The effectiveness of a rapid response team (RRT) in preventing further deterioration of patients and decreasing the rates patients require a higher level of care has been presented in research. Hospitals collect data to validate the effectiveness of rapid response teams via outcomes, but the true measurement of this type of team is difficult to measure the actual impact. A team that continues to pour their clinical expertise, energy, care, and love into not only patients but the colleagues that they hold space for when they answer the call for help. We are very fortunate at UC Davis Health (UCDH), to have an Action/RRT Team. There is no other group of people or team quite like the action/rapid response team (which will be shortened to the Action Team in this nomination). The Nursing Supervisors of UCDH have written about the Action Team:

This is a very unique group of nurses that pretty much do everything. They often run short-staffed but continue to keep a positive, easy-going “I’ll do whatever you need” attitude. They run code blue as lead, even over the doctors, and do an amazing job with clear discretion and leadership. They are constantly on the go from one emergency to the next while the rest of the group supports traveling for procedures, help with lab work/ lab draws and putting in IVs for the most difficult patient. I am in awe when I watch them work. I am not sure if they have ever been nominated [for the DAISY Award], but if not it is long overdue.

Through the years, the Action Team has been an invaluable resource that touches every aspect of UCDH. There truly isn’t any area that they do not touch, whether it’s acute care to critical care, ED to GI lab, radiology to the cancer center, and inpatient and outpatient areas. The Action Team possesses skills that no other Registered Nurses have combined. They are constantly triaging and prioritizing calls whether from difficult IVs on a pediatric patient who has already had 15 pokes, to an adult patient experiencing shortness of breath on an acute care unit. This past year of 2020-2021 has been trialing for every healthcare provider, but it has been especially difficult for the Action Team. The UCDH Action Team not only acts as the rapid response in the acute care specialty units, but they also provide essential and emergent support to the sepsis alerts, Code Strokes, and Code Blue, as well as continued increase support to PIV’s and lab draws.

Additionally, they support the transport of patients within the main hospital and to outlying clinics. They are also called upon to help with lunch and break relief, or a resource for units that are short-staffed. In a time when most healthcare providers are experiencing moral distress, the Action Team continues to provide physical, psychological, and emotional support even when they’re also experiencing burnout from the pandemic.

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An MRI tech wrote the following to one of our departmental ANII’s:

Surprisingly, I believe the Action Team is truly worthy of recognition because of things that they Did Not do. During this past year, which has been crazy and difficult beyond anything anyone has seen in decades, your nurses did not run and hide. They did not try to get out of taking care of COVID patients. They did not find excuses when things got hard. They did not falter in any way that I could discern. They also deserve recognition for something they Did do.

During the early, fearful days of COVID-19, they did their jobs, and they were brave. They made me feel brave. They made others feel brave. They led from the front. In the military, there are unit citations which are a formal, honorary mention by the high authority of a military unit's specific and outstanding performance, notably in battle. I think your team qualifies. The Team has received various recognitions from the different units and departments they support each day. Below are a few examples of what has been received:

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In the midst of persistent low-level (or maybe at times mid-level) crisis thank you for your dedication to your "real job," but also for giving a genuine picture of life at UCDH with humor and poignancy, by introducing newly hired nurses to the Rapid Response/Action Team.

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I just wanted to gloat about the wonderful care and response that your team provided to me this past Friday when I fell acutely ill in the South 1 area. They helped me and escorted me from the DRA to the CT scanner and started my IV. He is fabulous and has wonderful bedside manner. Please extend my deepest thanks for his help. I am also hoping that if there were other nurses that responded to the event to thank them as well.

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During rounds, one of our patients wished to specifically recognize you and the care you provided him. We are pleased to share this wonderful compliment with you on his behalf and thank you for your commitment to our patients. The verbatim compliment: “The Action Nurse was really great and stands out to me as someone deserving of recognition.”

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I Just wanted to send a note to tell you how much I appreciate the Action Nurse team and all the assistance they have provided to the ED over the years. I would also like to thank you for the help yesterday in providing great patient care in the ED with two procedure sedations on a very busy day. Our patients benefit from all the excellent care your team provides.

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Thank you so much for all of your help with my coding patient! You literally walked in and made everything better. You were calm, cool, collected, and communicated. Your presence literally made all the difference. Thank you so much for always making a point to check on us. You are so nice and I am so grateful to work with you!

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To everyone that helped during the Code Blue on North 3 Vascular Access Unit, we wish to extend a huge Thank You! A code is always a stressful time especially in our small unit that is set away from the rest of the hospital, we appreciate that we have friends and neighbors who are so willing to help in emergent times. The room was full to capacity and we wish to thank everyone so please forgive me if I don’t mention your name, however, there are some individuals that require a shout-out for going above and beyond. Rapid Response/Code Team: Thank you for your quick response and diligence throughout the code. You all exhibited the utmost professionalism. You were assertive yet kind and provided positive and constructive feedback.

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Whenever we have an emergency on the unit, the Action Team comes to help and makes the staff feel at ease. They are so smart, thorough, approachable, and always willing to help. Thank you for all you do! I hope you know how much everyone appreciates you! Thank you especially for assisting with my stroke alert and my end of shift blood cultures. You are a rock star!

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I would like to send the most amazing and thankful shout-out to the Action Team. Last week while working my first shift on S1 I had one of the most difficult shifts I've had in quite a while. One of my patients went into septic shock and I spent the entire day attempting to keep him stable. The Action Nurse assisted me with the rapid response and checked in on my patient and myself several times during the day. She was so incredibly helpful and I would like her and you all to know that I am so thankful! We have such a fantastic team!

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Thank you for all your expertise and help with my rapid response! I appreciate all of the help you gave me and my patient!

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Today you weren't just a Nurse, today you showed compassion to a patient that should be recognized. This patient has been here for about 30 days or more and his wife is a patient here in the hospital as well, so he hasn't seen her, only on FaceTime. After his procedure, you made it a point to take him to see his wife (bed and all) on another floor. He was so happy. You didn't have to do that and he and his family will always remember that. So, thank you again for being such an awesome Nurse and an amazing human being!

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Thank you all so much for helping us in the GI Lab during an emergency with our patient. You all stepped in and help us stabilize him and take him to the CT. We are grateful for your assistance. I wanted to also acknowledge the Action nurse and thank her for me. May God continue to bless your hands of healing.

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Thanks a million for always coming to help us, when our patients show early signs of deterioration. We are so lucky to have the most qualified Rapid Response Team!

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Thank you all for your teamwork in providing the best care possible during an emergency

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Due to the impact that the Action Team has in all areas of UCDH, I believe that when you uplift the Action Team, the rest of UCDH healthcare providers are also uplifted. The Action Team provides the calm, steady presence in a storm of clinical uncertainty. They are the listening, reassuring presence to the many nurses who express desire to leave the profession. • Data o Stroke  The Action Team is required to respond to all Code Strokes. • 2019 – 855, ED and Inpatient Stroke Alerts • 2020 – 840, ED and Inpatient Stroke Alerts • 2021 – 606, ED and Inpatient Stroke Alerts. The Action Team played a tremendous role in UCDH obtaining the Comprehensive Stroke, designation. The team has supported switching from tPA to TNK, and all team members are certified in mixing and administering it in the event the pharmacist is not able to be present. Involved in quality improvement discussions in terms of improving patient outcomes for “brain code” in collaboration with Neuro, starting fluids such as mannitol, 3% NaCl, 23.4% hypertonic solutions. o Sepsis. The Action Team responds to 5-6 of SAM/Sepsis alerts each day, providing supportive care in an attempt to keep the patient on the Acute Care Unit.  The Sepsis mortality index (Observed/Expected) has continued to decrease • 2019 – O/E 1.13 • 2020 – O/E 1.06 • 2021 – O/E 0.84 o Rapid calls  The number of Rapid Response calls have continued to trend upward. • 2020 – 166 calls per month • 2021 – 238 calls per month o Code Blue  The Action Team responds to 100% of the Code Blue events. • 2019 – 363 Code Blue Events • 2020 – 211 Code Blue Events • 2021 – 120 Code Blue Events (January- July) o Ultrasound Guided PIVs Project  100% of the Action Team attended the US guided PIV class, and several continue to support the teaching of this class. o PIV/Lab Draws  The Action Team has continued to increase the number of PIVs/Lab Draws they have supported. • 2019 – 658 per month • 2020 – 877 per month • 2021 – 1154 per month.

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I am one of the evening shift MRI techs and I frequently work with your team members. As someone outside of your department, I see and hear things that you do not, but I believe you should. Your team members operate at a very high level of proficiency, take a great personal interest in the quality of medical care they provide their patients and are experts in many aspects of their job, but this is not what makes them special. Your nurses communicate clearly and concisely with patients, technologists, physicians, other nurses and prevent many problems before they even happen, likely due to their extensive experience with every department in the hospital. Again, this is not new information to you and should probably be expected of a solid Action Nurse. I trust your nurses outright, no exceptions.

I have witnessed several times your staff respond to an emergency, instantly assess the situation, and then calmly and confidently guide everyone through what needs to be done. It's an amazing thing to witness. I want to thank Jeff Cryder for teaching me how to stay calm when things go wrong and don't make sense, Bruce Gittings for explaining how knowledge always beats fear, Susan Gourley for telling me exactly what to do in an emergency, Lorie Hobart for always being ready to bring patients down at a moment's notice, Heather Jones for always bringing calm and assigning roles, Alicia Kempenaan for being excessively positive, Taufa Lee for being patient with me, Amy Logsdon for her balanced approach to issues, John Mofidi for telling me to hurry up, Trevor Morton for making his patients feel like they are absolutely the coolest people ever, Tony Perez for teaching me to read between the lines of a situation and occasionally making me laugh until my ribs hurt, Sean Perkins for having his ultrasound vein finder attached to him at all times and his ever-present self improvement books, Malia Ryman for her tutelage in speaking professionally in difficult situations, Stefanie Stewart for her laid back confidence and can do attitude and Efren Verso who holds the record for shortest response time when called for help. I'm sure I am forgetting someone, please forgive me. Finally, Mr. Rose, even though I've never met you, I should thank you as well. I don't know how long you have headed up this section, or how many of the nurses you hired personally, but I don't think so many great people were assembled by luck!