Compliance with Rapid Response Follow Up at Stafford Hospital
Bibiana Cloonan BSN RN CCRN - SH Intensive Care Unit
The Stafford Medical Surgical Emergency Response RNs fill a unique role
wherein they serve not only as ICU caregiver, charge nurse but also as
a member of the MSET team. Being able to do two follow ups at 4 and 8
hours post call at Stafford Hospital was proving to be difficult (MWH
MSET RNs out of staffing and complete two follow ups post MSET call).
After researching more about patient deterioration following MSET in cases
when the patient wasn’t transferred to an ICU, I discovered that
the more appropriate window to follow up is within within 6 hours.
In collaboration with Debra Marinara and David Squeglia, we adapted the
SH MSET/Rapid Response Policy to fit our hospital needs. After policy
change, I wanted to be able to see if this new policy was being complied
with specifically the 6 hour window and no longer than 8 hours.
After educating the ICU nurses at our monthly staff meeting, I developed
a performance improvement tool to collect data in March-August of 2013.
It was noted that there was poor compliance with appropriate documented
follow up. It was noted that our MSET RNs had a wide range in their ICU
experience levels some being just at 6 months in the ICU. Therefore I
was going to need to relook at education of ICU the staff. I adapted an
existing MSET CBL for new hires to focus on Stafford and included a post-test
to monitor understanding. In addition I developed a CBOT for MSET RNs
Over the next 6 months, there was a sustained improvement in follow up
and documentation of the follow up visit. I also developed an evaluation
form for the ICU RNs to be able to voice problems they encountered during
their MSET calls, i.e., no one present in patient room, no current vital
signs. Likewise, I also developed an evaluation form for the floor nurses
to communicate their issues with MSET visits. This information was discussed
at the SH MSET/Resuscitation meetings and helped guide our plans for better
communications between the ICU staff and the inpatient floor RNS.
The next steps in this project will be to look at patient outcomes post
MSET and resuscitation at my facility. We have already demonstrated a
reduction in patient code blues per patient days from 0.37% in 2013 to
0.16% in 2015. We will look at overall patient outcomes at time of discharge
and whether patients were readmitted within 30 days. MSET calls within
6 hours of ER admission are currently referred to the emergency department
manager for further review.