Clinical Exemplar 1

Clinical Exemplar Paper

Megan R. Hargraves

University of South Florida

Clinical Exemplar 2

Clinical Exemplar Paper

Rapid response systems are among the most common systems used across the world to

recognize and treat patients who are rapidly deteriorating. According to Smith et al., (2019),

there is an intense statistical relationship between making timely calls to rapid response teams

and situations that result in death and cardiac arrest. This reflection aims to identify a clinical

situation in which a rapid response was a necessary to ensure the safety of a client. It will reflect

upon the decisions made prior to calling the rapid response, the decisions made during, and an

evaluation of the clinical outcome once the client was stabilized.

Clinical Situation

On September 10th, 2023, as a level four nursing student, I was able to participate in a

Rapid Response on a patient who was experiencing frequent run-ons of ventricular tachycardia.

To give some background information on the situation, this patient had been transferred to the

unit I was precepting on, only 10 minutes prior to the rapid response being called. The patient

had been experiencing some shortness of breath and “heart-fluttering” and opted to go to the

free-standing emergency room. Upon arrival to the main hospital, my preceptor and I received

report from the free-standing hospital, but there was no mention of the patient ever experiencing

any ventricular tachycardia.

Noticing

Once the patient was settled in the room on the unit, they were immediately connected to

telemetry, continuous pulse oximetry, and blood pressure readings. While the patient did not

report shortness of breath or chest pain, they did receive two liters of supplemental oxygen via

nasal canula due to the patient reporting “dizziness”. No issues were apparent until the team was

not able to obtain a blood pressure reading on the patient via Dynamap. A blood pressure was
Clinical Exemplar 3

attempted three times via Dynamap until a manual blood pressure was taken. The manual blood

pressure was elevated but the number was not concerning, as the patient did have a history of

hypertension and notified the nursing staff that they had not taken their blood pressure medicine.

Interpreting

Throughout this process, the patient was calm but did appear to be becoming anxious due

to the alarm that was now identifying ventricular tachycardia on the telemetry monitor. Once this

arrythmia was identified, a rapid response was called. The PA on call was notified and my

preceptor and I requested that he come assess the patient immediately. Without the client having

any prior cardiac history, it was difficult to understand what may have been causing this

abnormal heart rhythm. The free-standing hospital had completed the clients chemistry

screenings prior to their arrival to the main hospital and the client’s Troponin came back as

within normal range.

Responding

The rapid response team arrived within five minutes and immediately asked for an EKG

and an order for a beta-blocker from the provider on call. An EKG was completed; however, I

took it upon myself to complete this task without much experience doing so. This task took me

longer than it should have and may have delayed the process of stabilizing the patient. During

this time, my preceptor and I were not the delegator’s, we were the delegatee’s. This made the

process flow smoothly and allowed the rapid response team to directly communicate with the PA

and develop a plan quickly.

Reflecting

After the patient was stabilized and able to be transferred, I was able to reflect on the

events that occurred and speak with the rapid response nurse about how I can improve when
Clinical Exemplar 4

these situations arise in the future. After reflecting on the steps taken in this situation, the most

important takeaway was understanding my prior knowledge of the situation and ability to take

care of the situation prior to calling the rapid response. However, it is also important to

understand that if the rapid response was not called in a timely manner, additional harm may

have been caused. This is especially important to consider when evidence suggests that older

patients are at an increased risk for receiving delayed activation for rapid responses due to

traditional signs of deterioration that are not easily recognizable in this population (Fernando et

al., 2018).

All things considered, my biggest take away from this situation and my “ah ha” moment,

was completing an ECG once the rapid response is called. Having this step completed prior to

the rapid response team arriving allowed them to do their job faster and identify additional

complications the client may be experiencing. I can anticipate the provider ordering in this

situation and I realized the importance of completing the ECG tracing in a timely manner when

the rapid response team arrived. Every situation is going to have a different priority depending

on the client’s status, but during this semester especially, I have often found asking, what can I

do for this patient as a nurse?

Overall, I learned a lot from this situation. My “ah ha” moment was not dramatic, but it

was a reminder that there are things I can do as a nurse to help facilitate situations that need to be

handled in a timely manner. In any emergent situation, especially the first time experiencing

something like this, it can be overwhelming. I am confident in saying that I stayed calm and tried

to think about the “what-if’s”. For example, what if this patient does not come out of the rhythm.

Or, what if this patient becomes unresponsive? I wanted to prepare myself for what could

happen.
Clinical Exemplar 5

Conclusion

There are many different outcomes that could have emerged from this situation.

Thankfully, the patient was stabilized and was able to be moved to a unit that could better serve

her immediate needs. Without timely noticing, interpretation of vital signs and arrythmias, and

responding in a timely manner, the patient could have suffered serious outcomes such as cardiac

arrest. This situation highlights the importance of understanding one’s scope of practice and

anticipating outcomes.
Clinical Exemplar 6

References

Fernando, S. , Reardon, P. , McIsaac, D. , Eagles, D. , Murphy, K. , Tanuseputro, P. , Heyland, D.

& Kyeremanteng, K. (2018). Outcomes of Older Hospitalized Patients Requiring Rapid

Response Team Activation for Acute Deterioration. Critical Care

Medicine, 46 (12), 1953-1960. doi: 10.1097/CCM.0000000000003442.

Smith, D., Sekhon, M., Francis, J. J., & Aitken, L. M. (2019). How actionable are staff

behaviours specified in policy documents? A document analysis of protocols for

managing deteriorating patients. Journal of Clinical Nursing, 28(21-22), 4139–4149.

https://doi.org/10.1111/jocn.15005