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Success –Development of Team Characteristics –Determination of Support Measures Preplanning • Action Plan – Development of processes • FMEA – Determination of process failures prior to implementation • PDSA – Maintenance of rapid cycle change Action Plan ITEM ACTION DUE DATE Presentation 1.Introduction of Plan to Resource staff 2, Introduction of Plan to Critical Care staff 3.Introduction of Plan to PCU staff 4. Presentation of action plan to monthly peer to peer MD meeting 11/14/05 By Dec staff mtg 11/28 11/17 Education 1.Develop scenarios for Resource staff 2. Develop scenarios for PCU staff 3.Train Resource staff 4.Train PCU staff 5. Training of Resp. staff 11/14/05 12/5/05 Week of 11/28 12/5-12/23 By 12/23 Data collection Development of data collection tool Data collection at time of RRT calls 11/28 ongoing Meet and Greet with RNs and MDs Meeting of staff involved with RRT Set up 12/20 Pre-Pilot Gear Up Week! Week of 1/2/06 Pilot Unit-PCU from 1/9/05 to 3/31/05 1/9/06 Key Elements • Communication – Staff – Ancillary Departments – Physicians – Hospital Management – Senior Management • GET THE WORD OUT THERE!!!!! Key Elements • Education – Critical Care Staff – Respiratory Therapists – Hospitalists – Pilot Unit – Senior Management – Physicians Education • Staff Pocket Cards Criteria for calling RRT -Acute change in heart rate < 40 or > 130 bpm. -Acute change in systolic BP < 90 or > 180mmHg. -Acute change in RR < 8 or > 28 per minutes. -Acute change in SaO2 < 90% despite oxygen. -Acute change in consciousness or cognition, or seizures. -Acute change in urine output < 50ml in 4 hours. -Staff is worried about the patient -> “They just don’t look right”. Expectations of Those Utilizing RRT -Be prepared to give concise information, with chart in hand. Including latest lab results. -Assuring emergency equipment and supplies are available. -Remaining present to assist RRT. -Contact primary physician. -Follow-up assessments, documentation, report to receiving nurse if patient is transferred. -“Never leave your wingman” To call RRT: Dial 8122 -> Give your unit and the phone extension to the patient’s room. Education • Role of the Respiratory Care Department on the RRT – Assess respiratory status and consult with other team members – Draw and analyze arterial blood sample as needed – Select device and apply/adjust oxygen therapy as needed – Administer one dose of albuterol vial medicated aerosol as indicated – Maintain patent airway as indicated (including ET intubation) – Provide assisted ventilation as needed Respiratory Therapist Attributes: – Demonstrated competency in critical respiratory care – Able to communicate effectively with other team members Education • SBAR – Purpose • What is it? – Consistent form of communication that enables the caregiver to provide clear concise information about the patient. – Expectation • When to use it? – During RRT – When giving report to next caregiver – When calling Physician Key Elements • Data Collection – Recognition of core measures – Development of additional measures – Development of Event Record – Development of Surveys • Data Assessment Evaluation of RRT calls Evaluation of codes Data Collection •Event Documentation Tool Date: December ’05 • Pilot-January-February ’06 • Data collection-outcomes to be measured and reported to staff on continuous basis • Revisions utilizing Rapid cycle change In Process • Delmarva collaborative – March 2006 – December 2006 – Learning sessions – List serves – Networking – Implementation of frequent team meetings In Process • Changes Implemented: – Addressed issue of designated RT. – Clarification of data collection. – Addition of Med/Surg nurse to collaborative team. – Increased education to MedSurg Staff. – Feedback from critical care, respiratory and floor staff. – Initiation of SBAR. Feedback • Surveys • Given to RRT RN and Staff RN at time of event • Respiratory Survey done randomly • Recognition • Saving Lives Report - # calls/unit • “Thank You for Helping Us to save ____lives this month by calling RRT” • Implementation of “Essential Piece” • Recruitment • Managers informing new candidates of