Proactive assessment and planning to address worry improves rapid response activation for nurses

Introduction: Identification of patients in crisis and early activation of the Rapid Response Team (RRT) can improve patient outcomes. However, if knowledge gaps exist related to activation triggers or recognizing subtle physiological changes in patients, nurses may not activate the RRT reliably, even if they are worried. We sought to understand, if a proactive, relationship-based approach could increase the RRT activation rate. Methods: This practice-focused project implemented RRT+, a proactive safety practice, designed to support the psychological safety of bedside nurses, and increase the number of adult RRT activations. RRT nurses proactively sought out patients at risk for deterioration, provided education to nurses about signs of deterioration, created a safety plan, then followed up at two and four-hour intervals. Combined, these four elements were predicted to raise the intentions and change behavior of nurses to activate the RRT. Multiple process and outcome measures were recorded and evaluated at 3 and 6-month intervals using a mixed-methods approach. RRT activations were evaluated for magnitude of effect and statistical significance, while qualitative survey and focus group data were evaluated for clinical significance. This project was monitored continuously for unintended adverse events. Results: A statistically significant increase in RRT activations was observed. For the initial three-months, RRT activations expected were (x ̅) ± (SD) x ̅=14.92 ± (7.83) and observed x ̅=21.80 ± (11.82); a 46.1% increase. A large and statistically significant effect was observed at the three-month interval d=0.943; t (df) = -4.18 (4), p = 0.013 (two tailed), and six-month d=.885, -2.86 (4), p=0.045 intervals compared to baseline. Testimony from stakeholders was positive, RRT responders had a favorable view of RRT+ “I like it, nurses are asking us questions because we’re approaching them… it’s having an impact on RRT activation.” Conclusions: This project shifted a reactive RRT model into an effective proactive model, aimed at improving patient care. Point-of-care education and safety planning helped bedside nurses better respond to patient deterioration and seek help. RRT+ elements to address worry, focused education, and proactive safety planning are sustainable practices and transferrable to most settings.