Investigating Nurses' Decision Making in Activating the Rapid Response Team

Abstract

Background: Patients experiencing cardiac arrest in hospitals often exhibit signs and symptoms of deterioration for hours leading up to the event (Franklin & Matthew, 1994; Schein, Hazday, Pena, Ruben, & Sprung, 1990). This issue has led to a focus on intervening before patients succumb to this event, and the creation of rapid response teams (RRTs) or medical emergency teams (METs) (Solomon, Corwin, Barclay, Quddusi, & Dannenberg, 2016). These teams have been recognized to produce significant reductions in both hospital mortality and in-hospital cardiac arrest (Solomon et al., 2016). However, RRTs are only effectual if there is recognition of patient need and activation of the RRT (Jackson, 2017). This knowledge makes it significant to investigate the factors and elements that are in involved in the decision making processes of nurses to activate the RRT. Purpose: To investigate nurses’ decision making processes in calling a rapid response, with the ultimate goal of increasing understanding and thus promoting better patient outcomes. Methods: This project used a descriptive design, enabling nurses to share their experiences with RRT activation. A convenience sample of 10 registered nurses from a Medical-Surgical Oncology unit, ranging in experience from advanced beginner to expert, was interviewed utilizing a semi-structured interview tool derived from cognitive work analysis and Benner’s theory of skill acquisition. Quantitative data were analyzed using descriptive statistics, while narrative data were analyzed through content analysis. Results: A variety of resources influenced nurses' decisions to activate the RRT, including education and dynamics with other staff. There were also a variety of tasks associated with justifying an RRT activation, including patient assessment and implementing associated interventions. Nurses also described strategies they utilize before activating the RRT, including seeking out assistance from other members of the team and activating a “code blue.” The social system was also identified as a factor affecting RRT activation, although there were varying opinions on the state of unit culture. Nurses also described cues leading them to RRT activation, which was most commonly an abrupt change in patient condition. Nurses also described RRTs as highly beneficial for their patients, despite some identified challenges or negative aspects of RRT activation. Discussion: The results of this project were consistent with the literature surrounding decision making to activate the RRT. This project’s findings also indicate the need for further education in regards to RRT activation, including training on activation criteria, barriers to activation, and improving communication among team members. Future work to increase understanding of appropriate RRT activation may lead to timely RRT activations and better patient outcomes.