Marie Segars, Senior Vice President and Administrator for McLeod Regional Medical Center, spent a day shadowing one of our new developments with the Rapid Response Team. I thought her insights into our work … and what she learned directly from our staff … was helpful to our overall efforts to improve patient care. It will give you a glimpse into the work of the Rapid Response Team and the difference this is making in patient care.
Often, the most discerning views are those observed from ‘the-outside-looking-in.’ That is one of the benefits of the clinical support to patients and staff from the Rapid Response Teams.
‘Roving’ … to find potential issues in a pro-active mode … is a new component of the Rapid Response Team. The ‘rover program’ is a collaborative approach to identifying and managing at-risk patients in our medical center. The nurses who do this work are affectionately called ‘Rovers.’ Recently, I had the privilege to shadow one of these team members. It was an extremely rewarding experience to witness this impressive patient care in action.
Deanna Tedder, RN, with our Trauma Surgical Care Unit, allowed me to follow her for the day. She is a member of the McLeod Rapid Response Team with other ICU trained nurses. This concept of the ‘rover’ was initiated at McLeod more than a year ago in order to improve the care of patients who may be at risk for clinical deterioration. The RNs on the team ‘rove’ the hospital to work with the patient’s nurse to assess and identify patients at risk for changes in conditions. The ‘roving’ nurse is also able to respond to a call for the Rapid Response Team. The ‘roving’ work is based on patient criteria developed from our McLeod experience, as well as the medical literature.
Deanna Tedder, RN (at center) and Amanda Carter, RN (right) review Rapid Response Team progress notes with Marie Segars, Adminstrator of McLeod Regional Medical Center, who shadowed with the staff for the day.
The ‘roving’ nurse works with the patient’s nurse to review the clinical data, evaluate the patient, provide a critical care perspective, and coordinate transfers to ICU, if needed. This is a pro-active approach to identifying patients who might be at risk for complications like:
-Patients just transferring out of any ICU;
-Patients on pain therapy, using Pain Controlled Analgesia (PCA);
-Any patient that the nurse is concerned about;
-Patients with heart rhythm changes as observed on telemetry; and
-Patients on the SAS protocol for Alcohol Withdrawal
We began our day together with routine visits to see patients and their nurse. Some of the day is detailed below:
-A post-operative patient with a pain pump did not look comfortable. Deanna Tedder assessed the patient’s pain and reviewed the plans for care. The patient’s breathing appeared to be more shallow than desired. Deanna conferred with the patient’s nurse and through this interaction and collaboration, an adjustment was made to improve the patients oxygen saturation.
-A patient, withdrawing from chemical dependency, was observed by the nurse who was concerned for the patient’s overall health. The nurse discussed her concerns with Deanna and they agreed the patient was in need of new treatments. A review of this treatment resulted in calling on the doctor for new orders.
-Then, we were interrupted by a phone call for the Rapid Response Team. Making our way from the McLeod Pavilion, 9th floor, we traveled to 4E, in the McLeod Tower. A large patient was having a life threatening irregular heart rhythm. Fortunately, he was better, but his physician was notified. Deanna and the patient’s nurse talked about their plan should the patient have these irregularities again.
-We left 4E and went to see a patient on 7E in the McLeod Tower. This patient was transferred from the ICU in the prior 8 hours. Although there were no problems, the family thanked us for checking on the patient and being attentive to their needs. Then, we were called back by 4E, the patient with the arrhythmia was in need of another review. Deanna spoke to the patient’s physician about the urgent need for a response. The nurse on 4E was very busy on this day.
-While on 4E, the phone rang again with another call for the Rapid Response Team. A patient on the 9th floor was experiencing severe chest pain. As we entered the next patient’s room, she looked very sick, her pain was at a 9 to 10 level, and nitroglycerin had already been given. The nurses on 9th floor were already on top of the situation, and Mary Allred, RN, was responding to the patient’s needs — with a heart monitor. Deanna, the ‘roving’ nurse ordered an EKG and some oxygen in accordance with her protocols. Deanna assessed and administered a second nitroglycerin. Deanna checked the patient’s oxygen saturation, and called the physician who was caring for the patient. Deanna noted the patient had an order for a blood transfusion and suggested to Mary to go ahead with the transfusion. This action would help improve the patient’s oxygen level. After conferring with the physician and the cardiologist, the patient was moved to the intensive care unit.
In all these interactions and others I observed throughout the day, Deanna Tedder was very respectful with other staff, recognizing the daily challenges and complexity in caring for the individual needs of each patient. Deanna worked on one of our Medical & Surgical Nursing Units before going to work on the Trauma Surgical Care Unit. Deanna told me that she feels this ‘roving’ experience has also helped her to understand the best ways she can be helpful to the nurse taking care of the patient when on a call for the Rapid Response Team. Our nursing staff welcomed ‘the additional set of eyes and hands’ that Deanna offered during the day. Together, they embraced our responsibility of providing the best care possible for patients. It was a busy day and one that served as a reminder to me of the extraordinary talent of our McLeod caregivers. It was reassuring to see in action the truly lifesaving teamwork. My gratitude goes to Deanna for being such a great teacher for me and a really good sport for allowing me to tag along and learn.
We continue to remain optimistic about the overall improvement in outcomes for patients and families as the Rapid Response Team assists our nurses in patient care. We appreciate all the work that is done each day to make care safer and more effective. I appreciate Marie’s ‘hands on’ approach to learn about ways in which we can improve our service as leaders. Understanding the daily needs better can assist leaders in removing obstacles in the efficiency and effectiveness of our work processes.