Paul Clarke, RN BSN

Rapid Resuscitation Action Plan:How One Unit Tries To Beat The Odds

Disclosure Statement

I do not have any relevant financial relationships with any commercial interests to disclose.

Objectives

Discuss Goals for Rapid Resuscitation Action Plans

Review Inclusion Criteria

Current Methodology

Preliminary Outcomes

Problem

Current Pediatric CVICU Code Outcomes Nursing Turnover Jr. Physicians

Solution

Unit Specific Code Review Committee

Examined Past Codes

RAP, ASAP

Goals

To prevent code events in the CVICU at Children’s of Alabama by identifying patients at high risk for cardiac or respiratory arrest

To reduce severity of remaining code events by identifying best choice interventions based on most likely route of deterioration

Goals

Improve efficiency of code events by pre-identifying healthcare provider roles to speed time to first interventions

Decreased code events and reduction in severity will improve patient outcomes

Inclusion Criteria

Single Ventricle physiology pre or post Stage I palliation

Neonates with restrictive atrial septum (d-TGA or single ventricle)

Neonates POD 0 and POD 1

Open Sternum

Inclusion Criteria

High inotropic/vasopressor support including Three or more infusions (milrinone only included if 1

mcg/kg/min or greater) Epinephrine > 0.05 mcg/kg/min Vasopressin > 0.04 units/kg/hr

History of prior arrest during current hospitalization

Inclusion Criteria

New onset cardiomyopathy/myocarditis on epinephrine and/or dopamine infusion

Known difficult airway/upper airway obstruction

ECMO patients up to 48 hours post-decannulation

Inclusion Criteria

Known pulmonary hypertension

Severe lung disease requiring: PEEP > 10 100% FiO2 and iNO

Process

Multidisciplinary “RAP” team

RAP rounds twice daily, once per shift

RAP Sheet

Process

RAP sheet to include Reason(s) patient is high risk Warning signs and notification parameters for RN/RT Potential prevention measures for arrest Necessary equipment and medication to have

readily available at bedside Patient specific first steps in event of arrest

Process

RAP sheet reviewed and updated each round

Bedside Nurse responsible for keeping needed medications in locked bedside cart

Process

RAP sheet reviewed for all nursing handoffs

Code Roles preassigned to minimize role duplication and extraneous personnel

Interventions Beyond RAP

Three Person Suction

Pre-sedate with noxious stimuli/Minimal Stimuli

Prostaglandin Checks

20/10’s Rule

Current Progress

Initiated August 2014

Better multidisciplinary awareness and communication

MD, NP, RT and RN acceptance