Rapid Response 101

1. Starting January 2018, there are Virtual Rapid Response (RR) medication kits available on every hospital unit except dialysis. These are stored in the "Accudose" machines where nurses can easily get them from. The list is below. Please note, that ketamine and rocuronium should never be ordered without the intensivist being present in the room and ready to manage the airway. 

2. Starting April 10th 2018 a Rapid Response Power Plan will be available in Powerchart. It contains all of the meds outlined above, as well as some of laboratory and imaging studies that are frequently used during RR. It will replace the Rapid Response orderset. Please make sure to utilize the plan frequently, ideally every RR!

3. There are hospital protocols that prevent nurses on certain units from administering some of the meds used in Rapid Response. This is one of the reasons why the ICU charge nurse is a vital part of the RR team. Some medications in the Virtual kit can only be administered by the critical care trained RN; therefore, please make sure that ICU charge nurse stays with the patient for the whole duration of the RR, until the patient is either stabilized or transferred to the higher level of care.

4. Recently, a Rapid Response Team Record form was added to Powerchart, which should be filled out every time the RR is activated. Patient's bedside nurse is responsible for filling it out, and we would like to ask you to ascertain that this is happening. Please remind the RN to do the Rapid Response Team Form for every RR. The form is new and some of the nurses might not be aware that they need to complete it. Ultimately, it will be used to track the data behind RRs to try and optimize RRT utilization.  

6:45AM: The rapid response pager is picked up by the Medicine Consult resident on all weekdays. During weekends, the rapid in house team resident picks up the rapid pager at 6:45AM. During holidays, the rapid long call resident picks up the rapid pager at 6:45AM.

• Weekdays: The rapid response pager will be handed to the long call resident at 12PM.

• Weekends: 

  • The rapid in house resident holds the pager from 6:45AM to 4PM.

  • At 4PM, the rapid response pager is transferred to the rapid long call resident.

6:45PM: The rapid response pager is handed to the NF Resident.

• Staffing Rapids

  • Every rapid response must be staffed with an Attending.

  • Label the interdisciplinary note “Rapid Response Note”. This note should be written immediately after a rapid response.

  • Staff all Medicine rapid responses with the primary team attending or primary hospitalist. 

  • Staff all non-Medicine rapid responses with the non-call Himelfarb or Tabatznik attending.

  • Specify which attending the rapid response is staffed with in the note.

  • Sign and submit the rapid response note to the attending.

  • During nights, staff all rapid responses with the Nocturnist.

• Following Up

  • During a rapid response, especially during the night, follow up on labs and imaging studies ordered even if a medicine teaching team is not the primary contact. This is for safety purposes.

• Asking For Help

  • There is always someone to help, during all hours of the day. At night, ask for help from a coresident and the nocturnist [call the gatekeeper phone]. During the day, ask fellow residents for help and attendings are always there.

  • If there are simultaneous rapid responses, ask for help! Ask Sinai Med, coresidents on floors, etc.

  • Do not hesitate to place a MICU consult. Call the MICU Intensivist phone if needed if care needs to be escalated.

• Work as a team! Multiple interdisciplinary team members attend rapid responses - work together to help the patient.

• If there are any issues or concerns, email or call the chief residents immediately.