Enhancing Registered Nurse Preparedness for Rapid Response Interventions

Hospitalized patients can and do experience sudden physiologic deterioration. Early recognition, action, and communication are critical to mitigate worsening deterioration. Rapid response teams (RRTs) are composed of specialized healthcare providers (physicians, nurses, respiratory therapists, others) urgently called to the bedside most often by the registered nurse (RN). RRTs enhance patient outcomes by providing prompt and effective critical care interventions. The RRT initiative encompasses two distinct limbs: 1) the ‘afferent limb’ known as the detection of deteriorating patients and the prompt notification of the RRT; and 2) the ‘efferent limb’ or the interventions started once the team has arrived. The bedside RN is optimally positioned, due to familiarity and literal proximity with their patients, for recognizing acute changes in health status, and subsequently summoning a ‘rapid response team intervention’. Failure of the RN to recognize, react, and relay critical information can result in care delays leading to poor patient outcomes.
A literature review was conducted by searching the Cumulative Index to Nursing and Allied Health (CINAHL) and PubMed (MEDLINE) databases to investigate bedside care delays in the context of RRT initiatives. A single center, retrospective observational study conducted by Gupta et al. (2017) reported that a delay of 15 minutes or more of calling the RRT is commonplace and is associated with increased in-hospital mortality and increased length of hospital admission. Ludikhuize et al. (2012) identified weaknesses in identification of deteriorating patients on medical or surgical units. The study results showed that 80% of patients admitted to an intensive care unit from a medical surgical floor or that experienced cardiopulmonary arrest had signs of deterioration in the preceding 24-hours that were not acted on due to lack of knowledge and skills, inability to appreciate clinical urgency and failure to seek advice. Davies et al. (2014) found that 24 – 35% of physicians and nurses studied were unfamiliar with the rapid response activation criteria. An extensive review of literature indicates that a gap in knowledge of the bedside RN exists specific to early warning signs of patient physiologic deterioration, as well as knowing what common interventions are appropriate while simultaneously initiating the RRT. The majority if not all these interventions are within the professional RN scope of practice. The goal of this scholarly project is to offer a continuing education program addressing this knowledge gap. By working in cooperation with the Michigan Nurse Association (MNA), a continuing educational (CE) training module was made available to MNA members (and non-members). Successful completion of the module awarded participants 1.5 credit hours. A required survey was included within the training to evaluate the teaching content. Forty-four participant surveys were initially collected and analyzed. All survey respondents indicated at minimum that the professional development activity enhanced their knowledge on the rapid response system. Additionally, 97% of respondents indicated they feel more confident in initiating a rapid response call, and 95% feel more confident in actively participating during a rapid response. The favorable responses suggest the curriculum was well-received and sufficiently addressed the existing knowledge gap.