Improving Patient Surveillance: Instituting a Respiratory Risk Screening Tool

Purpose:
To share a evidence-based protocol that has been successfully implemented to avert respiratory failure in patients who display signs and symptoms for respiratory compromise and define how to successfully manage moderate and high risk patients with timely interventions.

Significance:
Respiratory failure is a life-threatening condition. As early as eight hours prior to a respiratory failure event, symptoms can be detected warning care providers that the patient is entering a crisis situation.

Strategy and Implementation:
The Respiratory Risk Assessment Tool is embedded within the electronic medical record and has been incorporated into the daily assessment for all patients. A patient's risk of developing respiratory failure is assessed by examining six criteria and assigning a score. Based on the risk score patients are flagged within the system, risk stratified, and interventions are recommended at multiple levels. Critical junctures are defined and interdisciplinary cross-monitoring established to avoid further deterioration. Rapid response teams have been advocated to reduce failure to rescue events, however; our data suggests that the RRST has been successful in rescuing patients even before a rapid response or code blue is called.

Evaluation:
Since the inception of this protocol the number of patients requiring a rapid response, condition H, or code blue failure has been reduced by 77% and no patient has experienced a respiratory related failure to rescue episode.

Implications for Practice:
Nursing has significant influence in patient outcomes and hospital performance. The RRST is easy to use and sensitive in detecting early respiratory failure. Swift recognition of clinical signs and standardizing care through the electronic medical record assists nurses in responding to patients.