Date of Award

2021

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Bonnie Bowie

Readers

Todd Ray

Abstract

Background: Rapid response system afferent limb failure (ALF) is associated with increased hospital mortality rates, unplanned transfer to the ICU, and increased hospital length of stay. Factors contributing to ALF are complex, including individual, team, organizational, and systemic barriers. The aims of this study were to evaluate the impact of implementation of a proactive rapid response team nurse (RRT RN) rounding protocol on the frequency of ALF preceding adverse events, patient disposition following RRT activation, and discharge disposition of patients experiencing adverse events during their hospital stay at a 281 bed community hospital.

Methods: This was a two part quantitative, descriptive study using retrospective review of patient medical records who experienced adverse events on inpatient medical-surgical units to evaluate the frequency of ALF preceding adverse events, unplanned transfer to the ICU, and hospital mortality following intervention implementation.

Results: Following implementation of the RRT RN rounding protocol there was a decrease in frequency of ALF preceding adverse events (35.1% to 20.8%, p < .001), frequency of patients transferred to the ICU following RRT activation (25.9% to10.7%, p = .009), frequency of patients discharged to a skilled nursing following hospitalization (22.6% to 12.6%, p = .015). There was no significant change in frequency of patients experiencing in hospital mortality (17.6% vs 22.3%, p = 207), rates of adverse events (11.5 vs 14.0, p = .615), or unplanned transfers to the ICU (3.05 vs 8.05, p = .077) per 1000 inpatient medical surgical inpatient day.

Conclusion: Proactive rounding by a RRT RN is associated with improved rate of ALF preceding adverse events and decreased transfer to the ICU following RRT activation.

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