapist, assistance or equipment. 5.7. House Supervisor 5.7.1. Facilitate immediate transfer of the patient to a higher level of care if deemed necessary. 5.7.2. Assist with the acquisition of additional resources, caregivers or equipment 5.7.3. In the event of a RRT nurse being unavailable the House Supervisor will perform the role of the RRT nurse. 6. Primary Assessment After completing the rapid assessment, the RRT team members will formulate a plan of action.

NWN St. Joseph MC Page: 4 of 7 7. Utilization of the Rapid Response Team Nurse Initiated Orders 7.1. A Rapid Response needs to be initiated to use the General Rapid Response Team Focused Orders. 7.2. The RRT nurse will initiate use of the General Rapid Response Team Focused Orders. based upon the primary assessment findings in the absence of a provider. Whenever possible call provider to review RRT assessment and requests. 7.3. The General Rapid Response Team Focused Orders do not have to be initiated in their entirety. The RRT nurse will initiate the orders that are necessary to stabilize the patient s emergent condition based on patient presentation and assessment findings in the event a provider is not readily available. 7.4. The RRT nurse may not alter the content of the General Rapid Response Team Focused Orders or practice beyond the guidelines set therein. 7.5. The RRT nurse is accountable and responsible for the delegation of any interventions ordered on the General Rapid Response Team Focused Orders. 7.6. General Rapid Response Team Focused Orders, if utilized, will be entered into the patient s Electronic Health Record (EHR). 8. Communication 8.1. The primary care nurse or the NTL maybe asked to contact the attending provider to report the change in the patient s condition. 8.2. If the General Rapid Response Team Focused Orders are implemented, the RRT nurse will contact the attending provider to provide an SBAR report regarding the patient s condition, interventions taken, patient response to treatment and recommendations. 8.3. RRT nurse will ask attending provider to come to patient location with the RRT team deems it is clinical necessity. 8.3.1. If patient condition becomes unstable a Code Blue should be called. 8.4. Off-going RRT nurse will report all RRT patients to the on-coming RRT nurse that did not transfer to a higher level of care. Priority will be given by on-coming RRT nurse to round on all RRT patients from the prior shift. 9. Documentation 9.1. The RRT RN will use the RRT navigator in the EHR to document the following: 9.1.1. Arrival time

NWN St. Joseph MC Page: 5 of 7 9.1.2. Focused assessment 9.1.3. Interventions and outcomes 9.1.4. Provider notified and time 9.1.5. Time if patient is transferred 9.1.6. Time reported off to primary RN 9.1.7. RRT nurse will follow up with the primary nurse of the RRT patient and the RRT patients 2-4 hours after initial RRT call and document the patient s status in the EHR. 9.2. RRT nurse will fill out the Rapid Response Team Audit Tool for data collection and review. 9.3. Patient Primary RN will document a nursing note to include reason for call and summary of events leading up to the call. 9.4. Respiratory Therapist will document in the EHR the treatments and summary of events. 10. Debrief 10.1. Will be done by the Stat RN, Primary RN, NTL and any other staff who helped participate in the RRT call. DEFINITIONS Adult: For this document is individual aged 14 years or older. SBAR: A technique that provides a framework for communication between members of the health care team about a patient s condition: (S) background (B), Assessment (A), Recommendation (R). RELATED DOCUMENTS, RESOURCES 200.6.110 Rapid Response Code Blue Job aid General Rapid Response Team Focused Orders When to Call a Rapid Response VS a Code Blue Rapid Response Team Audit Tool -located on Crossroads Clinical Stat Webpage REFERENCES Institute for Clinical Systems Improvement (ICSI) Rapid Response Team, Fourth Edition July 2011.

NWN St. Joseph MC Page: 6 of 7 Sebat,F. (Ed.) (2009) Designing, implementing and enhancing a rapid response system. Chicago, IL: Society of Critical Care Medicine. HELP: For questions or assistance with this policy, please contact the Rapid Response Nurse, House Manager, Float Manager. End of Policy The last page of this policy document contains approval, review and revision information only.

NWN St. Joseph MC Page: 7 of 7 CREATION: Author: Margie Campbell: Critical Care Service-Manager Responsible Party: Margie Campbell: Critical Care Service-Manager Reviewed By: Margie Campbell: Critical Care Service-Manager Approved By: Margie Campbell: Critical Care Service-Manager Date: 1/24/2008 REVIEW: Reviewer: Margie Campbell: Critical Care Service-Manager Date: 5/12/2011 Reviewer: Terry Carter: Patient Care Support Manager Date: 9/14/2017 Reviewer: Date: REVISIONS: Revision #2 Responsible Party: Terry Carter: Patient Care Support Manager Revised By: Terry Carter: Patient Care Support Manager 2/6/2018 Approved By: Cindy Preston, Service Line Director Date: 2/8/2018 Roseanna Bell, CNO Date: 2/8/2018 Reason/Summary of Changes: Updated content, added new Job Aid to reference section: Rapid Response Code Blue 200.6.110 and related. RETIRED: Requested By: Approved By: Reason for Retirement: Date: