EVIDENCE-BASED NURSING

GROUP 30 BSN 208 DE GUZMAN, Lord James DE JESUS, John Samuel DE PERDO, Roshleen Ann DELA PENA, Ma. Charmina DOMINGO, Trizha Marie EDEJER, Pia Maeven FAJARDO, Ella Camille FIDEL, Jennifer FIGUEROA, Jett Arney GASMEN, Mediatrix GONZALES, Mika JIMENEZ, Bernadette Claudine

Given problem: You're a staff nurse on a busy medicalsurgical unit. Over the past three months, you've noticed that the patients on your unit seem to have a higher acuity level than usual, with at least three cardiac arrests per month, and of those patients who arrested, four died. Today, you saw a report about a recently published study in Critical Care Medicine on the use of rapid response teams to decrease rates of in-hospital cardiac arrests and unplanned ICU admissions. The study found a significant decrease in both outcomes after implementation of a rapid response team led by physician assistants with specialized skills. You're so impressed with these findings that you bring the report to your nurse manager, believing that a rapid response team would be a great idea for your hospital. The nurse manager is excited that you have come to her with these findings and encourages you to search for more evidence to support this practice and for research on whether rapid response teams are valid and reliable. I. Clinical Question The effectiveness of rapid response team in decreasing rates of cardiac arrest in ICU and unplanned ICU admissions. II. Citation

The effect of the Medical Emergency Team on unexpected cardiac arrest and death at the VA Caribbean Healthcare System: a retrospective study.
Rivera, Biomaris M., Santiago, Zulmari C., Palacios, Alfonso T., Cintrn, William R. (2010) III. Study Characteristics 1. Patients included

The patients included were the Adult patients admitted to regular ward between November 2007 to February 2008 and November 2008 to February 2009 at the VA Caribbean Healthcare System were evaluated. Medical emergency team education and program rollout occurred from February through June 2008. - This study shows an Experimental approach. 2. Interventions compared

-The effectiveness of rapid response team versus the usual clinical team in a hospital setting in relation to Cardiopulmunary Arrest and unplanned ICU admissions.

3. Outcomes monitored
-The results were monitored thru the incidence of unexpected inhospital cardiorespiratory arrest, death, and unplanned ICU admission rates.

4. Does the study focus on a significant problem in clinical practice?

-The incidence of unexpected cardiopulmonary arrest and unplanned ICU admission is detrimental to the population. Thus, it is significant in the clinical practice.

IV. Methodology/ design

1. Methods used
-Researcher used a Quantitative Retrospective type of study in an uncontrolled group of cardiac arrest clients and unplanned ICU admission.

2. Design
-The design of the study uses a quantitative causal approach providing information about the effects of implementing rapid response teams in a hospital setting.

3. Setting
-The study was taken at the VA Caribbean Healthcare System

4. Data sources
-The data source used is Internal Secondary data source because the data was only taken from hospital record and not in actual data gathering. It is generally less expensive than primary research. The bulk of secondary research data gathering does not require the use of expensive, specialized, highly trained personnel. 5. Subject selection a. Inclusion criteria

-The inclusion of this study focuses on the patients in one clinical setting that belong to the given time table (November 2007 to February 2008 and November 2008 to February 2009) and given venue, which is the VA Caribbean Healthcare.

b. Exclusion criteria
-Those excluded criteria are as follows: a specific age bracket or group, a specific gender and specific diagnosis and the patients that dont belong to the given span of time. 6. Has the original study been replicated? -The study has no report of replication; the study stands to be original to conduct in that given number of people in that setting. Others may have also studied about the rapid response team, but there are many differences seen as to be compared to this study.

7. What were the risks and benefits of the nursing action or intervention
tested in the study? -The down side of this intervention is that it requires additional member of the medical team, thus imposing an increase on salary consumption. However, with the aid of this intervention on the long run there will be a great cost cutting effect which is commonly used in the treatment of cardio-pulmonary arrest and unplanned ICU admission expenses. V. Results of the study

There was no effect on unexpected death nor 48 hour survival after the intervention there was no change in DNR status previous to MET and after MET implementation. There was no change of unexpected cardio-respiratory arrest, although lower rates of non-ICU colds were observed during the study time period.

VI. Authors conclusion or recommendation 1. What contribution to client health status does the nursing action\intervention make?

The rapid response team helps save patients lives faster and help the nurse practice the speed and accuracy of implementation of intervention to the clients.

2. What overall contribution to nursing knowledge does the study make? -The rapid response team decreases the incidence of in-hospital cardiopulmonary arrest and unplanned ICU admission because if greater action

of the health team is required, there would be lesser number of incidents of cardiac arrest and death in the hospital. This study gives an idea to the health professional to maximize their skills and use it in a faster manner.

VII. Applicability 1. Does the study provide a direct enough answer to your clinical question in terms of type of patients intervention and outcome? -Yes, the study provides a direct enough answer inl question and supported the clinical question. 2. Is it feasible to carry out the nursing action in the real world? -Yes, because the cause of any treatment of cardiopulmonary arrest or ICU admission is more likely to be a very effective intervention to any kind of disease.

VIII. Reviewers Conclusion Since the study shows that the rapid response team does not compromise the safety of the healthcare system, it could be concluded that rapid response teams effectiveness is acceptable enough and needs highly competent and skillful member of the team. Moreover, this said team is appropriate enough in all of the care units of the hospital. Thus, accessibility must always be free. Lastly, more researches should be done to increase show relative effectiveness in most of the hospital setting.