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Handle Urgent or Emergency Situations Better With Rapid Evaluation Teams

Nursing homes have to prepare emergency operations plans to be compliant with the emergency preparedness regulations that are detailed in Appendix Z of the State Operations Manual, points out Amanda Thorson, MSN, BSN, RN, CMSRN, GERO-BC, PHN, the director of nursing services (DNS) at Carris Health Care Center and Therapy Suites in Willmar, MN. “However, the human side of emergency preparedness—the care-related emergencies—often doesn’t get as much attention as natural and manmade disasters. How do you want staff to respond when there is a medical emergency or acute change in condition? What if you were the person needing the help? Would you want to be in a facility where the staff knew exactly what to do at any given moment?”

Directors of nursing services (DNSs) should consider implementing rapid evaluation teams, aka rapid response teams, so that staff members are prepared both to call for help and to rapidly respond with appropriate interventions—using a systematic approach—to any kind of emergency situation, suggests Thorson.

“Rapid evaluation teams historically have been popular in the hospital setting,” says Thorson. “When a patient or a situation is declining in the hospital, staff can call to get a rapid evaluation team to respond at the bedside where they are. This team may include multiple disciplines. For example, a respiratory therapist, a head certified nursing assistant (CNA), and an emergency room (ER) nurse all could be on the team. But, the entire rapid evaluation team immediately converges on the staff member who calls for assistance to respond to whatever need they have depending on what is happening with that patient.”

‘I would just call the charge nurse’

When Thorson initially asked her own staff whether they felt confident to deal with emergency clinical situations, their common answer was, “I would just call the charge nurse,” she points out. “Staffing ratios in hospitals can run four to six patients per nurse, but the ratios in nursing homes are much higher, running 24 to 30 residents per nurse. So, what if the charge nurse is not available? Or, what if you are the charge nurse—how will you get help?”

Typically, a lot of new-graduate nurses are coming to work in nursing homes, as well as many first-time CNAs, says Thorson. “So, it’s important to have a systematic process that (1) gives all staff across all shifts the tools to call for help and not leave the resident’s bedside in any emergency situation, and (2) quickly brings in the appropriate staff to assess and take the necessary actions. That’s why I decided to revamp rapid evaluation teams for implementation in long-term care.”

The COVID-19 pandemic and the worsened staffing crisis have brought awareness to the need for smarter, more effective care delivery, adds Thorson. “Improving your preparedness to respond to medical emergencies and acute changes in condition should be part of that.”

DNSs should look at the tools and resources, as well as the staff, that are in the facility to implement rapid evaluation teams using the following core process, according to Thorson:

Rapid Evaluation Team Basics  

  • Create a crash cart/emergency kit, and audit it consistently.
  • Develop a communications system that includes the initial criteria that should trigger any staff to call for a rapid evaluation team, as well as how that call should be made (e.g., pagers, walkie-talkies, etc.)
  • Establish a consistent location for the resident’s code status to ensure staff across all shifts can find it easily, and have a process for auditing code status to ensure it is always up-to-date.
  • Lay out the workflow for the rapid evaluation team, including who is on the team, who should serve as the team lead, and the tasks that the team lead may assign.
  • Conduct drills on a routine basis to ensure staff competency and identify areas for improvement.

Who should call? Who should answer?

Anyone in the facility should be able to call a rapid evaluation team, says Thorson. “So, all staff should be taught what rapid evaluation teams are for, how and when to call one, and where the crash cart is, says Thorson. “New employees, contract staff (e.g., therapists), agency nurses, agency CNAs, dietary staff, maintenance staff—everyone needs to be prepared to call a rapid evaluation team.”

Rapid evaluation team members should respond en masse, suggests Thorson. “Who is on the teams will be facility-specific, but you may want to include at least two licensed staff members on each team. No matter where they are in the building, everyone on the team who is available should go running to that room when a rapid evaluation team is called, and the person closest to the crash cart should grab it on the way. In an emergency situation, it is much easier for the team leader to dismiss people and say, ‘We only need you, you, and you,’ than it is to be waiting on additional help to come.”

Crash carts: What does the facility already have?

Implementing rapid evaluation teams shouldn’t have high costs in terms of resources, says Thorson. “There are costs related to education and training. However, nursing homes are required to have certain emergency equipment as part of providing basic care to residents. So, most of what you will need is already available. You just need to pull it together into one place—and think outside the box for any elements that you don’t have. For example, you may not have a good crash cart system. If that’s the case, can you put together an emergency duffel bag similar to what emergency medical technicians might use? You want staff to be able to grab key supplies and run to the room when a rapid evaluation team is called.”

Providers also should re-evaluate their crash carts/emergency kits periodically, says Thorson. “For example, we added extra personal protective equipment (PPE) to our crash carts because of the pandemic, but in hindsight, we probably should have included those resources in the first place. You want to constantly tune into little things that you may have missed when setting it up.”

Opportunities for expansion

Once DNSs establish rapid evaluation teams, they may want to consider expanding their use beyond resident-focused scenarios, suggests Thorson. “In my facility, we now use rapid evaluation teams for not only emergency situations with residents, but also with any human being who is within our walls.”

For example, a staff member who was helping a resident had a medical emergency, so the other staff member who was there working with them called a rapid evaluation team, explains Thorson. “We had drilled and implemented rapid evaluation teams to do this, so the team was able both to support the staff member who had the medical emergency and to help debrief the resident who was involved in the experience. So, rapid evaluation teams can take care of your whole team, as well as residents.”

Implementation tools

Thorson called on her 10 years of hospital experience to revamp the concept of rapid evaluation teams to fit the nursing home setting. She then worked with LeadingAge Minnesota in St. Paul to develop implementation materials. These include a training video that shows an example of how a rapid evaluation team is called and then goes rapidly into action.

In addition, there is a Rapid Evaluation Team (RET) Roadmap that outlines step by step the process for creating, implementing, and improving rapid evaluation teams in nursing homes. The RET Roadmap includes additional links for tools that can assist DNSs with implementation of each component. For example, the RET Process Steps and Tasks section includes links to sample workflows and policies, as well as drill scenarios for different medical emergencies, such as a stroke, fall from wheelchair, or an unresponsive resident. All told, Thorson has already helped more than 50 nursing homes in Minnesota alone to implement rapid evaluation teams.

A rapid evaluation team program is not really a complex system to put into place, says Thorson. “The benefits by far outweigh the complexity. Your entire team—and anyone who comes into the facility—will feel more comfortable. It’s especially helpful for the DNS because you know that if an emergency situation happens after your shift ends, your team is equipped with the knowledge and the tools to provide the best possible care.”

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