Purpose/Objectives:
The purpose of this evidence-based practice project was to improve patient outcomes through implementation of a rapid response team (RRT). A secondary goal was to affect organizational culture by enhancing the nurses' capability to intervene early, preventing crisis situations.
Significance:
Research indicates improved patient outcomes when complications are recognized early and interventions are quickly implemented to prevent cardiac arrest (Mailey et al, 2006). Nurse-led RRTs have become a standard of practice in many hospitals nationwide and are impacting mortality rates outside of the intensive care unit (Scholle and Mininni, 2006).
Design/Background/Rationale:
The Code Blue Nurse Consultation Model, the ACE Star Model of Knowledge Transformation, and Lewins' change theory provided theoretical framework. Targeted outcomes measured included (1) number of code blue calls, (2) number of RRT calls, (3) mortality rate per 1,000 discharges, and (4) patients who arrested but survived until discharge. Nursing staff knowledge transformation regarding activation and operation of RRT was measured using presurveys and postsurveys.
Methods/Description:
Hospital-wide training and education were implemented for staff nurses and the RRT, including criteria for calling the RRT, modified early warning scorecard, and situation background assessment recommendation communication systems. Team members attended a medical team management simulation exercise.
Findings/Outcomes:
This project measured outcomes over 2 quarters and compared these results with the same quarters from the previous year. The number of code blue calls outside of the intensive care units decreased to 6 per 1,000 discharges. The overall mortality rate remained constant at 22%. Unanticipated transfers from the medical-surgical units to the intensive care units were decreased by 10%.
Conclusions:
The RRT program proved successful in saving lives and in providing support for staff nurses and additional resources for physicians. The quality of rescue efforts relates to early identification and rapid intervention measures.
Implications for Practice:
The results denote a positive trend in decreasing early patient deterioration situations. Staff satisfaction improved significantly with a positive trend of improved nurse-to-nurse interactions.
Section Description
The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.
Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.
The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.