MANAGEMENT OF DETERIORATING Patient ( RAPID RESPONSE TEAM)
Rapid Response Team (RRT) – a formally designated multidisciplinary team that responds to the call of health care providers from inpatient units except MICU, SICU, CCU, SDU and NICU regarding deteriorating patients. Team provides coverage 24 hrs a day, 7 days a week.
Early Warning Signs (EWS) – are medical signs and symptoms which allow staffs to identify and respond to patients who are deteriorating clinically. Scores used are the adult Modified Early Warning Score (MEWS), and the Pediatric Early Warning Scores (PEWS).
- To provide an integrated approach to the recognition and response to at risk patients, preventing avoidable deterioration.
- To improve patient outcomes by identifying and acting upon early signs of deterioration in a patient’s condition through the implementation of the EWS system and support of the RRT when activated.
- To formalize procedures and responsibilities of each members of the team.
All adult and pediatric patients admitted to the hospital (except lCUs and SDU) shall:
- Have real time vital signs recorded and EWS calculated to provide both the initial baseline and ongoing trends. Documentation shall be done in the MEWS and PEWS Scoring Guide Form.
- Be managed according to their EWS score and appropriate referral to physician or RRT shall be implemented according to score.
Rapid Response Team comprises of:
ADULT Rapid Response Team:
- On-call Medical Resident
- ICU Nurse
- Hospital Nursing Supervisor
- Respiratory Therapist
- EMT
PEDIATRIC Rapid Reponses Team:
- On-call Pediatric Resident
- NICU Nurse
- Hospital Nursing Supervisor
- Respiratory Therapist
- EMT
The appropriate RRT (Adult or Pediatric), when called, shall manage the care of an unstable patient in all in-patient units except MICU, SICU, CCU, SDU and NICU.
The RRT will be activated whenever the condition of the patient meets the activation criteria.
The allocated RRT per shift will be seen on each specified department duty rota as arranged by the head of the department.
RRT will report to the unit in less than 5 minutes from the time of RRT activation.
The role of RRT is not intended to replace Code Blue activation. Upon activation and arrival of the Rapid Response Team and if patient is in imminent cardiopulmonary failure then the CODE BLUE shall be activated.
The RRT will introduce necessary interventions in the absence of treating physician’s order that address the patient’s emergency condition.
RRT Leader shall request Anesthetist, treating doctor (Most Responsible Physician) or his designee if required.
After every RRT activation, a debriefing of the RRT’s overall response process shall be done where the whole team shall review how the overall response process went through.
Rapid Response Team activities are documented in Rapid Response Team Event Record and shall be completed by all members of the RRT.
ICU/NICU Nurse is responsible to assist and monitor the patient during the event or if patient to be transferred to ICU immediately after the event.
If patient is stable after Rapid Response Team Management and does not require transfer to ICU Doctor will document it in the file and ICU/NICU Nurse will endorse the patient to Unit Nurse.
RRT events shall be discussed and acted upon through the CPR Committee when needed.
