DiscussionFeatures of an Intensive Care based Medical Emergency Team nurse training program in a University Teaching Hospital
Introduction
Rapid Response Teams (RRTs also known locally as MET) have been introduced into hospitals worldwide to improve the identification and timely management of deteriorating ward patients.1 Australia was an early adopter of this model of care as METs, which is now a mandatory requirement for all acute hospitals.2 Intensive Care Unit (ICU) nurses3 and ICU liaison nurses3, 4 are frequent participants in METs, and many hospitals are now seeing more than 450 calls annually.5
Despite this, there is relatively little research describing the role of ICU nurses within the predominant Australian model of physician-led METs. In addition, there are no published guidelines to describe the necessary skill set, reasonable scope of practice or training requirements for nurses who participate in the MET.
The recent 2014 Australian and New Zealand Intensive Care Society (ANZICS) conference on the role of Intensive Care with RRTs provided data and narrative from MET experiences, with considerable interest surrounding the education of nurses involved. The purpose of this communication is to provide a brief description of the pre-requisites for application, expected roles, responsibilities and methods of training and assessment for ICU nurses wishing to participate in the MET within our ICU. We hope that this will promote discussion and contribute to the development of guidelines and educational material in this area and a new body of knowledge.
Section snippets
Hospital setting and details and emergency response systems
Austin Health is a tertiary level teaching hospital in the north of Melbourne, Australia. It has a total of 980 beds, including more than 500 acute care beds and is a statewide referral centre for spinal cord injuries, chronic ventilatory failure, and liver transplant medicine. There is also a co-located mental health precinct as well as separate campuses for low risk elective surgery and rehabilitation. Navigation to the co-located Olivia Newton John Cancer and Wellness Centre (ONJCWC) takes
Overview of MET nurse training
The Austin ICU implemented our first MET program in 2007 which was coordinated by the Nurse Unit Manager (NUM) and a number of Clinical Nurse Specialists. This resulted in approximately 50 current staff being accredited. A re-launch of the program provided by a “MET panel” of four senior ICU nurses commenced in September 2011 to provide greater governance and a more supportive training focus for the program. The new course was introduced in response to a substantial increase in the number of
Expected roles and responsibilities of the MET nurse
The MET nurse is expected to carry out a variety of roles and responsibilities (Table 1). We included these skills as essential components of the MET nurse training program as we found them to be important elements in our first 10 years of running a Rapid Response System. This list was developed and revised in consultation with the 50 existing MET nurses who collectively had seen 10,500 MET calls before revising the program.
Expected skill set of the MET nurse
All MET nurses are expected to have a comprehensive knowledge of Austin Health protocols and procedures in relation to the MET, EMR and Respond Blue calls. The expected skill set of the MET nurse falls into the domains of clinical performance and technical skills, professional behaviours, interpersonal and non-technical skills (Table 2).
Eligibility and application process for MET program
All applicants should have at least three years of post-graduate experience in a level 3 tertiary ICU, based on feedback from existing ICU MET nurses who suggested that commencing the role before this period was excessively challenging. They must provide a one page typed expression of interest as application to the team and have at least one ICU associate nurse unit manager as referee. All applications are assessed in conjunction with the ICU NUM with intakes during March and September over the
Details of MET program
Successful candidates choose at least one MET nurse mentor from the pool of senior ICU MET nurses. Each is given a handbook outlining requirements and competencies (Table 3) and is expected to complete the program in approximately six months. The nature of the mentor–mentee combination is not formalised and depends on the needs of the candidate.
The MET lecture outlines roles and responsibilities of the MET nurse as well as background and rationale of our MET service. The MET behaviour workshop
Details of MET program candidate completion
We have now completed four programs, with eight participants in the first program and six in the subsequent three programs. One nurse temporarily withdrew from the program and an additional nurse required an extension beyond the six month period. Of the 75 nurses accredited to attend MET calls, 25 have completed the revised MET program that commenced in 2011. At the end of the program the MET nurses complete an evaluation form containing seven Likert agreement scale questions with a section for
Impressions and recommendations
In the context of our current resources and workload it is burdensome to support eight participants through a program, and we now recommend only six nurses be enrolled each time. Despite education and training, sub-optimal behaviour occasionally required feedback during the initial phase of the program. Many ICU nurses desire to be a MET nurse for variety in their daily work, increased responsibility and autonomy, and to challenge themselves clinically and professionally. Many consider the
Authors’ contributions
MT, BR, DB, and R. Mck are the key MET leaders at Austin Health who conceived the concept of a structured education program and teach this regularly.
DJ and IB provided liaison consultation and advice, academic support, and helped in writing of this paper.
JR, IB, DJ contributed to the editing and writing of the final manuscript.
All authors approved the final article and acknowledge the contributors accordingly.
References (7)
- et al.
Current concepts: rapid-response teams
NEJM
(2011) - et al.
Deteriorating patients in hospital: the need for a paradigm shift
MJA
(2012) Rapid Response Team composition, resourcing and calling criteria in Australia
Resuscitation
(2012)