Activating the Rapid Response Team: Barriers and Facilitating Factors for Oncology Nurses

The Institute for Healthcare Improvement introduced the idea of a rapid response team (RRT) in 2004. The goal was to quickly mobilize critical expertise and intervention to the bedside as soon as signs of patient deterioration are noted. If the RRT is called, patients can receive appropriate interventions and/or be transferred to the intensive care unit (ICU) more rapidly. Nurses often hesitate to call the RRT due to cultural behaviors and attitudes or because of prior experiences. Barriers can place patients at risk for increased cardiopulmonary arrest and increased mortality. The success of the RRT has been studied over the past 10 to 15 years with mixed results. However, researchers in recent studies report RRT alerts do reduce the number of in-hospital cardiopulmonary arrests and improve in-hospital patient mortality. Signs of deterioration occur up to six hours before cardiac arrest. The primary nurse is generally responsible for calling the RRT when worried about a patient and believes more resources and expertise are needed. Nurses that report barriers, such as feeling criticized by physicians or RRT members, hesitate to call the RRT again. Nurses that have positive experiences with the RRT are more likely to call again. The purpose of this Doctor of Nursing Practice (DNP) project was to better understand oncology nurses' perceived barriers and facilitating factors for activating the RRT. The objectives of the project included 1) to identify and explore barriers and factors that facilitate nurses calling a RRT alert 2) determine the top barriers and facilitating factors to calling the RRT at this oncology hospital and 3) to disseminate the information in a professional presentation to the inpatient medical directors and unit nursing managers and to submit an abstract for a poster presentation. Interviews with nurses from three inpatient units were conducted to understand their experiences with the RRT at an academic oncology hospital. Based on the information obtained from the interviews, a questionnaire was developed and sent to all the inpatient nurses, except ICU nurses. Evaluations of the project were based on completing the interviews and sending the questionnaire. The results were shared with the hospital administration and staff and an abstract was submitted for a poster presentation. Results from both the interviews and questionnaire indicated that the RRT experience is generally positive, particularly with regards to the RRT team members themselves. The main barriers are nurses not being certain if patients meet criteria and being concerned about provider responses. Inadequate night and weekend coverage was also a concern. Facilitating factors included nurses getting critical care expertise and needed skills to the bedside quickly. Understanding these barriers and facilitating factors can guide the hospital administration and management to change or implement processes, policies, system resources, and training to ensure the RRT is being called when appropriate.