Have you implemented family-initiated rapid response in your maternal-child setting? This is an innovation now reported in newspapers and Internet stories, and nurses on more than one discussion list have shared thoughts, experiences, and strategies on this hot topic. A rapid response team is a trained group of clinicians called to stabilize a patient whose condition is deteriorating. The team typically is called by staff members and arrives at the patient bedside within minutes. Team members could include a physician, nurse, respiratory therapist, anesthesiologist, pharmacist, an administrative nursing coordinator, and a hospital manager with authority to transfer patients. Teams may be known by different names including Condition Help, Code H, Code Care, or Medical Emergency Team. We all know about these teams from our work, but the difference in a Family-Initiated Rapid Response team is that it is the family who calls for the team to attend to their family member.

Some nurses have posted concerns that family members cannot appropriately judge what is an emergency, would make unnecessary calls, and would drain critical resources. However, these concerns were answered with reports from other nurses that families did not abuse the emergency team resource, and that only a few calls were received from families each month. Some nurses reported performance evaluation results indicting that the majority of the calls would have led to potentially harmful patient situations if the team had not been called. One nurse asked, "If families are able to call 911 from their home, why is this control taken away from them when they are hospitalized?"

Nurses on discussion lists promote family calls as a "safety net" for patients and describe how current patient safety initiatives include encouraging the patient and family to seek assistance when conditions worsen. The family knows the patient best and may be the first to sense that something doesn't seem right. Family-initiated rapid response can also contribute to risk management, since ignoring family concerns can be the root of litigation.

Family Preparation

Preparation is key to the smooth operation of this initiative. The patient and family should receive information about how to contact the staff if the mother/baby/ or child's condition worsens, or if the family feels staff is not responding to the patient's condition. Information may be verbal or written and should be given upon admission (labor and delivery), and should emphasize that the team is for emergencies only. Evidence of instruction should be documented in the medical record. The emergency number might be placed on a telephone sticker, wall poster, or brochure. Nurses instruct the family member to contact their nurse first before calling the whole team.

Implementation Resources

Online resources can help nurses who want to implement family-initiated calls. The Institute for Healthcare Improvement site (2008) has a how-to guide for pediatric teams, references and tools for implementation and process measurement, slide presentations, parent brochures, and a guide for rural settings. The Josie King Foundation site (2007) details the development of Condition Help at the University of Pittsburgh and provides sample announcement, education, and training documents to download. The Josie King site also describes the pediatric rapid response team at Johns Hopkins Children's Center. The Robert Wood Johnson Foundation site (2008) describes the team implemented at Pittsburgh, provides downloads and a list of "lessons learned." The site describes projects at nine organizations that were awarded grants to increase the adoption of rapid response teams.

Use these resources to implement family activated teams in maternal-child settings. Evaluate your processes and publish an article to share your findings with your colleagues!!

References