Qualitative exploration of nurses' decisions to activate rapid response teams

Astroth, Kim Schafer; Woith, Wendy M.; Stapleton, Stephen J.; Degitz, R. Joseph; Jenkins, Sheryl

doi:10.1111/jocn.12067

Cited by 82 publications

(241 citation statements)

References 28 publications

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“…This would result in MET calls in almost one out of five admitted patients. Moreover, research has shown that ward physicians prefer to be called first and nurses prefer to call the responsible ward physician, before calling the MET [9,33,41,43,44] , thereby involving ward physicians in the treatment of the patient at risk.…”

Section: Discussionmentioning

confidence: 99%

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Effect of implementation of a rapid response system on protocol adherence in a surgical ward

Simmes

Schoonhoven²,

Mintjes

et al. 2013

JHA

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Objective: To describe the implementation of a rapid response system and adherence to its afferent limb in order to identify key elements for improvement. Implementation:We developed a multifaceted implementation strategy to introduce the Rapid Response System (RRS) on a 60-bed surgical ward of a university hospital. The strategy included the use of clear objectives, key leaders, an early warning score (EWS) observation protocol and a two-tiered medical emergency team (MET) warning protocol, a 1-day training program including a before-after knowledge test, mandatory for nurses and optional for ward physicians, reminders and feedback. Study design and methods:We retrospectively analyzed a sample of 10,653 patient days and 101 medical records of patients with a serious adverse event (SAE). Outcome measures were EWS recording rates, the nurse to ward physician and the ward physician to the MET calling rates following abnormal EWS recordings, and the indicators triggering these calls.Results: EWS recordings were present in 90% of the day shifts, 88% of the evening shifts and 80% of the night shifts. EWSs were recorded at least once in 92/101 medical records in the three days before an SAE; in 91/101 records EWSs were abnormal at least once. In case of an abnormal score, the nurse called the ward physician once or more in 87% (79/91). After being called by the nurse, the ward physician called the MET once or more in 75% (59/79). However, in 18% (15/79) there was a delay of one or two days before the ward physician/MET was called. Overall, medical emergency team calls were absent or delayed in over 50%. Conclusions:After RRS implementation, recording of the EWS was high. Adequate warning in case of abnormal scores was suboptimal in nurses as well as ward physicians. Future implementation strategies should therefore be aimed at the interdisciplinary team.

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Section: Discussionmentioning

confidence: 99%

“…This implicates that training programs concerning critically ill patients should be team oriented and integrated in a broader safety intervention program [49] . In addition, support by management facilitates activation of rapid response teams [43] .…”

Section: Key Elements For Improvementmentioning

confidence: 99%

Effect of implementation of a rapid response system on protocol adherence in a surgical ward

Simmes

Schoonhoven²,

Mintjes

et al. 2013

JHA

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“…(26) In this context, the professionals' lack of training can generate fear in activations, as they feel embarrassed to show little knowledge of the critical situation and consider themselves unable to handoff the case of the patient to efferent teams. (27) Institutional culture, therefore, can adversely influence professionals towards not executing activations in the correct time and consequently causing delays and worse outcomes. (27) This finding was also observed in the study of Tirkkonen et al 2013, in which even with the identification …”

Section: Discussionmentioning

confidence: 99%

“…(27) Institutional culture, therefore, can adversely influence professionals towards not executing activations in the correct time and consequently causing delays and worse outcomes. (27) This finding was also observed in the study of Tirkkonen et al 2013, in which even with the identification …”

Section: Discussionmentioning

confidence: 99%

Rapid response team: what factors interfere with its performance

et al. 2018

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Objective. Describe the knowledge in the literature related to factors that influence the performance of response teams. Methods. Integrative review of the literature of articles published in Portuguese, English or Spanish between 2006 and 2016. The descriptors hospital rapid response equipment, cardiac arrest and hospital mortality were used for the search in the PubMed/ Medline, Lilacs -Bireme and CINAHL bibliographic databases. Results. 19 studies were included for the analysis. The results were categorized in: sociocultural barriers and institutional policies, late activation of the rapid response team, composition and/or strengthening of the team's capacity, and use of facilitating tools. The sociocultural barriers found were: the presence of interprofessional hierarchies and beliefs, the limitations of institutional policies were related to the lack of training and human resources deficit. Late activations increased mortality, duration of hospitalization, and admission Descriptors: hospital rapid response team; heart arrest; hospital mortality; critical care.Equipo de respuesta rápida: ¿qué factores interfieren con su desempeño?Objetivo. Describir el conocimiento en la literatura relacionado con factores que influyen en el desempeño de equipos de respuesta. Métodos. Revisión integradora de la literatura de artículos publicados en portugués, inglés o español entre 2006 a 2016. Se emplearon los descriptores hospital equipo de respuesta rápida, paro cardíaco y mortalidad hospitalaria para la búsqueda en las bases bibliográficas PubMed/Medline, Lilacs -Bireme y CINAHL. Resultados. Se incluyeron para el análisis 19 estudios. Los resultados se categorizaron en: barreras socioculturales y políticas institucionales; activación tardía del equipo de respuesta rápida; composición y/o fortalecimiento de la capacidad del equipo; y uso de herramientas facilitadoras. Las barreras socioculturales encontradas fueron: presencia de creencias y jerarquías interprofesionales. Las limitaciones de las políticas institucionales se relacionaron con la falta de capacitación y déficit de recurso humano. Las activaciones tardías aumentaron la mortalidad, la duración de la hospitalización y el ingreso del paciente a la unidad de cuidados intensivos. Los equipos compuestos por profesionales de cuidados intensivos mostraron una reducción en la mortalidad y en la ocurrencia de paro cardíaco. El uso de nuevas herramientas no promovió cambios en la respuesta del equipo. Conclusión. Los factores encontrados en esta revisión influyen en el desempeño del equipo de

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“…Conflicting conclusions exist related to activation barriers such as the impact of team support and attitude, impact on workload and human resources, hierarchy of activation, informal social rules, and influence of experience on activation. 19,[31][32][33][34][35][36] Although most studies have been conducted in academic medical centers, a small number of studies have taken place in community hospitals. The population most often studied is nurses working in a medical-surgical setting.…”

mentioning

confidence: 99%

Factors Influencing Registered Nurses’ Decision to Activate an Adult Rapid Response Team in a Community Hospital

Jackson¹,

Penprase²,

Grobbel³

2016

Dimensions of Critical Care Nursing

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Organizations should examine RRT activation delays particularly in the area of calls to covering physicians prior to RRT activations. Differences between specialty groups highlight the need for education across specialties on the recognition of the acutely deteriorating patient. The findings indicate that the inexperienced nurse requires support from experienced colleagues and temporary adjustments to workload during situations of acute deterioration of a patient.

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Qualitative exploration of nurses' decisions to activate rapid response teams

Abstract: Nurses can build upon knowledge of facilitators and barriers related to RRT characteristics and nursing unit culture.

Cited by 82 publications

References 28 publications

Effect of implementation of a rapid response system on protocol adherence in a surgical ward

Effect of implementation of a rapid response system on protocol adherence in a surgical ward

Rapid response team: what factors interfere with its performance

Factors Influencing Registered Nurses’ Decision to Activate an Adult Rapid Response Team in a Community Hospital

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