PeraHealth Insights

Proactive Rounding with the Rothman Index Helps Decrease Code Blues and Mentor New Nurses

VitalsHospitals like Carilion Roanoke Memorial Hospital and Penn State Health Milton S. Hershey Medical Center are re-inventing the Rapid Response Team (RRT) model to drive earlier clinical intervention by using a proactive rounding approach.

Proactive rounding happens when a care team preemptively reviews clinical surveillance information and treatment plans to establish (and re-establish) appropriate care levels. Think of it as the marriage of rounding and clinical surveillance.

Our Sept. 6 webinar, titled, “Proactive Rounding Based on Clinical Surveillance: A Team Approach for Rapid Response and Better Patient Outcomes,” illustrates how a clinical team can conduct proactive rounding with the Rothman Index (RI) and focus attention on at-risk patients before there is a patient crisis. View the full webinar recording here.

Two experts share approaches to integrating proactive rounding with clinical workflows: Heather Bramblett, BSN, RN, CCRN, Director, Clinical Administrators, Carilion Roanoke Memorial Hospital; and Janine Hair, BSN, RN, Nurse Resource Coordinator, Penn State Health Milton S. Hershey Medical Center.

Their compelling stories include these themes:

Integrating the RI with specific nursing roles helps solidify those roles

Heather shared that after she witnessed a great catch by a progressive care nurse using the RI, she determined it would be helpful to have the Clinical Administrators, like herself, proactively review the RI rather than wait to be alerted. Clinical Administrators serve many roles, including bedside assessments, starting IVs and inserting feeding tubes, and performing afterhours medical records and employee health duties.

Janine’s team began using the RI in 2015, when the hospital started to pilot a Nurse Resource Coordinator role. These nurses respond to code blues, brain attacks, and heart alerts as well as provide hands on critical care in the ED and ICU. They interpret and trend RI scores with the care team during proactive rounding, twice each shift.

Decreasing code blues is possible

Heather reports code blues are down this year, and along with other projects, “PeraHealth has definitely helped.” Janine also reports a dramatic decrease in code blues since 2014. She says contributing success factors include a high-performing nursing team and excellent physician engagement, especially since physicians were the ones who initially rolled out the RI, led by the director of trauma surgery.

The RI helps experienced nurses mentor others

Janine says she uses the RI to train new nurses by “pulling apart target points” on the graph to see why patients are declining. As she explains how the RI uses nursing assessments in addition to vital signs and labs, she says, “It is an empowering moment for nursing when they see their assessment is weighted more heavily…a lightbulb comes on.”

Regarding motivation to use the RI, she adds, “We coach by having a kiosk on each floor near the charge nurse’s desk. Floor nurses know that the experienced charge nurse is going to be asking about the patient if the RI drops.”

Seeing timely response in action builds confidence in the RI and responding staff

Heather shares an example where she helped a progressive care nurse convince a physician to discontinue transfer orders for a patient from the packed ICU to progressive care, because the RI showed a downtrend. The patient remained in the ICU, where he further declined, but received the advanced care there he needed to eventually recover.

Janine shares how she got an RI alert and promptly showed up to assist an overwhelmed floor nurse who said, “I hadn’t thought to call you yet. How did you know I needed an extra set of hands?” She says, “If nurses have had a great experience by having us show up, they will use the RI the next time.”

Many thanks to Janine and Heather for sharing their experiences with the RI.

To learn more about the RI, join us for a live webinar titled, “Rethinking Sepsis: The Promise of Global Clinical Surveillance,” for more on PeraHealth’s approach to getting objective, timely, and effective data to flag patients who warrant closer clinical attention – for sepsis, or any reason.