Ensuring Rapid Response Team Care Aligns With Patients' Limitations of Medical Therapy A Quality Improvement Project

Background:Rapid response teams (RRTs) are designed to improve patient care during deterioration in clinical condition. Local Problem:Patients' desired limitations of medical therapy (LOMTs) were not documented or communicated to the RRT, and patients received care not aligned with their wishes. Methods:A multidisciplinary team developed a process for improving documentation, communication of LOMTs, and care delivery on 3 medical cardiology units. The team implemented 3 Plan-Do-Study-Act (PDSA) cycles over 6 months. Interventions:In cycle 1, team members taught the unit nurses, RRT members, and physicians to share LOMTs during handoff communications. Cycle 2 engaged case managers in LOMT documentation. In cycle 3, unit-based RRT simulation was conducted. Results:All care delivered by the RRT aligned with the documented LOMTs. Documentation of LOMTs increased from 76% to 82.5% (P = .014). Conclusions:Education, scripting, and simulation were successful strategies to ensure that care given during RRT events aligned with patients' wishes.