Nurse practitioners take part in a rapid response simulation in the Center for Experiential Learning and Assessment. (Photo by April Kapu)
Nurse practitioners added to rapid response units
“Typically, rapid response teams include a charge nurse and a respiratory therapist, but due to growing patient needs, VUH wanted to add a provider to the team,” said April Kapu, MSN, R.N., assistant director Advanced Practice Critical Care for Vanderbilt University Hospital. “Nurse Practitioners were the first thought, because they are so flexible.”
Before the pilot launched, the nurse practitioners were put through simulation training in the Center for Experiential Learning and Assessment, led by Art Wheeler, M.D., associate professor, Allergy/Pulmonary and Critical Care Medical Division. Five simulation days with 90-minute sessions addressed many of the typical scenarios played out in real life every day at the Medical Center. The providers would participate in the various scenarios, followed by a debriefing to break down each individual response and component of care.
Starting in January, nurse practitioners from the Surgical Intensive Care Unit were added to rapid response teams on surgical floors such as 9 North and 9 South and nurse practitioners from the Medical Intensive Care Unit were added to the medicine floors such as 8 North and 8 South. The Neurology Care Unit has started to send their nurse practitioners to all stroke alert calls, a specialty-focused rapid response, and the Cardiovascular unit will start sending nurse practitioners to the Cardiac floors in the upcoming months.
It's been busy, with hundreds of rapid response calls each month.
Part of what makes the rapid response teams more effective is the Medical Center-wide initiative to detect the early warning signs for urgent patient needs, such as labored breathing, hypotension and heart rate increase or decrease. The bedside nurse, family members, or anyone else who sees an early warning sign or something that doesn't seem right is encouraged to call 1-1111.
The call connects to LifeFlight, which dispatches the rapid response team and alerts the primary physician. The rapid response team arrives on the scene within five minutes.
“Nurse practitioners on rapid response teams help to decrease the time between symptom onset and early management. They evaluate, diagnose and initiate early management and facilitate rapid transfer to the ICU when necessary,” said Kapu.
Sometimes the patient stays on the floor, sometimes the patient is taken to an Intensive Care Unit because there is more to be investigated, and sometimes the call is handled with education and communication with patients and family members.
“It is gratifying to see us meet an important need by testing out this new structure,” said Wheeler. “I know first-hand that these enhanced rapid response teams are saving lives.”
The nurse practitioners are also collecting data on each rapid response call to evaluate the interventions. The nurse practitioner team in the Medical Intensive Care Unit recently published an article in Hospital Practice Quarterly Journal about the evolution of their nurse practitioner-led rapid response team and best practices.