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Friday, December 28, 2007

Rapid Response Teams are awesome

I thinkRapid Response Teams are really cool.

I can't even count how many times I've had a patient who doesn't look good to me or the nurses, only for the nurse to call the doctor and the doctor say, "Mumble, mumble, mumble... Give 20 of Lasix, mumble, mumble, mumble."


That's okay sometimes, but I know there have been many times we've stressed out the rest of the night about the patient, especially if the lasix didn't work. Sometimes these patients end up in the CCU and we saw it coming.

Now if a patient doesn't look good the nurse pages the RRT and an RT, a CCU nurse and the RN supervisor go STAT to the patient's room. We assess the patient and perform procedures and tests we feel are appropriate.

Tonight I had such a call. The patient was sitting on the edge of the bed, arms spread across the bedside table, paradoxically breathing. I arrived and took charge.

"It looks like she's wet." I said before I even assessed the patient. After doing this job for so many years you become good at observations. However, a full assessment would be needed.

"That's what I was thinking." The nurse, Abba, was setting the pulse ox probe on the patient's finger. The sat read 86%. "Her blood pressure is also way high."

Peering up at the monitor, the BP read 192/124. I reached for my handy dandy stethescope and took a quick listen. Happy, the nurses supervisor, and a second nurse arrived and were now standing by my side.

"What do you think? Wet?" Abba asked. She was a good nurse. I had her trained well. A less worthy nurse would have said, "We need a treatment," without further assessment. This was working out just perfect. The way it should be done.

"Yep." I said.

"I think we should do an EKG, ABG and perhaps a treatment." Wow. It feels good using my brain.. A rush of joy filled my veins. Man, it feels so good to use my skills..

I paused a moment. I looked at the patient. Her head was now bowed between her arms so the back of her head stared at the ceiling. It's a miserable feeling not being able to breath. I understood completely.

I paused, however, because I wanted to make sure I wasn't overstepping my bounds. I didn't want to do a bunch of procedures that were not necessary. Rather, I didn't want the nurses in the room to think I was on a power trip like the Air-Flight nurse the other night. I looked at Happy. "Do you agree?"

"Oh, definitely," she said.

As per protocol, the doctor was called before the tests were completed. As I arrived back at the nurses station after running my ABG, the nurse set the phone on the receiver and peered over at me. "He said, 'Mumble, mumble, mumble, give her 20 of Lasix, mumble, mumble, mumble.'"

"As expected," I said, smiling.

"I told him that we did the treatment and the ABG, and he slammed the phone in my ear." She smiled as though she had expected as much. "I guess he doesn't care. So I'll write the order for those."

I said, "Hey, that's fine, because at least now we don't have to stress out about not knowing what her status is. We got all the test results done before the doctor was called. How many times do you sit and worry about a patient the doctor appears not to care about?"

"Not any more," she said, " But I'm glad we did the EKG at least, because her blood pressure is still in the 190s. He didn't seem to care at all about that. And I told him we did the ABGs and he still hung up the phone in my ear. It was almost as though he was annoyed that I even called."

"Well, perhaps we overstepped our bounds a bit. But I think it's great that we have this team. And I think we should always call the RRT before the doctor is called on these patients so we can do the tests we think are needed that the doctor won't order."

"I absolutely agree. I mean, we are the ones at the patient's bedside. We see right up close how the patient is doing, how she feels. The doctor just wants to get off the phone so he can get back to bed."

"Well, to be fair not all doctors are like that, but that one is."

I checked on the patient. She was snuggled under the blankets and the head of the bed was all the way down, a sure sign she was fine now. Despite that, I said, "Mrs. Beer, are you feeling better."

She nodded, turned to look at me, "Yes."

"Did the treatment work for you?"

"Yeah, I'm still a little short of breath, but I feel much more comfortable."

I know you guys are saying: "Why the hell did you give the breathing treatment when you figured the patient was wet? If a doctor did that you'd complain about it."

True. But sometimes pulmonary edema can cause bronchospasm, and sometimes a treatment can help treat that symptom. What I hate is when the treatment is ordered Q4 after the fact, when they are no longer needed. I have no problem trying one treatment.

I checked on her a few times the rest of the noc shift and she was sleeping comfortably each time, which meant the doctor was right on this one.

The patient gave us no further trouble, which was a good thing, because a half hour after I was finished with her, "SIGNAL ONE in CCU!" railed across the overhead speakers.

It was one busy night. But one in which I used my skills. It was awesome.


The Anonymous Therapist said...

I love the Rapid Response Team. When I worked at a hospital in Massachusetts, we used to have one and I'd often go to the RRTs because they were interesting. Where I work now we have the "CCAT," the Critical Care Assessment Team. I don't get to go on the CCAT calls (that's a charge responsibility,) but I do like having the team because it really cuts down on the number of codes and adverse events.

mielikki said...

we have a rapid response team at my little hospital, too, I am on it. I love it as well. We have specific protocols where we have the orders we need, no doc has to order them for us (just routine stuff). Then, we call the MD and tell them our discoveries. So far, it's been working well.