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Nurses need to feel free to call when anything looks awry

Quality Improvement Monitor, August 17, 2007

Hospitals that want to set up successful rapid response systems need to ensure that all nurses feel safe to call another clinician for help whenever their gut tells them something is wrong-even if it's not readily apparent.

"If the culture is that you can call any time you're worried about your patient, then more people will be rescued," says Kathy Duncan, RN, who has taught hospitals throughout the country how to implement rapid response teams as the point person for the Institute for Healthcare Improvement (IHI). She is now on the faculty of the IHI's 5 Million Lives Campaign.

"What I like to tell rapid response teams just getting started is, it's easier to begin with a script," says Duncan. "The first person in the room, whoever that is, says, 'Thank you for calling, how can I help you?' "

That sets the stage, she says, for a collegial conversation in which nurses can tell the person or people who respond: "I don't know what's wrong, but he looks a little grayer than he used to. He's talking a little slower than he used to. He's napping a lot today, and that's very different from yesterday."

For example, a new orthopedics nurse may not be able to detect signs of renal failure, something a critical care nurse might spot right away. The hospital administration, Duncan says, must guarantee a nurse never feels belittled, even if he or she makes a rapid response call that may be unwarranted. "It is never okay for anybody to be worried about a patient and not be able to get help," she explains.

Access the full story in the August issue of the Quality Improvement Report; access is free for subscribers, nonsubscribers can sign up for a 30-day free trial of BOJExtra! or purchase a copy of the story for $10. For more information, click here.

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