Elsevier

Australian Critical Care

Volume 29, Issue 1, February 2016, Pages 46-49
Australian Critical Care

Discussion
Features of an Intensive Care based Medical Emergency Team nurse training program in a University Teaching Hospital

https://doi.org/10.1016/j.aucc.2015.03.001Get rights and content

Abstract

Background

Medical Emergency Teams (METs) involve specialist staff who respond to acutely deteriorating ward patients. There is little literature describing the scope of practice and training of MET responders.

Purpose

To describe and discuss an education and training program for Intensive Care Unit (ICU) nurses who function in a high capability teaching hospital MET.

Findings

The program is overseen and coordinated by four senior nurses. Applicants require at least three years experience working as an ICU nurse in a level 3 tertiary ICU. Each program participant is allocated a mentor and must complete the program within six months. Induction involves attending lectures outlining expected roles, responsibilities and appropriate conduct during MET calls. A course handbook outlines a series of competencies including checking of the MET trolley, assisting endo-tracheal intubation, commencement of non-invasive ventilation and high flow oxygen. Each participant attends the first five MET calls under supervision. A series of case scenarios are discussed and reviewed and an oral examination on two such cases is undertaken prior to completion of the program. Throughout, candidates are trained in their expected roles and responsibilities during MET calls, follow-up of at-risk and deteriorating patients, emergency calls in the mental health precinct, and assisting with procedures outside of the ICU. Emphasis is placed on both technical and non-technical skills.

Conclusions

We have provided a framework for the development of a MET nurse training program. The applicability of this program to other settings and effects of this program on patient outcomes remain unknown.

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)

  • D.A. Jones et al.

    Current concepts: rapid-response teams

    NEJM

    (2011)
  • D.A. Jones 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)
There are more references available in the full text version of this article.

Cited by (0)

View full text