Professional Documents
Culture Documents
Caller:_______________________ Date:__________ Time Called: ________ Arrival Time: _______ Time Event Ended:_______
(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 _____________________________________________
QPS