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

POSTER

Title Szuanne Milne, BSN, RN PURPOSE METHODS Better understand oncology nurses’ perceived barriers and facilitating factors for activating the Rapid Response Team (RRT) in order to improve patient outcomes. •Identify and explore barriers and facilitating factors for nurses to activate the RRT •Determine the top barriers and facilitating factors to activate the RRT at this oncology hospital •Disseminate the information in professional presentations to the hospital staff/management in the appropriate forums. Prepare and submit an abstract for a poster presentation. •Results can guide hospital administration and staff to AIMS plan education, identify points to communicate to physician teams, revise processes, increase resources, and improve patient safety. •. • Conducted interviews with 12 nurses, four nurses from RESULTS: three different inpatient units (except the ICU) to determine hospital specific barriers and facilitating factors as well as attitudes, culture, and common practices. • Developed a questionnaire based on interview information and current literature. • Disseminated questionnaire to inpatient nursing staff • Presented results to hospital staff and management. • Recommended changes to policies, culture, resources, and training based on results. Top 5 Barriers 1.Uncertain if patient meets criteria; don’t want to look dumb 2.Call other nurses to assess patient first 3.Worrying about how the primary team will respond 4.Having to justify the call, particularly to the primary team 5.Should call the primary team first T 1. 2. 3. 4. 5. Top 5 Facilitating Factors More experience and knowledge at the bedside Patients get the care they need RRTs prevent patients from coding Primary team is not listening to me More people/hands to help deal with the situation PROCEDURES BACKGROUND • The Institute for Healthcare Improvement introduced the idea of rapid response teams (RRTs) in 2004 to quickly mobilize critical expertise and interventions to the bedside as soon as signs of patient deterioration are recognized. • In 2008, The Joint Commission determined that RRTs should be part of hospital accreditation criteria. • Researchers report that the use of RRTs reduces the number of in-hospital cardiopulmonary arrests and decreases in-hospital mortality. • Signs of deterioration occur several hours before cardiac arrest - median time 6 hours • Nurses hesitate to call RRTs for many reasons, and at this oncology hospital, some RRTs are turning into codes because of the delay in activating the RRT. Quotes “Quickest way to get our patients what they need. Can be life saving” “Don’t want attending to get mad” “Gets lots of people there quickly and lots of brains thinking about what’s going on” “Don’t want to look dumb” “Call RRT especially when a provider won’t listen to you” CONCLUSIONS/IMPLICATIONS • Overwhelmingly, nurses hesitate to call RRTs for many reasons • Newer nurses hesitate more than experiences nurses • Provider teams present the most barriers • Additional education and training would help nurses feel more comfortable when to call a RRT • Surgery teams are harder to reach, particularly on nights and weekends • Nurses don’t always trust that moonlighters have enough experience with oncology patients • Communication and role definitions during RRTs needs to be improved • MEWs alerts help make patients safer, but they are often snoozed and ignored • Nurses think RRTs are very important, and they keep patients safe • This oncology hospital has many areas of focus to improve RRTs: RN training and education, provider responses, improved communication during RRTs, additional resources. • The RRT at this oncology hospital are a valued tool. Acknowledgments: Project Chair: Gillian Tufts, DNP Content Experts: Alexa Doig, PhD and Kencee Graves, MD