Emergency Teams at MUSC

1
Emergency Teams at MUSC
2
Several Emergency Teams-one number

• Mayday-cardiopulmonary arrest or imminent life
  threatening danger
• Pharmacy Response Team-for codes in the ICU only
  on intubated patients
• Rapid Response Intubation-for urgent intubation
  in the ICUs only-like calling anesthesia stat
• MET-Medical Emergency Team-responds to
  deteriorating patients on the general care floors
• BAT-Brain Attack Team-responds to patients with
  signs/symptoms of stroke

Just call 2-3333!
3
What is a MET?

• Medical Emergency Team- Responds when the
  hospitalized patient has deteriorated... to the
  point where there is an imminent risk of serious
  harm.
• MET-Rapid Response Team with MD component
• Responders are a RT, RN and MD from the ICU.

DeVita, et al., 2006
4
MUSC MET-Adults

• ART team-CCU RNS, the respiratory therapy
  coordinator and a cardiology fellow cover during
  the day. Off hours, a medical resident covers
  for the fellow.
• Main Hospital Adult Team-MICU RNs, the
  respiratory therapy coordinator and a pulmonary
  fellow cover the Main adult hospital. Off hours,
  a medical resident also covers this team.

5
MUSC MET -Pediatrics

• There are 2 teams in Childrens. One is based
  out of the PCICU and services 7CHC with the
  cardiology fellow. 7A, 7B and 8D are covered by
  PICU nurses. During the day, the attending
  responds. At night, it is the PICU resident.

6
How is the MET called?

• Adult Activation Criteria
• Staff member is worried about the patient
• Acute decrease in pulse oximetry saturation to
  
  of 50 or greater. (
  disease.
• Acute change in conscious state
• Acute change in urine output
• Acute vital sign changes as from patient baseline

7
How is the MET called?

• Pediatric Activation Criteria
• Staff member is worried about the patient
• Acute decrease in pulse oximetry saturation to
  
  of 50 or greater. (
  disease.
• Acute change in conscious state
• Acute change in urine output
• Acute vital sign changes as from patient baseline

8
MET Procedure

• If the patient demonstrates calling criteria, the
  nurse consults with the primary team about
  calling a MET. The nurse may call a MET at any
  time, but should let the house staff know first,
  if patient status permits.
• Floor caregiver calls 2-3333 and asks for MET
  team. Caller also gives name of primary service
  MD to be called. This MD gets a text page a MET
  has been called.

9
MET Procedure

• Floor caregiver gives information to team via
  SBAR protocol. Floor caregiver remains with the
  MET team throughout intervention.
• Standing orders allow RNs/RTs to begin medical
  treatment if MD is delayed.
• MET team documents on MET form

10
Mayday, Mayday!!
Mayday! Mayday! This is flight 97! I'm in
trouble!... My second engine's on fire, my
landing gear's jammed and my worthless co-pilot's
frozen!"
11
MUHA Mayday Teams -all called by 2-3333

• MUH Adult Mayday Team
• ART Mayday Team
• Childrens Hospital Mayday Team
• Rutledge Tower Pediatric Mayday Team
• Rutledge Tower Adult Mayday Team
• Institute of Psychiatry Mayday Team
• CMH Mayday Team
• BSB Mayday Team
• Hollings Mayday Team
• Campus Response Mayday Team

Remember to tell the operator what building
you are in!
12
How do you call?- if you work on the general
floors

• Call the operator at 2-3333. Information to
  give
• Where you are-exactly! We have a big campus
  here, so 5th floor wont work. Tell the
  operator the room number and the building.
• Adult or pediatric. We have several teams here,
  so they need to know who to call.
• Your name and call back number, so the operator
  can confirm someone responded.

13
How do you call?- if you work in the ICU

• For Maydays in the Intensive Care Units, staff
  will call a Pharmacy Response Team if the patient
  is intubated. If the patient is not intubated, a
  full Mayday Team response will be called for.
• Call 2-3333, give the name and location of the
  ICU, your name and call back number and if the
  patient is adult or pediatric.

MUHA Policy C-14, page 4
14
Pharmacy Response TeamICU, ED and PACU ONLY

• If the patient is intubated or has a
  tracheostomy, you may call for the Pharmacy
  Response Team. This brings the pharmacist with
  their bag, the HSC (as appropriate) and the
  chaplain.
• On the floor, pharmacy responds with the full
  team, so the Pharmacy Response team is
  unnecessary

15
Rapid Response Intubation ICU, ED and PACU ONLY

• If anesthesia is needed for urgent intubation-the
  patient hasnt coded, yet-call 2-3333 and ask for
  the Rapid Response Intubation Team.

16
Remember to call 2-3333 for Maydays and ask for
the Stab Team. The Stab team responds to all
nursery codes!
How do you call?-If you work in the NNICU or the
Nurseries

• Stab team consists of
• Pharmacy
• Residents/Interns
• Attending
• Stab Nurse
• NNPs
• Respiratory
• HSC

17
Remember to Document

• Have one person be the timekeeper-if you use your
  watch, the monitor and the wall clock, the times
  on the sheet will be misleading.
• Fill out sheet completely-fill it out as you are
  going along, so that you dont forget anything.
  Remember, the code sheet counts as MD orders and
  the MAR.

18
http//www.musc.edu/cce/ORDFRMS/pdf/cprform.pdf
19
Team Training

• Mayday team members are undergoing Team Training.
  This training decreases the number of people at
  the bedside and increases efficiency.

20
Mayday Teams-Training
Current Mayday team members
Roles
Team originated by DeVita, et al.
21
Brain Attack Team BAT Emergency response
team that provides rapid assessment, diagnosis
treatment of stroke

22
MUSC Primary Certified Stroke Center (July 20,
2007 per the Joint Commission )

• In an attempt to improve the organization and
  delivery of care to stroke patients, the Brain
  Attack Coalition published 2 sets of
  recommendations, one for primary stroke centers
  (PSCs) and, more recently, one for comprehensive
  stroke centers (CSCs).
• Recommendations for comprehensive stroke
  centers a consensus statement from the Brain
  Attack Coalition. Stroke. 200536 15971616.
• A PSC has the personnel, programs, expertise, and
  infrastructure to care for many patients with
  uncomplicated strokes, uses many acute therapies
  (such as intravenous tPA), and admits such
  patients into a stroke unit.
• Brain Attack Coalition. Recommendations for the
  establishment of primary stroke centers. JAMA.
  2000283 31023109.

23
MUSC Primary Certified Stroke Center (July 20,
2007)

• The CSC is designed to care for patients with
  complicated types of strokes, patients with
  intracerebral hemorrhage or subarachnoid
  hemorrhage, and those requiring specific
  interventions (eg, surgery or endovascular
  procedures) or an intensive care unit type of
  setting.
• MUSC has the components of a CSC, but the actual
  certification process has not been implemented by
  the Joint Commission yet.

24
Time lost Brain Lost

• Rapid Assessment for Signs and/or symptoms of
  stroke with onset (last known at baseline) 8
  hours
• 24/7 Emergency response team to ED, adult
  inpatient areas of main hospital adult
  outpatient areas
• 15 minute response to ED or bedside
• Stroke Neurology Resident, Stroke RN

25
Stroke Warning Signs

• Is your patient experiencing
• Sudden numbness or weakness of face, arm, or leg,
  especially on one side of the body
• Sudden confusion or trouble speaking or
  understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of
  balance or coordination
• Sudden severe headache with no known cause
• Call 2-3333 and page the MUSC Brain Attack Team
  to your patients bedside.
• With a Stroke, Time Lost is Brain Lost.

26
Time lost Brain Lost
27
Time lost Brain Lost

• Rapid diagnostic evaluation for Signs and/or
  symptoms of stroke
• Labs collected 10 from time pt presents to ED
  or response team to patient on floor
• 24/7 CT/CTP/CTA Scan completed (goal 25
  minutes) from time pt presents to ED or response
  team to patient on floor
• EKG, NIH Stroke Scale

28
Time lost Brain Lost

• Rapid treatment for Signs and/or symptoms of
  stroke
• Hemorrhagic Stroke Consult Neurosurgery
• Ischemic Stroke with onset (last known at baseline) tPA
  considered (goal 60 minutes from time pt
  presents to ED or response team to patient on
  floor to the initiation of the drug
• Ischemic Stroke with onset (last known at baseline)
  Thrombectomy and/or Thrombolysis
  Neuro-Interventional Radiology

29
JC Requires Documentation on

• Dysphagia Screening before any PO
• Including medication
• Stroke Specific Education
• Related to patient specific risk factors
• See ClinDoc ? Disease Specific Stroke Education
• Smoking Cessation
• Admission Assessment
• Disease Specific Stroke Education

30
BAT Team Support

• Neuro-Intensivist
• Stroke Neurologist
• Stroke Program Nurse
• NSICU Charge RN
• Chest Pain Center/DDC ICU Charge RN
• Neurology House-Staff
• Support staff on pager
• Neurosurgery - Neuro- Interventional Radiology
• ED Operations Coordinator - Pharmacy - HSC - ATC

31
REMEMBER TIME MATTERS AND BRAIN IS MATTER OF
TIME

CALL 23333 FOR BAT