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

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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