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DUCS and RATS

DUCS and RATS. INTEGRIS Health. How Did We Get Here?. 70% arrests with evidence of respiratory/neurological deterioration within 8 hours (Schein, Chest 1990; 98: 1388-92)

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DUCS and RATS

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  1. DUCS and RATS INTEGRIS Health

  2. How Did We Get Here? • 70% arrests with evidence of respiratory/neurological deterioration within 8 hours (Schein, Chest 1990; 98: 1388-92) • 66% had abnormal signs and symptoms within 6 hours of arrest and MD notified in 25% of cases. (Franklin, Crit Care Med;1994; 22: 224-247)

  3. DUCS Criteria • Acute change in heart rate to <50 or >120 • Acute change in SBP <90mmHg • Acute change in respiratory rate <10 or > 30 • Acute change in Oxygen saturation <90% in despite oxygen therapy • Acute change in LOC • Acute change in urine output to <50ml in 4 hrs • “Gut feeling” something is wrong

  4. What do you do if you have a DUC? If your patient exhibits any of the previous signs and symptoms contact: Day shift: • The patient nurse or your Team Manager/Clinical Director Evenings, Nights, or Weekends: • The patient’s nurse or Team Manager/Administrative supervisor

  5. RATS • Rapid Assessment Team (RAT) - developed to prevent deaths in patients who are progressively failing outside the ICU • INTEGRIS believes healthcare providers should share their knowledge across departments to assist each other in meeting patient needs and improving outcomes.

  6. What Difference Can a Rat Make? • Literature Review: Other hospitals that have implemented such teams have reported: • 50% reduction in non-ICU arrests (Buist, BMJ 02) • 12-30% reduction in hospital mortality • 44% Reduction in post-op emergency ICU transfers • Improved staff satisfaction and recruitment with the presence of a support team • Improved patient satisfaction

  7. Goals of the Rapid Assessment team • Be a resource for support of staff nurses • Improved time to treatment • Improved communication between all of the patient’s care providers • Reduction of Code Blues and hospital mortality • Enhanced learning opportunities

  8. Who’s On the RAT Team? • At IBMC: • House Officer • Critical Care Registered Nurse-Code Blue Designated back-up RN • Registered Respiratory therapist

  9. At ISMC • House Officer or an Advanced Practice Nurse – CNS or ARNP • Critical Care Registered Nurse ICU Team Leader • Registered Respiratory therapist

  10. RAT Response • The advanced practice RN and the critical care RN will respond to assist the patient’s primary nurse in assessing the situation, determining nursing diagnosis, initiating appropriate protocols, and communicating with the physician. • The primary nurse in the lead nurse.

  11. RAT Duties • Obtain report from the patient’s primary nurse (including code status). • Evaluate patient. • Determine if situation is one of rapid decline or a stable problem. • Identify clinical problem – circulatory, respiratory, neurological. • Treat or transfer as indicated. • Implement RAT order sets.

  12. SMURFS( If All Else Fails) • Code Blue VS. “Dr. A” • A code blue will be called to summon adequate personnel and equipment for resuscitative efforts in all hospital areas. • A “DR. A” will be called to summon all members of the code blue team with the exception of the ACLS critical care nurses.

  13. Code Blue Team Members • House Physician • 2 Respiratory Therapists • ACLS Critical care RNs • Primary nurse of the Patient • Administrative supervisor • Pharmacist • Chaplain

  14. Prior to the Code Team Arrival • Determine Unresponsiveness • Start BLS • Call for help *911 • Get Crash cart • Place backboard under patient • Connect BVM to 100% oxygen and ventilate • Apply hands-free defib pads • Remove furniture from the room

  15. Prior to Code Team Arrival • If coding patient is in a semi-private room. Relocate the other patient to another room or stay with the other patient during the code. • Monitor for adequate pulse with compressions. • Move family to another area. • Analyze rhythm if AED available. Deliver shock if advised by AED. • Set up suction • Perform chest compressions

  16. Roles and Responsibilities • House Physician will assume charge • Primary nurse of the patient remains • Unit personnel will be relieved by code team to assume care of the other patients on the unit. • Clinical Director or Administrative Supervisor will arrange for critical care bed • Chaplain remains with the family to provide support.

  17. Roles and Responsibilities • Respiratory Therapists assume ventilations and assists physician with intubation. • Pharmacist pulls and assembles emergency medications, IV fluids, and other supplies as needed from crash cart

  18. The Moral of the Story • DUCS and RATS Keep away Smurfs

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