ACT (Assessment Consultation Team)

1. ACT(Assessment Consultation Team) • Outcome • To rescue patients by providing early and rapid intervention • Promote improved outcomes • Reduced cardiac and/or respiratory arrests • Reduced or more timely transfers to ICU • Reduced emergent intubations • Reduced number of deaths • Reduced overall length of stay (LOS), etc.

2. ACT Members • Critical Care RN (ICU) • Respiratory Therapist • Primary Care Nurse

3. ACT Goal • Provide a multidisciplinary assessment team to implement early assessment and rapid intervention • Provide care in collaboration with the primary care provider to promote effective efficient patient management • Improved patient outcomes

4. ACT Availability • ACT will be available 24/7 to all patient care areas excluding: • ICU • CVICU • ED • L&D • NICU • Pediatric Patients • OR Areas • PACU

5. Criteria For Calling ACT • Acute or trending change in HR • Acute or trending change in BP • Acute or trending change in Respiratory Status • Acute change in LOC (Level of Consciousness) • Acute Bleeding • Failure to respond to current treatment for acute problem/symptom • Staff member concerned/worried about the patient

6. Activating ACT • Pager (327-9111) • Enter phone extension at the location • May call the ICU immediately after paging if necessary (ext. 6600) • ACT response time goal • Five minutes

7. Critical Care RN Responsibilities • Review/Clarify situation, background and assessment of the patient • Collaborate with primary care nurse in reassessment of patient • Institute interventions as per approved protocol or through verbal physicians orders • Speak with physician as necessary about situation and evaluation of patient for any further orders • Assure family/significant others are updated • Assist/facilitate with transfer to higher level of care if indicated

8. Respiratory Therapist Responsibilities • Provide Respiratory Assessment • Implement treatment per approved protocol as determined through assessment findings in collaboration with ACT RN and Primary Care Nurse • Notify physician for further orders as needed • Assist with facilitation of transfer to higher level of care if indicated

9. ACT Protocol (Respiratory) • Initiate Pulse Oximetry • Start 02 @ 2-4 L/m if Sp02 < 90% • Goal 90-92% or 88-89% if known C02 retainer • Stat neb tx with 0.5cc Albuterol/2.5cc NS • May add 0.5mg Atrovent if indicated • ABG’s for respiratory distress or  Sp02 • Place oral or nasopharyngeal airway & suction PRN if airway compromised • Initiate BI-PAP per RT Protocol if pH 7.2-7.3

10. Primary Care Nurse • Assist with patient assessment • Provide current and historical information on patient status • Provide reason/concern for activating ACT • Assist in obtaining necessary equipment or medications • Remain with patient and ACT until patient stable or relieved of their responsibility

11. Documentation • ACT Response Record • Completed per Nursing Staff • Respiratory Therapy documentation • Via Computer

12. Designated ACT Therapist • Most senior therapist in ICU • Page will come across the 327-7975 ICU pager • Must be validated in intubation

13. Code Gray • Code Gray has been incorporated with ACT • ACT RN will initiate Code Gray if indicated • ACT RN and Therapist will already be at bedside

14. ACT Trial • January 30th 2006 • Trial Areas • Respiratory Stepdown • Family Practice • Medical Stepdown