When seconds matter: Rapid response teams and nurse decision making

Perceived Barriers to Rapid Response Team Activation Among Nurses

The purpose of this literature review was to investigate the major barriers nurses face when it is necessary to seek additional assistance and resources by calling the rapid response team (RRT) in order to manage and stabilize a clinically deteriorating patient. A total of 40 articles were reviewed. Eight barriers were identified as having an impact on RRT activation, either causing a delay in activation time or preventing activation altogether: a lack of consistent RRT education among nurses, the established hierarchy in the hospital, an uncertainty about when to call the RRT if clinical deterioration is subtle or gradual rather than abrupt, a perceived need to justify a decision to call the RRT, the increased workload for both the ICU nurse and the medical-surgical nurse, negative past experiences with RRTs, an unsupportive unit culture, and less nursing experience. Suggestions for overcoming these barriers include RRT education for nurses and physicians in addition to fostering a supportive unit culture.

Accuracy of Defining Characteristics for Nursing Diagnoses Related to Patients with Respiratory Deterioration

PURPOSE

To evaluate accuracy of defining characteristics (DCs) for impaired gas exchange (IGE), impaired spontaneous ventilation (ISV), and ineffective breathing pattern (IBP) in respiratory deterioration.

METHODS

This study is a retrospective analysis of medical records. The accuracy and predictive ability of DC or of clusters are calculated.

FINDINGS

In this study, 391 records were evaluated. For IGE, DCs or clusters with higher efficiency were "hypercapnia" (78%), "somnolence" (74.4%), and "hypercapnia + tachycardia" (88%); for ISV, the cluster with higher efficiency was "increased heart rate ± decrease in cooperation" (70.1%); and for IBP, no DC or cluster exceeded 70% efficiency. These were confirmed by logistic regression.

CONCLUSION

Few DCs had adequate efficiency for respiratory nursing diagnoses, while in some cases clusters accounted for higher efficiency.

IMPLICATIONS FOR NURSING PRACTICE

Clusters of DC may be relevant for respiratory diagnoses.