annual nursing research & evidenced based practice symposium decreasing preventable codes...
TRANSCRIPT
Annual Nursing Research & Evidenced Based Practice Symposium
Decreasing Preventable CodesSeptember 10, 2009
By
Minnie Gaffney RN, CCRN
The Rapid Response Team and MEWS
The Rapid Response Team and MEWSBackground
• Initiated at NMH, January 2006
• Nurse lead, dedicated team
• Proactive
• Wanted to impact patient care
Choices
• APACHE II– ER/ICU population
– Lengthy
– Not all information available for general population
– Labor intensive for primary floor nurses
• MEWS – Easy short form for hand
calculations
– All information easily available
– Readily accepted by RNs and PCTs who assisted with trial
Modified Early Warning Score
3 2 1 0 1 2 3
Systolic Blood pressure (mmHg)
<70 71-80 81-100 101-199 ≥200
Heart Rate (bpm)
<40 41-50 51-100 101-110 111-129 ≥130
Respiratory rate (bpm)
<9 9-14 15-20 21-29 ≥30
Temperature (°C)
<35 35-38.4 ≥38.5
AVPU score Alert Reacting to
Voice
Reacting to
Pain
Unresponsive
MEWS (Modified Early Warning Score)
3 2 1 0 1 2 3 Total
Temp <36°C
<96.8°F
36-38°C
96.8-100.4°F
>38°
>100.4°
HR (bpm) <41 41-50 51-100 101-110 111-129 >129
RR (bpm) <10 10-20 21-24 25-28 >28
SpO2 <91% 91-94% 95-100%
SBP (mmHg) <81 81-90 91-100 101-160 161-170 171-180 >180
CAM + -
Resp Assessment + -
Rapid Response Team goes ElectronicAn electronic MEWS scoring patients based on vital sign data entered into PowerChart, was developed to assist RRT RNs in their proactive identification of at-risk patients.
Rapid Response Team: Results
Preventable Codes Per Patient Days(Lower is better)
0
0.2
0.4
0.6
0.8
1
1.2
FY06Q3
FY06Q4
FY07Q1
FY07Q2
FY07Q3
FY07Q4
FY08Q1
FY08Q2
FY08Q3
FY08Q4
FY09Q1
FY09Q2
Preventable Codes/Pt DaysFY08Linear (Preventable Codes/Pt Days)
RRT Calls / Patients Seen
0
50
100
150
200
250
300
350
400
450
500
Jan
08
Feb
08
Mar
08
Apr
il 0
8
May
08
June
08
July
08
Aug
08
Sept
08
Oct
08
Nov
08
Dec
08
Staff Activated MEWS Activations Other
An observed reduction in average number of preventable codes per 1000 patient days has been achieved since the implementation of the electronic MEWS; and on average an additional 250 patients are seen by the RRT RN each month. To date 15,870 patients have been seen by RRT.
Rapid Response Team: Results
Preventable Codes Per Patient Days(Lower is better)
0
0.2
0.4
0.6
0.8
1
1.2
Preventable Codes/Pt DaysFY08Linear (Preventable Codes/Pt Days)
An observed reduction in average number of preventable codes per 1000 patient days has been achieved since the implementation of the electronic MEWS; and on average an additional 250 patients are seen by the RRT RN each month. To date 15,870 patients have been seen by RRT.
Thank You!
• Pat Murphy, RN, MSN, MBA
• Kristin Ramsey RN, MSN, MPPM, NE-BC
• All of my Rapid Response Team colleagues, awesome nurses!