Assessment of rapid response teams

2nd Annual Nursing Research & Evidence-Based Practice

Symposium 

Promoting Nursing’s Future: Building Bridges from Classrooms to Clinical Settings

An assessment of nurses attitudes towards rapid response teams (2009)

Daniel Ampomah, RN, PhD, NE-BCPhillip Eaton, RN, MSN, RRT

Rodica Sandor-Scoma, RN, MSHA, MD.

Zewdensh Bryant, RN, BSN, MS.

MSET/RRT Data 2005-2007

TOTAL 2005 TOTAL 2006 TOTAL 20070

50

100

150

200

250

300

44 372330

4028

74 77

51

0

190

299

TOTAL MSETs AND RRTs 2005-2007

CCU NON CCU TOTAL RRT

YEAR

TO

TA

L M

SE

Ts

MSET/RRT Data 2007-2008

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan

RRT/ 500 dc

NaN NaN NaN NaN NaN NaN NaN NaN NaN NaN NaN NaN NaN

CCU MSET

3 1 4 0 6 2 0 0 0 1 2 4 2

Non CCU

4 2 0 2 2 3 3 2 3 2 2 3 7

2.5

7.5

12.5

1

3

5

7

9

11

2007-2008 MSETs AND RRTs

RRT/ 500 dc CCU MSET Non CCU

MS

ET

s

RR

Ts

Problem statement

In 2005 IMVH established a rapid response team to provide medical

intervention at the first signs of a patient’s

decline.

Data suggests the RRT has decreased the mortality rate from 2.6% to 2.2% and

increased the survival rate of this hospital.

The hospital had no data that explored the attitudes of the nurses to the rapid response

teams

Purpose

The purpose of this study was to assess whether nurses valued the RRT service and to determine whether barriers to calling the RRT exist.

Research questions

Do nurses understand the potential benefits of the rapid response team system?

Do nurses find the rapid response team service useful in managing sick patients?

Do obstacles exist that restrict nurses from using the rapid response team service?

Research design: Univariate descriptive

Population: RNs and LPNs working on nursing units and departments in Inova Mount Vernon Hospital

Sample: Convenience sample

Methodology

Inclusion & exclusion criteria

Newly hired and

currently in

orientation

Employed andWorking as anRN or LPN atIMVH

Travelers, contract or agency per diem nurses working at IMVH

Instruments

Nurses Attitudes to Medical Emergency Teams Survey (NAMETS) by Jones, et al. (2006).

Permission to use the NAMETS tool for this study was granted by Jones and Bellomo . For this study the tool was referred to as

Nurses Attitudes to Rapid Response Team Survey(NARRTS)

Demographic data sheet Reliability of NAMETS face

validity Reliability of NARRTS α

= .60

Paper survey Descriptive statistics

employing frequencies and percentages was used to answer the research questions.

Data collection & analysis

Characteristics of the sample

A total of 140 of the surveys werereturned.

At the time of the survey 266 nurses were employed at the hospital

196 questionnaires were distributed to nurses on day, evening and night shifts74% of the accessible

target population were surveyed

Overall response rate was

71%a

b

c

d

e

Age of respondents

Gender Race/Ethnicity Employmentstatus

Yrs nursing

practice

Years worked at IMVH

Youngest respondent was

24 years old

Male

13 (9%)

African-American/Black

63 (46%)

Full time91 (66%)

1-5 yrs24%

1-5yrs85 (62%)

Oldest respondent was

65 years old

Female

126 (91%)

Asian/Pacific Islander18 (13%)

Part time21 (15%)

6-10yrs21%

6-10 yrs38 (28%)

Mean age of the sample was 43

yrs

Caucasian/White47 (34%)

PRN27 (19%)

11-15yrs16%

Over 10yrs14 (10%)

Hispanic/ Latino2 (1%)

16-20yrs18%

Other8 (6%)

21-30yrs15%

31-47 yrs7%

Sample Matrix

Level of education

Work shift Specialty of practice

Have you ever called the RRT to manage a patient in your

care?

Diploma

10 (7%)

Day shift

71 (52%)

Psychiatry

15 (11%)Yes = 112 (84%)

Associate Degree

59 (42%)

Night shift

65 (47%)

Oncology

12 (9%)No = 22 (16%)

Baccalaureate

Degree

62 (45%)

Orthopedics

17 (13%)

Masters in nursing

6 (4%)

Medical/surgical

31 (23%)

Other

7 (1%)

Telemetry

27 (20%)

Rehabilitation

32 (24%)

Sample Matrix

MAJOR FINDINGS

In all, 96% of the respondents agreed or strongly agreed that patients in the

hospital have complex medical

problems.

Perception of nurses about patients in the hospital

Nurses understanding of the potential benefits of the RRT

95% of the nurses agreed or strongly agreed that RRT prevents unwell

patients from having an arrest.

90% of the nurses agreed or strongly

agreed that the RRT can be used to prevent a minor problem from

becoming a major problem.

96% of the nurses agreed or strongly agreed that RRT allowed them to seek help in managing a patient they are worried about

89% of the nurses disagreed or strongly disagreed when asked if they thought that the RRT is not helpful in managing sick patients.72% disagreed or strongly disagreed when asked if they thought that the RRT was overused in the management of hospital patients.

Usefulness of the RRT for the nursing staff

When asked if they were reluctant to make a RRT call on a patient for fear of criticism if the pt was not that unwell, 82% disagreed or strongly disagreed, only 13% agreed.94% of the nurses strongly disagreed or disagreed when questioned whether they do not like making RRT calls because they will be criticized for not looking after their patients well.

86% disagreed or strongly disagreed that using the RRT system increases their workload when caring for sick patients.

Obstacles to the nurses using the RRT service

52% of the nurses agreed or strongly

agreed that they would call the house doctor

before the RRT when one of their pt was sick. 28% disagreed and 20% were

unsure.

67% strongly agreed or agreed that they would

call the RRT if they could not contact the house

doctor about a sick patients.

Under what conditions do nurses make or not make RRT call?

74% agreed or strongly agreed that they would make a RRT call on a pt they were worried about even if their vital signs

were normal.

When asked if they would not make a RRT

call on a pt who fulfilled the RRT criteria but did not look unwell, 81% strongly disagreed or disagreed,13% were

unsure, and 6% agreed.

Under what conditions do nurses make or not make RRT call?

Almost 96% of the nurses disagreed or strongly disagreed about whether they

thought the RRT reduced their skills in

managing sick patients.

68% agreed or strongly agreed that

the RRT teaches them how to better manage sick patients in their

care.

Effect of nurses ability to manage sick patients well

The researchers found that:

Most respondents indicated that

they value the RRT service.

RRT was useful in the management

of hospital pts

RRT was not overused in the management of

hospital pts

Nurses in this hospital value the

use of clinical judge in decision

making.

Regardless, 52% of the nurses still said they would call the house doctor before

calling RRT for a sick pt.

Conclusion

Thank You

Questions?