Kathy Duncan
Faculty Expert, Rapid Response Teams
Institute for Healthcare Improvement
"To me it is all about the patient, and why wouldn’t you put the head of the bed up 30 degrees?" (1:38)
I’m Kathy Duncan. I’m the point person for the Rapid Response Teams for the Institute for Healthcare Improvement [100,000 Lives Campaign]. I graduated nursing school in 1981, worked at Baptist Hospital for 23 years. I was a staff nurse and then a head nurse and a manager, worked in several units, mostly critical care. In 2001 we had the opportunity to work with the IHI on their IMPACT for critical care [IHI's IMPACT network Learning and Innovation Community, “Improving Care in Critical Care Settings”]. And then the next year we signed up for the Hospital Mortality group and had the opportunity to hear that the Australian folks had done some work with Medical Emergency Teams and it intrigued me because we had done a whole lot of good stuff but we were still having, and I called them, these “Oh my God” events. We just started it. Went back, didn’t ask nobody, didn’t do anything. We just started and had a really good pilot and then had a really good two-and-a-half years being able to lead that, had a lot of good outcomes and got real excited about system issues, how these teams mature and grow and how culture changes.
When people question or say, “We can’t do this because... ,” to me it is all about the patient and why wouldn’t you put the head of the bed up 30 degrees? I mean it is no big deal. Why wouldn’t you involve the family in a Rapid Response Team? Why wouldn’t you do those kind of things? I think some of it, with the people that I’ve worked with or I have seen across the country, is that the people who are willing to look at what is best for the patient can just roll with it. The people who are looking at the extra paper or the Joint Commission or the state bothering them, if they are focused on those things, they are focused on the wrong thing.
"You don’t have to convince people it’s the right thing to do. It’s the operational steps that they really struggle with." (1:10)
A lot of people have done a lot of hard work to let folks know about Rapid Response Teams. Most of the time now you don’t have to convince people it’s the right thing to do. It’s the operational steps that they really struggle with. Fortunately, I get to learn from a whole bunch of folks about different tools, different tips. “No, you don’t have to do this.” “You don’t have to measure that.” All that kind of stuff really is exciting to me because I could save them months of work and, as recently being in that chair, I know what that means.
When you are looking at a blank piece of paper and trying to write a policy, it’s maddening. It’s probably like trying to write an article. You don’t have any notes. You don’t have a tape. I usually, especially when I go meet new folks that are wanting to get started, if they’ve not done this exercise, I think it’s very valuable to look at the last 20 codes in your building. They really probably don’t care what happened in Australia. They really don’t care what happens in the UK. They may not care what happens in these big medical centers, but they do care about the last 20 codes in their building and you can hook them with that. You can hook your administration, your doctors and your staff and, if you can tell them we can go from four codes to three, they will get excited about it.
"It is much easier to resuscitate sick people than it is to resuscitate dead people." (1:12)
As an old ICU nurse, number one, we think we’re special and we are really not. We think we are busier than everybody else and we are really not. But some of the ICU resistance on occasion is “I can’t do one more thing.” If I can paint them a picture that says, “When is the last time you got a patient from Orthopedics or some other floor and you looked at that chart and you said, ‘Why didn’t I notice this? What about this? I wish I....’” You know, or you get a patient after they have been coded and they have a tube in every orifice, they have six drips on, they have a doctor pumping on their chest when they are coming to the unit and you are thinking, “Oh, my stars, I can’t do one more thing!” What if you could have been there and spent 30 minutes six hours ago? Number one, this guy may have never come to you. About 50 percent of the Rapid Response Team calls stay where they are at.
Dr. Ken Hillman says from Australia that it’s much easier to resuscitate sick people than it is to resuscitate dead people. If you were a nurse all by yourself up there at 9:30 on a Saturday night, wouldn’t you have loved to call somebody, just to come help you assess the patient?
"The most important person on the team is the person who makes the call." (1:51)
I think it is important to do debriefings, to do conferences, to encourage, to reward people who call. It didn’t take me very long in that process to realize the most important person on the team is the person who makes the call. It is not me, the ICU nurse who runs up there with all my stuff and my cape on. You know, it is not me. It is not Respiratory Therapy. It is the person who makes the call. And by going back — and people do this a hundred ways — going back and doing some sort of debriefing, gathering up two or three people from down the hall and say, “Okay, you all remember Mr. Smith from the other day? Here is what Madge did. He was a little bit short of breath, a little bit of this. We gave him some Lasix, put him on oxygen, sent him to the unit, now he is going home tomorrow.” It does wonders for people. They are valued. They knew they did the right thing. They knew what happened to their patients and they might have learned something.
I was on a conference call with some folks from New Jersey, working on the ICU stuff, and I just told them everything I could think of, what I have seen people doing, because that was one of their questions. “How do we keep people energized about this? We have educated and we are measuring our data.” And I said, “Well, that is really good stuff but it ain’t enough. Use the real numbers. We went from five to one. We went from 50 codes a month to 30 codes a month.” They can feel that. They get it.
It could have been my mamma. It could have been your mamma. And I think it’s important to talk like that. I think it’s important to talk about how AMI care could save a life. Medication reconciliation could save this patient’s life. It seems like the first part of my career we were scared to say that. We blamed it on everybody else. We blamed it on the paperwork. We blamed it on the regulatory agencies. But it is about doing the right thing for the patient.
02/16/2006
