Shannan Hamlin, ACNP, CCRN, PhD, RN
Director, Center for Nursing Research, Education and Practice
Houston Methodist Hospital
Houston
Disclosure information not submitted.
Nicole Fontenot, DNP, APRN, ACNP-BC, CCNS, CCRN-K
Nurse Scientist
Houston Methodist Hospital
Houston, Texas, United States
Disclosure information not submitted.
Hsin-Mei Chen, PhD, MBA
Manager, Center for Nursing Research, Education and Practice
Houston Methodist Hospital
Houston, Texas, United States
Disclosure information not submitted.
Steven Hooker, MSN, RN, CCNS, NE-BC
Manager, Center for Nursing Research, Education and Practice
Houston Methodist Hospital
Houston, Texas, United States
Disclosure information not submitted.
Title: Nursing Assessment Reduces Delays in Rapid Response Team Activation, ICU Admissions and Mortality
Introduction: Knowledge of a patient’s clinical status and usual behaviors gained through a systems-based physical assessment (SPA) has consistently been shown to be a key influence on a nurse’s ability to recognize subtle changes in a patient’s condition. The importance of early recognition of deterioration before overt physiologic signs such as vital sign changes cannot be overstated given the preponderance of evidence linking unrecognized patient deterioration with serious adverse events (SAEs). However, the physical assessment skill set practiced daily in contemporary nursing has significantly diminished and instead focuses more on vital signs.
Methods: A quality improvement initiative titled Methodist Proficiency Assessment and Competency (MPAC) Certification© was conducted to improve the SPA performed by inpatient nurses. Pre-MPAC (baseline) and post-MPAC audits were conducted by directly observing randomly selected nurses perform their physical assessments and record findings on a standardized data collection sheet. MPAC training was 4 hours of teaching and simulated skills validation. We investigated clinical outcomes by retrospectively reviewing patient medical records who had a RRT activation for the period of six months before MPAC and six months after MPAC. During the 24 hours leading up to the RRT activation, vital sign data was reviewed for abnormalities meeting RRT call criteria.
Results: A total of 179 pre- and 1,379 post-MPAC audits were conducted showing consistent improvement in complete SPAs (78% pre- vs 94% post-MPAC; p< 0.001). After MPAC training, the average number of hours from the first sign of clinical deterioration to when the RRT was activated was reduced from 11.66 to 9.56 hours (p< 0.001). There were significant differences in all delay ( >31 minutes) categories (p< 0.001). Post-RRT ICU admissions went from 41.42% to 36.4% after the training (p=0.02). A multivariate logistic regression model for mortality found the odds of death were 4.65 times higher when the patient was transferred to the ICU than the patients who stay at the same level of care (OR=4.65, 95% CI 2.98-7.24, p< 0.01).
Conclusions: We conclude that nurses are better prepared to detect subtle signs of deterioration and intervene when they consistently perform a SPA which ultimately results in reduced SAEs including mortality.