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Ensuring Rapid Response Team Care Aligns With Patients' Limitations of Medical Therapy: A Quality Improvement Project
Nicolette C Mininni1, Kimberly Whiteman, Kimberly Stephens
1University of Pittsburg Medical Center (UPMC) Shadyside, Pittsburgh, Pennsylvania (Drs Mininni and George); and Waynesburg University, Waynesburg, Pennsylvania (Drs Whiteman, Stephens, and Swanson-Biearman).
Background:
Rapid response teams (RRTs) are designed to improve patient care during deterioration in clinical condition.
Local Problem:
Patients' desired limitations of medical therapy (LOMTs) were not documented or communicated to the RRT, and patients received care not aligned with their wishes.
Methods:
A multidisciplinary team developed a process for improving documentation, communication of LOMTs, and care delivery on 3 medical cardiology units. The team implemented 3 Plan-Do-Study-Act (PDSA) cycles over 6 months.
Interventions:
In cycle 1, team members taught the unit nurses, RRT members, and physicians to share LOMTs during handoff communications. Cycle 2 engaged case managers in LOMT documentation. In cycle 3, unit-based RRT simulation was conducted.
Results:
All care delivered by the RRT aligned with the documented LOMTs. Documentation of LOMTs increased from 76% to 82.5% ( P = .014).
Conclusions:
Education, scripting, and simulation were successful strategies to ensure that care given during RRT events aligned with patients' wishes.
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