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RRT Form

This document is a form used by a rapid response team to document a medical emergency. The form includes sections for situation, background, assessment, recommendations, treatments given and outcomes. It requests key details about the patient, caller, vital signs and interventions by the rapid response team.

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jepa kripa
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524 views1 page

RRT Form

This document is a form used by a rapid response team to document a medical emergency. The form includes sections for situation, background, assessment, recommendations, treatments given and outcomes. It requests key details about the patient, caller, vital signs and interventions by the rapid response team.

Uploaded by

jepa kripa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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RAPID RESPONSE TEAM FORM

Name of Patient: MRN: Nationality:


Age & Sex: / Department: Bed # Consultant Name:

Caller:_______________________ Date:__________ Time Called: ________ Arrival Time: _______ Time Event Ended:_______

(S) Situation: RAPID RESPONSE TEAM INTERVENTIONS:


Staff concerned/ worried AIRWAY/ BREATHING CIRCULATION
Specify: Oral Airway IV Fluid Bolus
________________________________________________ Suctioned Blood
Nebulizer treatment ECG
HR less than 40 HR greater than 130 Intubated CPR
SBP less than 90 mmHg Acute mental status change NPPV Defibrillation
RR less than 8 RR greater than 24 Bag Mask Cardioversion
SpO2 less than 90% FiO2 50% or greater O2 mask/ nasal No intervention
Acute significant bleed Seizures ABG
Change in Urine Output to <50 ml in 4 hours CXR
(B)Background No intervention
Other interventions:
Admitting Diagnosis: ________________________________________ _________________________________________________
_________________________________________________
Possible contributing factor/s to present situation:
_________________________________________________
Current medication: ____________________________________ _________________________________________________
Allergy status:__________________________________________ Medication(s):
Lab results: ____________________________________________ Dose Route
Name Frequency
Latest procedure/ treatment: _____________________________
_______________________________________________________
Others, specify __________________________________________
_______________________________________________________
_______________________________________________________

(A)Assessment
BP ___________ HR______ RR______ Temp_______ SpO2 _______ Outcome:
Stayed in room Transferred to HDU
The problem seems to be _________________________________ Transferred to ICU
Other, specify_____________________________________________
__________________________________________________________________
_____________________________________________
___________________________________________________________
Rapid Response Team (RRT) Recommendations:
(R) Recommendation _________________________________________________
Treatment _____________________________________________
_________________________________________________
Tests __________________________________________________ _________________________________________________
Other, specify __________________________________________ _________________________________________________
_______________________________________________________
_______________________________________________________ RRT Leader: __________________________________________
Notify Treating Physician: ________________ Time: _________ Team Stamp &Signature:
Members:________________________________________
Notifying Staff: ____________________________________________ _____________________________________________
Stamp & Signature _____________________________________________

Date: ____/____/_____Time: _________ Date: ____/____/_____Time: _________

QPS

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