Although a concerted effort has been made to improve patient safety in acute care settings, patient injuries, unexpected deaths, and unplanned admissions to the ICU still occur because of nurses' failure to recognize clinical deterioration. According to your February article "When Seconds Matter: Rapid Response Teams and Nurse Decision Making" by Alma McColl, MSN, RN, and Virginia Pesata, DNP, ARNP, NEA-BC, FNAP, there was a 60% reduction in cardiac arrests and a 40% reduction in mortality with the implementation of rapid response teams (RRTs) in controlled settings, such as the ICU. Unfortunately, there were poorer outcomes in uncontrolled areas, such as medical-surgical units. The majority of acute patient deterioration (APD) events occur on medical-surgical units. Nurses spend more time in direct patient contact than any other healthcare team member; therefore, nurses in all settings must be able to recognize when a patient is becoming critically ill and respond appropriately.

The underutilization of RRTs has been attributed to the need for increased nursing knowledge and skills. Medical-surgical nurses need to become as familiar with and comfortable in APD situations as critical care nurses. Nurse managers are vital to improving nurses' decision-making skills in RRT situations. The key to managing emergency situations is recognizing the change in a patient's condition early and managing the situation accordingly. Nurse managers should make recognition of APD and RRT training part of annual nurse competencies. Lastly, hospitals should make advanced cardiovascular life support certification and renewals mandatory for all nurses in direct patient care areas.

-T. Annette Ruata, BSN, RN

Tomball, Tex.