Room Service Resuscitation Sarah Webb @sarahbebewebb Nurse Practitioner, Intensive Care Unit Royal North Shore Hospital, Sydney, Australia MN (Nurse Practitioner), MN (ICU), Gdip (Midwifery), Gcert (ICU), Bach Nurs
Room Service Resuscitation
Sarah Webb@sarahbebewebb
Nurse Practitioner, Intensive Care Unit
Royal North Shore Hospital,
Sydney, Australia
MN (Nurse Practitioner), MN (ICU), Gdip (Midwifery), Gcert (ICU), Bach Nurs
CERS CNCDavid Wastell
RRT Clinical LeadProf Carole Foot
Resuscitation CNCSarah Webb
RRT Director
Dr Liz Hickson
11th February 2013
Critical Thinking
Protocols
Time Death
Pat
ien
tC
on
dit
ion
Early Warning
Signs
Late Warning
Signs
ALS
Prevention
Low systolic blood pressure
High systolic blood pressure
High heart rate
Low 02 saturations
Low respiratory rate
ALOC (Pain or Voice) Low heart rate
What we thought about RRT
What our ward colleagues thought of RRT
Your Logo
Staff deskilling• 95% strongly disagreed that the RRT caused deskilling• 91% disagree RRT calls are required because nursing staff have
mismanaged their patients
Patient Safety• 87% agreed RRT help teaches how to manage sick patients• 96% agreed the system allowed them to seek help when worried
Effective Teamwork• 96% agreed RRT encourage effective teamwork• 89% disagreed that they would be reluctant to call the RRT for fear of
being criticised
Intranet PagingEMR RR Form
CPA Form
Key
Performance
Indicators
Track and Trigger auditsSurveysResus Trolley TransitionREACHMedical ALS11 Met with MeritsState Innovation AwardTeam of the Year Award
Quality
14 Chapter Movie
Weekly RRT Teaching
Weekly mock events
93% education saturation
Education
2012-2013 2013-2014
Unexpected Cardiopulmonary Arrests(per 1000 separations)
0.8 1.1
Unplanned ICU Admissions(per 1000 separations)
0.6 0.8
Hospital Standardised Mortality Ratio 1.25 .95
Summary
References1 Jones DA, DeVita MA, Bellomo R. Rapid response teams. N Engl J Med 2011; 365: 139-146. 2 Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients — results from the Harvard Medical Practice Study I. N Engl J Med 1991; 324: 370-376. 3 Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471. 4 Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington, DC: National Academy Press, 2000. 5 Hillman K. The changing role of acute care hospitals. Med J Aust 1999; 170: 325-328. 6 Adhikari NKJ, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet 2010; 375: 1339-1346. 7 Donni-Lenhoff FG, Hedrick HL. Growth of specialization in graduate medical education. JAMA 2000; 284: 1284-1289. 8 Schein RM, Hazday N, Pena M, et al. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 1990; 98: 1388-1392. 9 Hillman KM, Bristow PJ, Chey T, et al. Antecedents to hospital deaths. Intern Med J 2001; 31: 343-348. 10 Hillman KM, Bristow PJ, Chey T, et al. Duration of life-threatening antecedents prior to intensive care admission. Intensive Care Med 2002; 28: 1629-1634. 11 Donaldson LJ, Panesar SS, Darzi A. Patient-safety-related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010–2012. PLoS Med 2014; 11: e1001667. 12 Hillman K, Chen J, Cretikos M, et al; MERIT Study Investigators. Introduction of the medical emergency team (MET) system: a clusterrandomised controlled trial. Lancet 2005; 365: 2091-
359.el-369.el. 15 Chen J, Ou L, Hollis SJ. How accurate are the diff erent predictive models in identifying deteriorating patients? The ViEWS may not be as clear as we fi rst thought. Crit Care Med 2014; 42: 986-987. 16 Gerdik C, Vallish RO, Miles K, et al. Successful implementation of a family and patient activated rapid response team in an adult level 1 trauma center. Resuscitation 2010; 81: 1676-1681. 17 Loekito E, Bailey J, Bellomo R, et al. Common laboratory tests predict imminent death in ward patients. Resuscitation 2013; 84: 280-285. 18 Esmonde L, McDonnell, Ball C, et al. Investigating the eff ectiveness of critical care outreach services: a systematic review. Intensive Care Med 2006; 32: 1713-1721. 19 Clinical Excellence Commission. Between the Flags project: the way forward. Sydney: CEC, 2008. http://www.cec.health.nsw.gov. au/__documents/programs/between-the-fl ags/2013/btf-the-wayforward-2008.pdf (accessed Jul 2014). 20 Chan PS, Jain R, Nallmothu BK, et al. Rapid response teams. A systematic review and meta-analysis. Arch Intern Med 2010; 170: 18-26. 21 Hillman KM. Run, don’t walk. Crit Care Med 2012; 40: 2712-2713. 22 Hillman K, Alexandrou E, Flabouris M, et al. Clinical outcome indicators in acute hospital medicine. Clin Intensive Care 2000; 11: 89-94. 23 Chen J, Bellomo R, Flabouris A, et al; MERIT Study Investigators for the Simpson Centre and the ANZICS Clinical Trials Group. The relationship between early emergency team calls and serious adverse events. Crit Care Med 2009; 37: 148-153. 24 Buist M, Bernard S, Nguyen TV, et al. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation 2004; 62: 137-141. 25 Bellomo R, Goldsmith D, Uchino S, et al. A prospective before-and-after trial of a medical emergency team. Med J Aust 2003; 179: 283-287. 26