Rapid Response and Crash Carts

What is a Rapid Response Team (RRT)?

It’s a small, experienced team of clinicians who respond when called to provide a second opinion and support for a clinician and patient, particularly when a patient showing signs of potential decline.

Research has shown that survival rates for patients requiring resuscitation during their inpatient admission is about 40 percent. The percent of patients who are successfully resuscitated and survive to discharge from the hospital drops to approximately 10 percent.Research has also shown that virtually all critical inpatient events are preceded by warning signs for an average of 6.5 hours

Why Do We Need a Rapid Response Team?

70% of patients showed evidence of respiratory deterioration within 8 hours prior to respiratory/cardiac arrest

66% of patients showed abnormal signs and symptoms within 6 hours of arrest and MD was notified in only 25% of cases

More Data to Support RRT

What Difference Can a Rapid Response Team Make?

Reduced codes

Reduced post-op emergency ICU transfers and deaths

Reduced codes prior to ICU transfer

Reduced unnecessary admissions to critical care

Increased nurse and patient satisfaction

At least three clinicians respond when a Rapid Response is called….

Assess and stabilize the patient

Assist with communication

Educate and support the staff

Assist with transfer, if necessary

An experienced critical care nurseA respiratory therapistThe resident on call

Their role is very clear…

Floyd’s Policy

Floyd’s Rapid Response policy encourages any staff member to call for the Rapid Response team to quickly examine a patient whose condition begins to deteriorate.

When should a Rapid Response be called?

Acute change or deterioration of patient status

Acute change in heart rate <40 or > 130 bpm

Acute change in systolic BP <90 mmHg

Acute change in respiratory rate <8 or >30 per min

Acute change in saturation <90% despite 02

Acute change in mental status or conscious state

When should a Rapid Response be called?

Paresis, weakness or loss of strength in extremities

Stupor

Other acute changes in neuro status

Acute change in urinary output of < 50 ml in 4 hours

Complaints of shortness of breath

Seizures

Complaints of chest pain

Know where the crash cart is located on your unit

Recognize the patient in cardiac/respiratory arrest, call for help and begin CPR immediately!!

Call the operator”0” #123 and tell them “Code Blue in Room #___”

If you are not doing CPR, bring the crash cart into the room.

The backboard is on the back of the cart; assist getting it under the patient

If the patient is yours, do not leave the room once the code team arrives.

Cardiac Arrest – Code Blue

Code Blue

Floyd’s Rapid Response Team responds to all cardiopulmonary arrests.

The team members are all ACLScertified. The members include:

• Medical residents and/or hospitalists• ICU nurse• Respiratory therapists• Others may be included – lab tech,

chaplain, etc.

What happens when a Code Blue is called?

An ACLS certified physician or ACLS nurse serves as a team leader

The physician gives orders and determines when to stop the code

Respiratory therapist intubates the patient

An ACLS nurse gives the medications

Any licensed staff can start IVs

Anyone certified in BCLS can do CPR

The Rapid Response Team also responds to these incidents:

Sepsis Screening

Suspicion of Infection

(2 out of 4) Fever, Fast HR, Fast RR, Hi WC

SBP < 90 after 20-30ml/kg fluid bolus or serum

lactate > 4

Stroke Screening

Negative

Positive (Telestroke protocol initiated)

How Is the Team Alerted?

The unit nurse calls the operator by dialing “0” then

punching in #123. When the operator

responds say:

“Rapid response in room #____”

The operator calls a “Medical Alert-Rapid Response” via the overhead

paging system

Crash Carts – It’s your responsibility to know the cart

Drawer # 1

Epi

Epi

Drawer # 2

Drawer # 3

Drawer # 4

Drawer # 5

Drawer # 6

Respiratory Box and Defibrillator

Sharps box and Suction set-up (RIGHT SIDE OF CART)

Defib Pads, Suction Catheters, and Backboard (BACK OF CART)

Ambu-Bag and Oxygen Tank (LEFT SIDE OF CART)

Replenishing the Cart

Once the code is past, designate someone to go to pharmacy to pick up a new, locked cart.

A new cart must be picked up in the pharmacy before the old one is returned.

When the new cart is on the floor, someone must take the used cart (medication drawer locked) to pharmacy (with a copy of the code sheet) and then to central supply.

The monitor and Intubation box stays on the unit.

The Zoll is wiped thoroughly wiped with Cavi wipe after use.

Crash Cart Information

Pharmacy checks the crash cart monthly

The charge nurse on your unit checks the

crash cart every shift:

• The Zoll defibrillator is checked on 30 joules

A Respiratory therapist replaces the Intubation

Box after each code

Rapid Response and Code Carts