Evidence-based practice shows that early identification and treatment of patient decompensation, in addition to effective use of rapid response teams, reduces unplanned ICU readmissions and out-of-ICU arrests, decreasing hospital LOS and mortality rates.
A need was identified for a formal, specialized educational program to empower progressive care nurses with the knowledge and skills necessary to aid in the early recognition and treatment of patient deterioration. The
Decompensation Assessment, Recognition and Treatment (DART) workshop is a quality initiative that was developed to support progressive care nurses in recognizing:
- signs and symptoms of patient decompensation
- crucial communication skills and role identification
- interventions during acute patient decompensation emergencies
Workshops were offered on a monthly basis at the start of January 2019. The workshop consisted of one 7-hour session, with 8-10 progressive care nurses (medical-surgical and IMCU nurses) utilizing 5 simulation scenarios with debriefing sessions, audience response, hands-on training and lecture.
Topics include respiratory compromise, sepsis, cardiac arrhythmias, neurological changes, vital signs/early warning systems and SBAR/effective communication. A pre and post-test is used to assess clinical knowledge and self-reported confidence in caring for acutely decompensating patients. Additionally, an objective tool is used to measure simulation performance throughout the day.
An analysis of pre/post-test scores found that the overall post-test scores were significantly higher than the pre-test scores. We also found a substantial difference in rapid response utilization pre-implementation and post-implementation. This statistical difference shows the DART workshop increased the use of the rapid response system institutionally.