j nichols final 4-12-16final

1Running head: RAPID RESPONSE TEAMS

Rapid Response Teams: Improving Patient Outcomes on Surgery and Medical Units

A Research Proposal

Submitted in Partial Fulfillment of the Requirements for

Nur6403 Non-Thesis Project

For the Master of Science in Nursing Administration

And Emergency Management at

Arkansas Tech University

Graduate Department of Nursing

By

James Nichols, B.S.N.

Spring 2016

RAPID RESPONSE TEAMS 2

Table of Contents

Introduction…………………….………………………………... 4

Significance of Problem to Nursing Profession…………….……..5

Statement of Purpose………………………………………….…..6

Theoretical Framework/Model………………………………….…6

Research Question………………………………………………....6

Review of Literature…………………………………………….... 8

Methodology…………………………………………………........12

Conclusion……………………………………………………….. 16

References…………………………………………………………18

Appendix A (Activation Protocol for RRT) ……………………...23

Appendix B (RRT Form) ………………………………………...24

Appendix C (RRT Feedback Form)………………………………25

Appendix D (RRT Ref Card for Badge & RRT Sign)……………26


Abstract

Rapid response teams (RRTs) made up of highly skilled nurse specialists are being implemented

in the United States in an effort to lead to more positive hospital patient outcomes in cases of

patient health downturn events. The implementation of such a unit in a Magnet certified urban

hospital will definitively allow for the determination of the effectiveness of these teams in regard

to shorter patient hospital stays, reduction in patients requiring increased level of care and

increased level of patient functionality at discharge. The purpose of this project is to determine if

implementing a RRT at a Magnet designated urban hospital will improve patient outcomes in a

medical surgical environment. This study will use the Iowa Model of Evidence Based Practice to

Promote Health Care combined with Abdallah’s Theory of Nursing focusing on 21 nursing

problems as a framework to develop practice guidelines incorporating a decision algorithm for

when it will be appropriate for the RN to activate the RRT.


Rapid Response Teams: Improving Patient Outcomes on Surgery and Medical Units

Introduction

Healthcare organizations around the United States (U. S.) are experiencing an

overwhelming increase in the acuity of the patients they treat with the combined issues of a

shortage of both registered nurses (RN) and skilled experienced technical staff. One initiative

used by health care organizations to increase patient safety, patient outcomes and to offset RN

staffing ratios that are low, is the implementation of a Rapid Response Team (RRT). The RRT

is a team of nurses usually an advanced practice nurse, a critical care nurse with trauma

experience, and a respiratory therapist on call by both staff and the patient’s family to respond

to a patient health downturn (Kapu, Lee, & Wheeler, 2014). A patient health downturn is a

reduction in the patients’ health condition that requires the immediate intervention of nursing

staff. The overall effectiveness of the RRT remains in question after several years of intensive

studies.

While RRTs have been credited with reduction in fatalities from cardiac events at the

same time admissions to intensive care units have increased due to RRT interventions. The

RN’s primary focus in patient safety is to become “an around the clock surveillance system in

hospitals for early detection and prompt intervention when patient’s conditions deteriorate”

(Aiken, 2002, p. 290). The RN is to identify and intervene in a timely manner if the patient

deteriorates physically or is in danger of death (Parker, 2014). The Institute for Healthcare

Improvements as part of its “100,000 Lives” Campaign in 2004 recommended RRTs to provide

floor nurses the resources needed to respond to patient downturns in their physical conditions

(Berrois, Caple, Elmer, Jensen, Kashyap, O’Horo, & Velagapudi, 2014). RRTs are based on the


concept that by having specialized teams of nurses providing interventions at the first

indication of a physical downturn negative patient events can be prevented (Berg et al., 2010).

Subsequent research has shown only a reduction in cardiac arrest after implementation of the

rapid response teams with only limited improvements in the categories of hospital mortality

and lowering the percentage of patients requiring an increase in level of care (Byrden &

McNeill, 2013).

RRTs have shown to reduce the average length of stay and increase hospital discharges

while increasing intensive care unit admissions (Evans, 2013). Despite predictions of cost

savings the actual cost of implementing a RRT has been estimated to be $23.00 per day for a

patient. However an increase in the number of intensive care unit admissions, may reduce the

overall cost to a hospital because of the increased reimbursement rates used by insurance and

government agencies for intensive care patients compared with patients on the medical surgical

units (Adang, Schoonhoven, Simmes, & Van der Hoven, 2014; Evans, 2013). The increased

admission rates to intensive care units combined with the increased daily reimbursement rate

for transferred patients, could increase hospital revenue if the change in level of care is not

determined to be the fault of hospital staff. Despite the fact that the U. S. health care system is

the most costly in the world, the U. S. still has between 50 and 100 thousand patient deaths

each year in a hospital setting (Evans, 2013). This statistic emphasizes the inefficiencies of the

current system (Evans, 2013).

Significance of the Problem to Nursing Practice

Between 44,000 and 98,000 hospital patients die each year because of medical errors or

oversights (Evans, 2013). RRTs are one intervention used to try to lower these numbers (Evans,


2013). The increasing acuity of patients on surgical and medical floors combined with the

continuing staffing limits make the safeguarding of patients a more challenging issue as time

goes by. The use of RRTs and other innovative techniques will be necessary in the future to

compensate for the lack of man power and increasing workload (Evans, 2013).

By staffing RRTs primarily with RNs and respiratory technicians the role and

responsibility of the allied health professions is broadened and expanded. Also, the use of RN’s

in the consulting role allows for more open and free communication between peers this free

exchange of ideas facilitates the problem solving process increasing patient safety while adding

to the job satisfaction of nurses (Kaput, Lee, & Wheeler, 2014).

Statement of Purpose

The purpose of this project is to determine if implementing a RRT at a Magnet designated

urban hospital will improve patient outcomes in a medical surgical environment.

Research Question

Will the implementation of a RRT on medical surgical units at a Magnet designated

urban hospital improve patient outcomes for at risk patients as measured by shorter patient

hospital stays, reduction in patients requiring increased level of care and increased level of

patient functionality at discharge?

Theoretical Framework/Model

This study will use the Iowa Model of Evidence Based Practice to Promote Health Care

combined with Abdallah’s Theory of Nursing focusing on 21 nursing problems as a framework


and to develop practice guidelines incorporating a decision algorithm for when it will be

appropriate for the RN to activate the RRT (George, 2012).

The Iowa Model of Evidence Based Practice explores each stage of health care delivery

from the overall infrastructure to the provider and to the patient (Dontje, 2007). When a patient

suffers a downturn in health the RN is limited by the inability to consult freely with experts and

request assistance in providing optimal care until the situation becomes critical. By using the

Iowa model this study will compare an intervention using the RRT and the current system of

calling a code white only in a critical patient situation. A code white is when a patient is in a

critical health state and the nurse activates the protocol which summons the house manager, a

respiratory therapist, a medical doctor from the emergency department, a cardiac intensive care

nurse, a pharmacist and all available nurses on the floor. By comparing patient outcomes for at

risk patients as measured by shorter patient hospital stays, reduction in patients requiring

increased level of care and increased level of patient functionality at discharge of the RRT group

(intervention group) to the code white group (control group) the outcome of the implementation

of a RRT group in a Magnet certified hospital can be assessed.

The theory that is most applicable to the use of RRT teams in the Medical Surgical units

is Admiral Abdallah’s Theory of Nursing focusing on 21 nursing problems which include every

aspect of the patient nurse interaction (George, 2012). Abdallah’s theory focuses on the health of

the patient in detail breaking down the different aspects of care into 21 nursing problems

spanning every aspect of the patient experience from physiological to psychological to spiritual

and environmental (George, 2012). Admiral Abdallah’s Theory of Nursing’s comprehensive

view is similar to the Iowa Model’s detailed and comprehensive definition of the broad


responsibilities of nursing in patient care which make the two theories appropriate in the study of

RRT’s.

The following nursing problems according to Admiral Abdallah’s list of 21 nursing

problems are specific to this situation:

Problem 3. To insure safety through the prevention of accident, injury and other trauma and

through prevention of the spread of infection.

Problem 5. Maintain supply of oxygen to the body cells. Provide respiratory therapy by the RRT

if needed.

Problem 8. Maintain electrolyte and fluid balance. Initiation of fluid bolus or blood

administration if needed by the RRT.

Problem 9. To recognize the physiological responses of the body to diseases condition. To watch

for changes in skin color, mental status and other signs of change by both the primary care RN

and later the RRT.

Problem 10. To facilitate and maintain the regulatory mechanism and functions. Monitoring both

the vital signs and the patient’s mental status by both the primary care RN and later by the RRT.

The Iowa theory relates to this project by investigating whether a RRT could improve the

results of patients on the medical surgical units who are taking a downturn preventing increases

in the level of care, shortening the length of patient’s stay and improving the patient’s level of

functionality at discharge as defined by goals 3, 5, 8, 9 and 10 of Admiral Abdallah’s 21 nursing

problems.


Review of Literature

The purpose of the review of literature is to present current research on the effectiveness

of RRTs in relation to improved patient outcomes and lower patient mortality rates. Between 50

and 98 thousand patients die from avoidable incidents while hospitalized each year (Evans,

2014). A literature review was performed in February of 2016 using these databases: PubMed,

CINAHL, Cochrane, Google Scholar, Ovid, and Ebsco in conjunction with the key terms RRT

and patient mortality. The following review of literature presents current research studies on

clinical outcomes and implementation of RRTs.

Clinical Outcomes

In a study by Evans (2013) utilizing a 300 bed non-urban hospital as a setting, the

researcher reviewed five years of data to determine the effects of implementation of a RRT on

patient mortality, patient cardiac arrest, length of patient stay and per patient cost (Evans, 2014).

Evans (2014) found that the increased cost per patient of implementation of the RRT cost the

hospital $23.00 for each patient in the facility each day, the increased cost was largely because of

the need for dedicated RRT nurses salary because these nurses were not based in one unit and

their services could not increase the census and thus billable hours overall. Evans (2013) also

found that the length of stay increased by an average of 0.40 days, a statistically lower number of

deaths occurred after the implementation of the RRT and total discharges increased while

admissions to the intensive care units increased (Evans, 2014). Similarly, Adang et al. (2014)

found increases of $21 for each patient in the hospital each day to implement a RRT.

Bryden and McNeill (2013) in a systematic review of 43 studies found a correlation

existed between the skill level of the members of the RRT and positive patient outcomes. Berg,


Jain, Nallmouthu, and Sasson (2010) conducted a systematic review and meta-analysis of 18

studies covering 1.3 million hospital admissions also found evidence lacking only finding a

reduction in cardiac arrest outside the intensive care units (ICU) with no corresponding increase

in survival of these same patients. Pham, Pfoh, Sydney, Weavers and Winters’ (2013) systematic

review of 44 studies of rapid response systems found that while rates of cardiac arrest were

lowered overall hospital mortality was not improved by the implementation of a Rapid Response

System. Also, Fikkers, Mintjes, Schoonhoven, Simmes and Van der Hoven (2012) found in a

study of patients before and after RRT implementation at a university medical center a 50

percent reduction in cardiac arrest and unexpected deaths.

RRT’s have shown various improvements in areas of decreased patient codes, of

decreased variability in recording patient downturns, of increased recognition of patient’s

downturns and increased RN initiation of escalation of patient’s level of care in three hospitals.

Avis, Foy, Grant, and Foy (2016) reported a decrease in patient codes two years after the

implementation of a RRT. Mackintosh, Rainey, and Sandall (2012) found that the use of RRTs

reduced variability in recording and recognizing a patient’s downturn, increased RNs initiating

procedures to escalate the level of care of patients and in the process increased patient safety and

positive patient outcomes. Bonafeide, Keren, Locailio, Viany, and Weinrich (2014) in a

quantitative study, with the sample of 1810 patients, found that a RRT intervention was 62%

effective in preventing escalation in the level of care.

Implementation of RRT

Avis et al. (2016) detailed the criteria for activation of the RRT which included heart rate

greater than 125 or less than 45, oxygen saturation less than 90%, systolic blood pressure greater

than 180, seizure, chest pain, change in mental status, postpartum hemorrhage, unplanned


spontaneous delivery, vaginal bleeding before delivery, patient non responsive to treatment and

concern of staff (See Appendix A). In educating staff about the RRT the hospital used video to

review the purpose, activation procedure and expectations of outcomes of the RRT with staff

(Johnson, 2009). Kapu et al. (2016) determined that the addition of the acute care nurse

practioner to the RRT increased efficiency by allowing facilitation of transfers and more

treatment option.

Several studies have focused on barriers to quick activation of RRTs. Bonafeide et al.

(2014) found that three barriers to quick activation of the RRT were lack of self-efficacy by the

RN, perception of hierarchy, and negative expectation of outcomes. One solution suggested by

Elliot and Scott (2014) detailed documentation forms and feedback forms to be used by RRTs

and activating staff which allowed for review of activation procedures and reduction of barriers

to activation (See Appendix B & C). Johansen, Lennes, Howell, Hsu, and Stevens (2012) found a

correlation between a primary team focused implementation and care provider’s willingness to

activate the RRT suggesting that the active participation of the medical surgical unit nurse

primarily responsible for the patient in the intervention is key to quick activation of the RRT.

Parker (2014) in a study found that nurses who utilize analytical decision making versus intuitive

decision making were twice as likely to activate the RRT suggesting hospitals focusing on

evidence based practice will be more successful in timely activation of the RRT’s.

Overall the literature has mixed reviews of RRT’s except for the lowering of cardiac

related deaths. While the lowering in cardiac deaths alone would prove the value of the RRT

research has shown an increase in nurse satisfaction with the implementation of the RRT’s. The

literature does address research studies on the implementation in the hospital setting, there are no

specific studies focusing solely on implementation of RRTs on a hospital medical surgical unit.


Utilizing current research studies and evidence based best practices to implement RRTs in the

medical surgical unit would potentially change the outcomes for patients and offer additional

support for nurses utilizing RRTs.

Methodology

The purpose of this project is to determine if implementing a RRT at a Magnet

designated urban hospital will improve patient outcomes in a medical surgical environment.

Setting

In order to establish the desirability of a RRT, the implementation of a RRT will be

undertaken at a Magnet certified urban hospital. The medical surgical floors will be the primary

focus of the study expanding to other units at a later date.

Target population

The target population will be medical surgical patients of a Magnet urban hospital who

face a patient health downturn.

Data Collection

Data will be collected using rapid response team records (see Appendix B) and feedback

to RRT forms (see Appendix C). The rapid response team record will be completed both by the

activating nurse with as much information filled out as possible before the team arrives and by

the designated team member during the event. The duplication of identical information will

allow for comparison and be an effective measure of the communications between the activating

personal and team members. The use of an identical instrument will allow for quicker and more

accurate communication under stress situations. The feedback to the RRT form serves many

purposes facilitating the after action reporting process, enhancing the quality control,

encouraging the improvement effort and providing information for comparison-analysis


purposes. Also, information on transfers to the ICU units from general surgery for two years

before the implementation of the RRT will need to be secured at the beginning of the survey. In

addition, all information regarding activation of code whites for the same two year period

including the medical records of all the individual records will need to be secured and all

identifying information for the patients will need to be removed from the data.

Implementation

The RRT will consist of a respiratory therapist (RT), an advanced practical nurse (APN)

and a trauma certified RN with several years of experience in a cardiac intensive care unit

(CICU). While operating as a seamless team of equals the APN will take the lead in

interventions and verbalize the orders; also, the APN will be able to rapidly implement

medication orders and transfer orders for patients (Kapu et al. 2016). The cardiac intensive care

RN will focus on advanced life support issues. The respiratory therapist will provide airway

management and pulmonary management support. The RRT members will need to undergo an

intensive training program and will need to observe an active RRT for six weeks to ensure they

understand the operations of a properly functioning RRT (Johnson, 2009). A great deal of effort

needs to be taken to allow for self-selection of teams. The group of candidates should be

selected, finalist should be put through a mock training event for two days and at the end of the

event all candidates should bid on who they want as team mates. This self-selection process

should allow for the optimal probability for an effective and coherent team formation. Also, a

deselection process should exist so that if two team members wish to deselect the third team

member this will be allowed (Northouse, 2016). As professionals it should be assumed that only

for professional reasons would a member be deselected (Loy, 2003).


A proper communication system connecting the RRT with the switchboard, units, call

number, physicians, MDs, intensive care units, pharmacist and all other resources needed will

need to be implemented and thoroughly tested. A text based system would be preferable as the

security of a visual system versus a verbal system will help to protect patient privacy and Health

Portability and Privacy Act (HIPPA) compliance (Haddow, 2009; Fearn-Banks, 2010). This will

also provide for more detailed and accurate information. The one exception would be during the

actual code when hands free speaker technology would be essential. The system will need to be

tested for redundancy and effectiveness even in the direst circumstances such as a natural

disaster (Haddow, 2009; Fearn-Banks, 2010).

A documentation system will be used to document the activating nurse’s view of the

RRT, the RRT member’s activities on each call, the outcome of each patient and the view of the

attending MD or charge nurse for the unit involved regarding the effectiveness of each call (See

Appendix B & C).

An educational session will include all hospital employees. The education session will

emphasize the contact number, when to call for the RRT (see Appendix A) and the expectations

of the RRT program (Johnson, 2009). The systems would need to utilize multiple approaches to

learning in order to maximize the effectiveness and retention of information for individuals with

different learning preferences and education levels (Roberts, 2005). A video with actual mock

codes and events would be optimal with multiple platforms for viewing for the healthcare team

via online access, at unit level meetings and organization level meetings, and audio pod-cast

technology (Johnson, 2009). Simple signs using visual cues and colors should be placed

throughout the hospital and each room promoting the RRT and the number to call. A card with

the RRT number and activation protocol should be produced and should be below each


employees ID for quick reference (see Appendix A & D). A yearly refresher course regarding

RRT activation should be included for each employee.

When the RRT is activated continuity of care is interrupted when new providers are

added to the patients care team. The primary care team according to an article by Berrios et al.

(2014) should remain actively engaged in the continued care of the patient working in

conjunction with the RRT when the RRT is activated, this ensures that the patient’s and families’

wishes are given the proper weight in any treatment. One on one educational events with the

RRT members and unit level staff would be beneficial in building a team “spirit de corp”

between the two groups and help to reinforce the essential nature of the medical surgical nurse in

the RRT intervention.

When time permits a safety huddle should be held immediately after the event and

include all personnel available. The safety huddle will allow for an open discussion of what went

correctly, what could have been done better, equipment needs, concepts for improvement,

needed training and will allow for psychological closure with a healing moment for those

involved. In the case of a patient death or critical change in patients’ health status called a

sentinel event a debrief chaired by the chief nursing officer with all involved parties needs to be

held to quickly determine what changes need to be made to improve patient safety and unit

efficiency (Roberts, 2005).

The data of all information will be compared such as the information involved in each

code white, the information involved in each patient transfer from the floor to a higher level of

care such as intensive care and any other pertinent information such as safety issues needs to be

copied and stored in an area so that two years of data is protected for comparison with the first

two years of operational outcome information for the RRT. In addition to the outcome measures


of shorter patient hospital stays, reduction in patients requiring increased level of care and

increased level of patient functionality at discharge additional review of, changes in patient

mortality rates, changes in patient morbidity rates and the change in cost of operations must be

undertaken in this study. A cost benefit analysis should also be done.

Ethics-

The hospital institutional review board (IRB) of the implementing hospital will approve

this project before implementation as data will be collected to measure the outcomes. Patient

confidentiality and privacy will be protected by removing all identifiable information from any

data used in this study.

The RRT implementation will also have to be approved by the Magnet hospital’s nursing

congress which as part of the shared governance tenet of Magnet hospital approves every change

in nursing care implemented at a Magnet hospital. Also, the medical board and executive board

of the Magnet hospital would have to approve the plan.

Conclusion

With increased patient acuity, lower staffing ratios, an aging population and limited

reimbursement for patient complications preventing patient injury and status downturns is

essential to the viability of the Magnet designated urban hospital and the long term health of the

community at large. Due to the lack of conclusive evidence and the individual differences in the

hospitals, RRT make ups, activation protocols and other factors a comparison of the same

hospitals’ medical surgical units before and after the implementation of a RRT using best

evidence based practice would be beneficial in determining whether a RRT is the correct way to

maximize the patient safety and patient outcomes at a Magnet designated urban hospital.


The literature supports a corresponding decrease in cardiac mortality and morbidity with a

corresponding reduction in hospital length of stay and increase in admissions to the intensive

care unit resulting from the implementation of a RRT (Evans, 2013). Implementation of the RRT

in the Magnet hospital environment may also lead to decreases in mortality/morbidity and

increases in patient functionality at discharge if best evidence practice is implemented in the

creation and operation of the RRT. The empowerment achieved by the use of RN’s in the

resource and support role of RRT team member will help to broaden the scope of practice of

RN’s and increase the job satisfaction levels of nurses on medical surgical units. Also, RRT will

increase the effectiveness of communications between the medical surgical RNs and emergency

response teams when a patient intervention is required by a patient health downturn event (Kaput

et al., 2014).

Future research should cover the effectiveness of interactions and communications of the

RRT, the medical surgical nursing staff and the medical doctors in interventions resulting from

patient health downturn events. Research should also focus on how to optimize communication

in these highly stressful and time critical events.


References

Adan, E., Schoonhoven, L., Simms, F., & Van Der Hoven, J. (2014). Financial consequences of

the implementation of a rapid response system on a surgical ward. Journal of Evaluation

in Clinical Practice, 20, 342-347. (DOI: 10.1111/jep.12134). Retrieved from

http://libcatalog.atu.edu:2059/ehost/pdfviewer/pdfviewer?sid=126d5357-0782-41cb-

a0f3-f7340b14c469%40sessionmgr4002&vid=0&hid=4212

Aiken, L., Clarke, S., Sloane, D., Slochalski, J., & Silber, J. (2002). Hospital nurse staffing and

patient mortality, nurse burnout, and job dissatisfaction. The Journal of American

Medical Association, 288, 1987-1993. (DOI: 10.1001/jama.288.16.1987) Retrieved

From: www.nursing.upenn.edu

Avis, E., Foy, M., Grant, L., & Foy, M. (2016). RRTs decreasing intubation and code blue rates

outside the intensive care unit. Critical Care Nurse, 36, 86. (DOI: 10.4037/ccn2016288 )

Retrieved from: http://libcatalog.atu.edu:2059/ehost/pd,fviewer/pdfviewer?

sid=b9794d46-c6aa-4b0b-8051-af71f02984b3%40sessionmgr4002&vid=0&hid=4212

Berg, R., Chan, P., Nallmothu, B., Jain, R., & Sasson, C. (2010). RRTs a systematic review and

meta-analysis. Journal of American Medical Association Internal Medicine, 170, 18-26.

(DOI 10.1001/archinternmed.2009.424) Retrieved from:

http://archinte.jamanetwork.com/article.aspx?articleid=481530

Berrois, R., Caple, S., Elmer, J., Jensen, J., Kashyap, R., O’Horo, J., & Velagapudi, V. (2014).

The role of the primary care team in the rapid response system. Journal of Critical Care.

http://archinte.jamanetwork.com/article.aspx?articleid=481530

http://libcatalog.atu.edu:2059/ehost/pdfviewer/pdfviewer?sid=b9794d46-c6aa-4b0b-8051-af71f02984b3@sessionmgr4002&vid=0&hid=4212

http://libcatalog.atu.edu:2059/ehost/pdfviewer/pdfviewer?sid=b9794d46-c6aa-4b0b-8051-af71f02984b3@sessionmgr4002&vid=0&hid=4212

http://libcatalog.atu.edu:2059/ehost/pdfviewer/pdfviewer?sid=126d5357-0782-41cb-a0f3-f7340b14c469@sessionmgr4002&vid=0&hid=4212

http://libcatalog.atu.edu:2059/ehost/pdfviewer/pdfviewer?sid=126d5357-0782-41cb-a0f3-f7340b14c469@sessionmgr4002&vid=0&hid=4212


30, 353-357. (DOI: 10.1016/j.jcrc.2014.10.022) Retrieved from:

http://libcatalog.atu.edu:2081/nursing/docview/1655761125/fulltextPDF/

6B50747691424032PQ/17?accountid=8364

Bonafeide, C., Keren, R., Locailio, R., Vian, M. & Weinrich C. (2014). Impact of rapid response

system implementation on critical deterioration events in children. Journal of American

Medical Association Internal Medicine, 168, 25-33. (DOI:

10.1001/jamapediatrics.2013.3266.) Retrieved from:

http://www.ncbi.nlm.nih.gov/pubmed/24217295

Byrden, D., & McNeill, G. (2013). Do either early warnings system or emergency response

teams improve hospital patient survival? A systemic review. Resuscitation, 84, 1652-

1667. (DOI 10.1016/j.resuscitation.2013.08.006. Epub 2013 Aug 17.) Retrieved from:

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=e3040bf9-6780-426d-

88bd-c321c22161d7%40sessionmgr113&vid=0&hid=128

Dontje, K. (2007). Iowa model. Medscape. Retrieved from:

http://www.medscape.com/viewarticle/567786_4

Elliot, S., & Scott. S. (2009). Implementation of a RRT. Critical Care Nurse, 29, 66-74. (DOI:

10.4037/ccn2009802) Retrieved from:

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=bf14c160-8e1f-4ac2-b68c-

023e957f4cd8%40sessionmgr115&vid=0&hid=128

Evans, M. (2013). The effects of a RRT on clinical outcomes. Journal of Nursing, 3, 3. Retrieved

from: http://libcatalog.atu.edu:2081/nursing/docview/1319285590/fulltextPDF/

6B50747691424032PQ/2?accountid=8364

http://libcatalog.atu.edu:2081/nursing/docview/1319285590/fulltextPDF/6B50747691424032PQ/2?accountid=8364


http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=bf14c160-8e1f-4ac2-b68c-023e957f4cd8@sessionmgr115&vid=0&hid=128

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=bf14c160-8e1f-4ac2-b68c-023e957f4cd8@sessionmgr115&vid=0&hid=128

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=e3040bf9-6780-426d-88bd-c321c22161d7@sessionmgr113&vid=0&hid=128

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=e3040bf9-6780-426d-88bd-c321c22161d7@sessionmgr113&vid=0&hid=128




Fearns, K. (2008). Crisis communication (4th Ed.). Los Angeles, C.A.: Routledge Publishing.

Fikkers, M., Mintjes, J., Schoonhoven, L., Simmes, G., & Van der Hoven, J. (2012). Incidence

of cardiac arrest and unexpected deaths in surgical patients before and after

implementation of a rapid response system. Annals of Intensive Care, 2, 1-6. (DOI:

10.1186/2110-5820-2-20) Retrieved From:

http://libcatalog.atu.edu:2081/nursing/docview/1652684521/6B50747691424032PQ/7?

accountid=8364

George, J. (2012). Nursing theories: the base for professional nursing practice. Upper Saddle

River, N.J.: Prentice Hall.

Haddow, G., & Haddow, K. (2009). Disaster communication in a changing media world.

Boston. M.A.: Butterworth-Heinman Publishing.

Johnson, A. (2009). Creative education for RRT implementation. The Journal of Continuing

Education in Nursing, 40, 38-42. Retrieved from:

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?vid=10&sid=90e4c36a-4684-

43dd-aa0a-7cefcbd4c472%40sessionmgr110&hid=128

Johansen, A., Lennes, I., Howell, M., Hsu, D., & Stevens, J. (2014). Long term culture change

related to rapid response system implementation. Medical Education, 48, 1211-1219.

(DOI: 10.1111/medu.12538) Retrieved from:

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=72b5d623-c054-407e-

a342-85123235b19b%40sessionmgr113&vid=0&hid=12

Kapu, A., Lee, B. & Wheeler, A. (2014). Addition of acute care nurse practitioners to medical

surgical RRTs. Critical Care Nurse, 34, 51-60. (DOI: 10.4037/ccn2014847) Retrieved

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=72b5d623-c054-407e-a342-85123235b19b@sessionmgr113&vid=0&hid=12

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?sid=72b5d623-c054-407e-a342-85123235b19b@sessionmgr113&vid=0&hid=12

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?vid=10&sid=90e4c36a-4684-43dd-aa0a-7cefcbd4c472@sessionmgr110&hid=128

http://libcatalog.atu.edu:2095/ehost/pdfviewer/pdfviewer?vid=10&sid=90e4c36a-4684-43dd-aa0a-7cefcbd4c472@sessionmgr110&hid=128

http://libcatalog.atu.edu:2081/nursing/docview/1652684521/6B50747691424032PQ/7?accountid=8364

http://libcatalog.atu.edu:2081/nursing/docview/1652684521/6B50747691424032PQ/7?accountid=8364


from: http://libcatalog.atu.edu:2059/ehost/pdfviewer/pdfviewer?sid=78792d18-6cad-

402a-8d4d-8a596e01595b%40sessionmgr4005&vid=0&hid=4212

Loy, J. (2003). Character in action: The U.S. Coast Guard on leadership. Annapolis, M.A.:

Naval Academy Press.

Mackintosh, N., Rainey, H., & Sandall, J. (2012) Understanding how rapid response systems

may improve safety for the acutely ill patient: Learning from the frontline. British

Medical Journal, 21, 135-144. (DOI: 10.1136/bmjqs-2011-000147. Epub 2011 Oct 4.)

Retrieved from: http://connection.ebscohost.com/c/articles/74697267/republished-

original-research-understanding-how-rapid-response-systems-may-improve-safety-

acutely-ill-patient-learning-from-frontline

Northouse, P. (2016). Leadership theory and practice (7th Ed.). Los Angles. Ca.: Sage

Publishing.

Parker, C. (2014). Decision making models used by medical surgical nurses to activate RRTs.

Med-Surg Nursing, 23, 159-164. Retrieved from:

http://libcatalog.atu.edu:2081/nursing/docview/1544897469/fulltextPDF/

6B50747691424032PQ/21?accountid=8364

Pham, J., Pfoh, E., Sydney, D., Weavers, S., & Winters, B. (2013). Rapid response systems as a

patient safety strategy. A systematic review. Annals of Internal Medicine, 158, 417-425.

(DOI 10.7326/0003-4819-158-5-201303051-00009) Retrieved from:

http://annals.org/article.aspx?articleid=1657886

Roberts, A. (2005). Crisis intervention handbook (3rd Ed.). Oxford, U.K.: Oxford University

Press.



http://libcatalog.atu.edu:2059/ehost/pdfviewer/pdfviewer?sid=78792d18-6cad-402a-8d4d-8a596e01595b@sessionmgr4005&vid=0&hid=4212

http://libcatalog.atu.edu:2059/ehost/pdfviewer/pdfviewer?sid=78792d18-6cad-402a-8d4d-8a596e01595b@sessionmgr4005&vid=0&hid=4212


Proposed Activation Protocol for RRT (Appendix A)

Respiratory Distress (Breaths / Minute) Less than 10 or Greater than 30

Change in Mental Status Sudden decrease in Level of Consciousness

Tachycardia (Beats/Minute) Greater than 130

Bradycardia (Beats/Minute) Less than 40

Blood Pressure SBP Less than 90 or greater than 180

Chest Pain Complaint non traumatic chest pain

Seizures Sudden or extended or prolonged

Pulse ox (SPO2) Less than 92%

Color change

Agitation

Limb weakness or smile droop

Nurse intuition


Documentation of RRT (Appendix B)

(Elliot & Scott, 2014)


Feed back to RRT (Appendix C)

Thank you for calling the RRT

The RRT is here for you. If there is anything we can do to improve our response, we need and

welcome your input

Please take a few minutes to answer our questions below

Did the team arrive promptly?

Yes No

Was the RN/RT efficient and respectful?

Yes No

Did you feel the patients’ needs were addressed appropriately?

Yes No

Did you feel supported by the RRT?

Yes No

Would you call the RRT?

Yes No

(Elliot & Scott, 2014)


Sign and Info Card for Badge (Appendix D)

j nichols final 4-12-16final

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