Unique Plan Description: RRT Protocol
Plan Selection Display: RRT Protocol
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2020-04-20 23:36:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-07-31 21:23:30
Available at all facilities: Yes

RRT Protocol
Laboratory
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
			Comment: If suspect electrolyte imbalance, cardiac chest pain, pleuritic chest pain, dyspnea, or sepsis. Ordered per Rapid Response Team Protocol
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
			Comment: If suspect electrolyte imbalance, cardiac chest pain, pleuritic chest pain, dyspnea, or sepsis. Ordered per Rapid Response Team Protocol
	.Culture Blood.
		T;N, Stat, spec type = Blood
			Comment: If suspect sepsis. Ordered per Rapid Response Team Protocol
	.Culture Blood
		T;N, Stat, spec type = Blood
			Comment: If suspect sepsis. Ordered per Rapid Response Team Protocol
	Procalcitonin
		T;N, Stat, spec type = Blood
			Comment: If suspect sepsis. Ordered per Rapid Response Team Protocol
	Magnesium Level
		T;N, Stat, spec type = Blood
			Comment: If suspect electrolyte imbalance, arrhythmias. Ordered per Rapid Response Team Protocol
	Phosphorus
		T;N, Stat, spec type = Blood
			Comment: If suspect electrolyte imbalance, arrhythmias. Ordered per Rapid Response Team Protocol
	ProBNP
		T;N, Stat, spec type = Blood
			Comment: If suspect fluid overload. Ordered per Rapid Response Team Protocol
	B-Type Natriuretic Peptide - FH
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
			Comment: Per respiratory protocol if :  SpO2<91% on greater than or equal to 6 L of O2, tachypneic > 30 breaths/min,respiratory compromise, suspected acid base disturbance, increased lethargy or change in LOC with suspected hypoventilation, unknown oxygenation status when unable to obtain pulse oximetry, suspected hypercarbia with LOC or vital sign changes. Ordered per Rapid Response Team Protocol
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	Complete Blood Count and Diff
		T;N, Stat, spec type = Blood
			Comment: If suspect cardiac chest pain, pleuritic chest pain, dyspnea, or sepsis. Ordered per Rapid Response Team Protocol
	Hemoglobin and Hematocrit
		T;N, Stat, spec type = Blood
			Comment: If suspect anemia and with acute hypotension or other related s/s (tachycardia, syncope, acute SOB-new or worsening, marked tachypnea), or suspect anemia due to bleeding or hemorrhage. Ordered per Rapid Response Team Protocol
	Lactate
		T;N, Stat, spec type = Blood
			Comment: Per respiratory protocol if suspect acid base disturbance and change in LOC or vital signs, suspected sepsis (based upon screening tool). Ordered per Rapid Response Team Protocol
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
			Comment: If suspect cardiac chest pain, pleuritic chest pain, or dyspnea. Ordered per Rapid Response Team Protocol
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
			Comment: If suspect cardiac chest pain, pleuritic chest pain, or dyspnea. Ordered per Rapid Response Team Protocol
		T;N, Stat, spec type = Therapeutic Blood
			Comment: If suspect cardiac chest pain, pleuritic chest pain, or dyspnea. Ordered per Rapid Response Team Protocol
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
			Comment: If suspect cardiac chest pain, pleuritic chest pain, or dyspnea. Ordered per Rapid Response Team Protocol
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
			Comment: If suspect cardiac chest pain, pleuritic chest pain, or dyspnea. Ordered per Rapid Response Team Protocol
	hs Troponin I - FH
		T;N, Stat, spec type = Blood
			Comment: If suspect cardiac chest pain or pleuritic chest pain. Ordered per Rapid Response Team Protocol
	hs Troponin T - MH/WH/JE
		T;N, Stat, spec type = Blood
			Comment: If suspect cardiac chest pain or pleuritic chest pain. Ordered per Rapid Response Team Protocol
		T;N+120, Timed, spec type = Blood
			Comment: If suspect cardiac chest pain or pleuritic chest pain. Ordered per Rapid Response Team Protocol
	UA (Culture Pos)
		T;N, Stat, Stat, spec type = Urine
			Comment: If suspect sepsis. Ordered per Rapid Response Team Protocol
Point of Care
	Blood Gas 1 Nurse Collect - RN
		T;N, Once
			Comment: Ordered per Rapid Response Team Protocol
	Chem 7 Nurse Collect - RN
		T;N, Once
			Comment: Ordered per Rapid Response Team Protocol
	WB Triage Panel Nurse Collect - RN
		T;N, Once
			Comment: Ordered per Rapid Response Team Protocol
	WB Triage Panel  without Gases Nurse Collect - RN
		T;N, Once
			Comment: Ordered per Rapid Response Team Protocol
	WB Glucose Nurse Collect - RN
		T;N, Once
			Comment: Ordered per Rapid Response Team Protocol
Diagnostic Tests

	Chest 1 View
		T;N, Stat, Chest Pain
			Comment: If not completed within past 24 H, call for stat overread (if overnight call on-call Radiologist). Ordered per Rapid Response Team Protocol
		T;N, Stat, Dyspnea
			Comment: If not completed within past 24 H, call for stat overread (if overnight call on-call Radiologist). Ordered per Rapid Response Team Protocol
	ECG
		T;N, Stat, Indication: Chest Pain of Uncertain Etiology
			Comment: Call on-call Cardiologist for STAT overread, unless cardiologist already on case if initial interpretation is abnormal or questionable. Ordered per Rapid Response Team Protocol
		T;N, Stat, Indication: ACS Rule Out
			Comment: Call on-call Cardiologist for STAT overread, unless cardiologist already on case if initial interpretation is abnormal or questionable. Ordered per Rapid Response Team Protocol
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, STAT, 1 Dose(s)/Time(s), 999 ml/hr
			Comment: Bolus 500mL, over 15 min, if SBP<90 and/or MAP<65 with suspected volume depletion or sepsis and no history of renal failure. Ordered per Rapid Response Team Protocol
Medications
	Tylenol
		650 mg, Tab, By Mouth, Once, PRN, temperature >  (see comment), STAT
			Comment: 102.00 Ordered per Rapid Response Team Protocol
		650 mg, Suppository, RECTALLY, Once, PRN, temperature >  (see comment), STAT
			Comment: 102.00 Ordered per Rapid Response Team Protocol
	Ativan
		1 mg, Injection, IV Push, Once, STAT
			Comment: If suspect ETOH withdrawal. Ordered per Rapid Response Team Protocol
	Dextrose 50%
		25 mL, Injection, IV Push, Once, STAT
			Comment: per hypoglycemia protocol. Ordered per Rapid Response Team Protocol
	morphine  IV
		1 mg, Syringe, IV PUSH, Once, STAT
			Comment: If suspect cardiac chest pain. Ordered per Rapid Response Team Protocol
	Narcan
		0.4 mg, Injection, IV Push, Once, STAT
			Comment: per naloxone protocol. Ordered per Rapid Response Team Protocol
	nitroglycerin
		0.4 mg, Tab, SUBLINGUAL, Q5MIN, PRN, chest pain, STAT, 3 Dose(s)/Time(s)
			Comment: If suspect cardiac chest pain, if SBP > 90, and if ECG does not show right heart ischemia. Ordered per Rapid Response Team Protocol
	racepinephrine 2.25% inhalation soln
		0.5 mL, Solution-Nebulization, NEBULIZED, Once, STAT
			Comment: If dyspnea with stridor. Ordered per Rapid Response Team Protocol
	flumazenil
		0.2 mg, Injection, IV Push, Once, STAT
			Comment: if patient has received benzodiazepine agent in the past 24 hours and patient becomes somnolent with minimal OR no response to stimuli or respiratory rate is <or= 10 bpm. Ordered per Rapid Response Team Protocol
	EPINEPHrine
		0.5 mg, Injection, IM-Intramuscular, Q10MIN, PRN for anaphylaxis, duration: 3 Dose(s)/Time(s)
			Comment: If suspected anaphylaxis. Ordered per Rapid Response Team Protocol.
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, STAT
			Comment: If dyspnea without chest pain, pleuritic chest pain. Ordered per Rapid Response Team Protocol
Patient Care
	Notify MD
		T;N, Notify Primary Provider and Surgeon with a phone call that a RRT has occurred. Notify any Specialist Providers as appropriate with phone call that a RRT has occurred
			Comment: Ordered per Rapid Response Team Protocol
	Glucose POC - RN
		T;N, Once
			Comment: if suspect hypoglycemia. Ordered per Rapid Response Team Protocol
	Initiate MD Plan for:
		T;N, Hypoglycemia protocol if blood sugar <70.
			Comment: Ordered per Rapid Response Team Protocol
Therapies
	Nasotracheal Suction-RT
		T;N
			Comment: when unable to complete oro-pharyngeal suctioning if: secretions present that compromise airway and pt cannot cough effectively to remove secretions.  Exclusion:  Recent sinus surgery or craniofacial surgery. Ordered per Rapid Response Team Protocol

Oxygen Protocol
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

RRT Dynamic Assessment of Fluid Responsiveness
IV Solutions

	Sodium Chloride 0.9% Intravenous Solution (Bolus)
		500 mL, IVPB, STAT, 1 Dose(s)/Time(s), 1 hr
			Comment: Perform Fluid Bolus Challenge Test Infuse over 5 min, for 1 Dose/Time per instructions outlined in attached reference text, for specific device being used
		Fluid Bolus Challenge Test Reassessment(NOTE)*
	Sodium Chloride 0.9%
		250 mL, IV, STAT, 1 Dose(s)/Time(s), BOLUS, 5 min(s)
			Comment: Perform Fluid Bolus Challenge Test. Notify MD: Stroke Volume (SV), or Stroke Volume Index (SVI) for further fluid order recommendations (>10% fluid responsive - needs more fluids, <10% not fluid responsive - no more fluids, think pressors, <0% fluid overload - think diuretics)
Patient Care
	Passive Leg Raise
		
	Notify MD
		Stroke Volume (SV), or Stroke Volume Index (SVI) for further fluid order recommendations  	(>10% fluid responsive - needs more fluids, <10% not fluid responsive - no more fluids, think pressors, <0% fluid overload - think diuretics)

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase