Identifying Early Warning Signs - PowerPoint Presentation

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Identifying Early Warning SignsMedical Emergency Team TrainingSlide2

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What is a MET Team?

Medical Emergency Team (MET) is a multidisciplinary team which purpose is to provide expert assessment, early intervention and stabilization of patients to prevent clinical deterioration or cardiopulmonary arrest.Slide3

Why do we need a MET Team?According to the Institute for Healthcare Improvement48% of all hospital deaths were “unexpected”All of the patients were admitted to non-ICU setting

When a MET team is implemented

Non-ICU arrests reduced by 50%

Mortality rates reduced by 37-50%

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Signs of Patient DeteriorationStudies show that 70% of patients show evidence of respiratory deterioration within 8 hours of arrest66% show abnormal vital signs within 6 hours of arrest and the MD was only notified 25% of the timeWhy does this happen?

Failure to adequately plan care

Assessments, goals, placement of the patient at the appropriate level of care

Failure to communicate

Patient to staff

Between healthcare providers

Failure to recognize patient deterioration

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What is the Role of the MET Team?The MET team is expected to:Respond to the location as soon as possible and should be at the bedside within 5 minutesPerform a thorough assessment to determine patient status

Assist with communication between nursing personnel and the MD using the SBAR format

Support and include the primary RN in all assessments and interventions performed so that he/she may increase his/her level of knowledge

Stabilize or assist with transfer of the patient

Document on the physician’s progress notes the reason and results for the consult, as well as in the nursing notes

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MET Team Responsibilities Per CHSB PolicyRespond to the MET call location

Perform a thorough assessmentConsult with the assigned nurse throughout the patient care process

Call the attending physician and make recommendations using SBAR

Document on Physician Progress Notes and Nurses Notes utilizing SBAR the reason for the call and the result

RT will perform a thorough respiratory assessment

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Criteria for Calling the MET at CHSBRespiratory distress, threatened airway, change in breathing patternAcute change in respiratory rate (less than 10 breaths/min or greater than 24 breaths/min)Acute change in blood pressure (systolic BP less than 90 mmHg)

Acute change in heart rate (less than 50 beats/min or greater than 120 beats/min)

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Criteria for Calling the MET at CHSB – cont’d

Decreased urine output (less than 50 ml in 4 hours - not on dialysis)

New, repeated, or prolonged seizures

Failure to respond to treatment

Staff “intuition” or concern

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Criteria For Calling Pediatric MET Response

Altered level of consciousness

Respiratory distress

New

onset of seizure

Other Pediatric Considerations

Children’s vital signs vary as the child matures

A single threshold for activation does not exist

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Composition of the CHSB MET team

ICCU Charge RN

Lead Respiratory Therapist

House Supervisor

ICCU Medical Director

Provide informational assistance

attendance not required

***Adult first responders include the ICU RN and

Resp

Therapist

***Pediatric first responders include ED RN and

Resp

Therapist

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Important MET team traitsMust be available to respond immediately when calledMust be onsite and accessibleMust have critical care skillsMust have good customer service skills

Respond with a smile

“Thank you for calling. How may I help you”

Staff must feel comfortable in order to call

If they feel ridiculed or condescended to they will be reluctant to call

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Important to RememberThe MET team does not work independently of the patient’s assigned nurse or physicianNo Pre-printed orders!ACLS Guidelines may be followed

Care should be taken to include both the patient’s nurse and the patient’s physician early and throughout the process of caring for the deteriorating patient

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Activating the MET TeamDue to the nature of the services, the MET Team will respond to all departments with the exception of the following:Pediatrics –

call ED RN (MET may be called for concerns regarding parent/visitor or other adult emergency

Couplet Care –

call L&D RN (L&D RN to assist MET Responders)

Children’s

Subacute

Center –

Call 911

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14Operator places an overhead page, “MET

TEAM TO FLOOR/UNIT ________”

Operator

activates pages

to

the following : ICCU Charge RN

,

Lead RT

, and House

Supervisor.

Staff Nurse Calls 1000

to request

the MET

Team and identify the location

Activating the MET Team –

cont’dSlide15

Perform a thorough assessment to determine the status of the patientA sepsis screening will be performed on all patientsIf patient screens positive for sepsis, lactic acid level and blood cultures are drawn

If patient screens positive for sepsis and has a systolic BP of <90 mmHg, the MET RN will administer a 20 ml/kg fluid bolus utilizing normal saline

The MET RN will contact the primary physician and inform him of the positive sepsis screen and obtain orders

Interventions by MET :

Registered Nurse

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Consider initiating a 500 ml normal saline bolus for patients with an SBP ≤70 mmHg with signs/symptoms of shock while awaiting physician call backEvaluate and assess the need to transfer to a higher level of care.In the event the physician cannot be reached, the MET team has the authority to move the patient to the appropriate level of care

Document on MET documentation for PI/review and fax to House Supervisor

Interventions by MET :

Registered Nurse –

cont’d

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Interventions by MET : Respiratory TherapistOxygen may be initiated for:

ALOC

Moderate to severe

dyspnea

Moderate cyanosis

Pallor

Moderate to severe hypotension

Aerosol bronchodilator therapy may be initiated as defined in RT protocol based on assessment

ABGs may be obtained to assess acid-base balance

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Bag-valve Mask ventilation may be initiated per assessed need:Respiratory InsufficiencyAlveolar HyperventilationSevere Respiratory Distress

Apnea

Interventions by MET :

Respiratory Therapist -

cont’d

Intubation may be done for:

Apnea

Severe Respiratory distress

Patient inability to maintain adequate oxygenation or ventilation

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Responsibility of the Patient’s NurseProvide the team with a status report upon team arrivalMake the medical record availableEnsure that any ordered therapy is available on the unit before calling the TeamAssist in transfer of the patient if required.

The accepting RN will check for IV patency or assist with establishing an IV site

Document in the Nursing Notes reason for MET call and patient’s response to the intervention

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MET Team Responders : What to AvoidMET Team responders should avoid “lateral violence” or “horizontal violence”Nurses who overtly or covertly direct their dissatisfaction toward each other, toward themselves, and/or toward those less powerfulConsidered behavior of an “oppressed population”

Lateral violence stops nurses from asking questions or seeking help when it is needed out of fear

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Examples of Lateral ViolenceNon-verbal innuendoRaising eyebrows, face-makingVerbal remarks

Snide comments, abrupt responses

Undermining

Turning away, ignoring questions

Scapegoating

Attributing patient condition to the nurse

Backstabbing

Complaining about the nurse to other individuals

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Avoiding Lateral ViolenceBe cooperative, despite feelings of dislikeDon’t denigrate co-workers to superiorsDon’t engage in negative conversations about co-workersDon’t criticize another nurse publicly

Look a co-worker in the eye when talking with them

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MET Process MonitoringFeed back from the MET team and initiating nurses will be collected and examined using the “MET Documentation Form”The form includes:Type of event, location , and patient outcome

Evaluation of MET procedure

Response time

Competency of team members

Availability and functioning of equipment

Accurate completion of forms

Data is evaluated by Code Blue and ICCU subcommittees

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Responsibility of the Patient’s NurseProvide the team with a status report upon team arrivalMake the medical record availableEnsure that any ordered therapy is available on the unit before calling the Team

Assist in transfer of the patient if required.The accepting RN will check for IV patency or assist with establishing an IV site

Document in the Nursing Notes reason for MET call and patient’s response to the intervention

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Important to RememberThe MET responders should be on the floor for interventions 30 minutes or less

Collaboration with the physician or triage to a higher level of care will usually be made within 30 minutes

However, patient safety comes first and the MET responders will assist in the safe transport of the patient to a higher level of care if required.

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