Purpose:
(1) Identify steps used to develop a Rapid Response Team. (2) Describe CNS role in development, implementation, and evaluation of a Rapid Response Team.
Significance:
Institute for Healthcare Improvement (IHI) has recommended the Rapid Response Team as 1 of 6 initiatives nationwide to enhance safety and outcomes of patients failing outside of ICU. Studies show that early warning signs of physiological deterioration leading to cardiopulmonary arrests are not always recognized by staff nurses.
Background/Design:
Rapid Response Teams have been very successful in Australia and United Kingdom for many years. Teams are gaining momentum in America.
Methods:
CNSs were challenged as leaders to develop, implement, and evaluate a multidisciplinary Rapid Response Team. The steps followed in the creation of a comprehensive Rapid Response Team initiative were as follows: Reviewed literature; Engaged stakeholders; Identified patient condition criteria; Selected system-wide patient and professional development outcome metrics; Collected baseline data; Designed process for ongoing outcome data analysis and program refinement; Developed Rapid Response Team policy; Modified supporting protocols and standing orders; Implemented house-wide education and marketing. Special emphasis was placed on the critical role of communication. The design included a process for postevent debriefing with team and staff nurses and the utilization of a customized Situation, Background, Assessment, and Recommendation (SBAR) communication format.
Findings:
Three recommended IHI outcomes were measured: percent of codes outside of ICU, codes per 1,000 discharges, and utilization of Rapid Response Team. Survival rate at end of codes was also selected. Ongoing professional development of staff was monitored.
Conclusions:
During the first 2 weeks of implementation, the Rapid Response Team responded to 12 calls, transferred 2 patients to ICU, and sent 1 patient back to surgery. No codes were called. Staff nurses reported appreciation for clinical assessment support at the bedside.
Implications for Practice:
The system and outcome focus of CNSs are vital resources for development, implementation, and evaluation of Rapid Response Teams. The involvement of the CNS in the professional development of staff nurses is producing enhanced assessment skills at the bedside in addition to saving lives.