Akutsjuksköterskans roll är att tillhandahålla omedelbar vård till människor eller att utföra en omvårdnadsåtgärd som kan förhindra att en nödsituation uppstår. Akutsjuksköterskan ska leda, initiera och samordna patientvården. Faktorer som påverkar patientsäkerheten är ledarskapet, att arbeta i team, att arbeta evidensbaserat, kommunikation, utbildning och att arbeta patientcentrerat. Rapid response system (RRS) utvecklades för att förbättra patientsäkerheten inom akutsjukvården. Det finns fyra enheter som är grundläggande för systemet. Den afferenta komponenten som omfattar av sjuksköterskan som ansvarar för identifiering av varningssignaler för kritiskt sjuka patienter och aktivering av RRS. Till sin hjälp har sjuksköterskan ett track- and triggersystem som baseras på patientens vitalparametrar för att identifiera kritiskt sjuka patienter på avdelning. De vanligaste förekommande vitalparametrarna inom akutsjukvården är: respiration, temperatur, blodtryck, hjärtfrekvens, medvetandegrad samt urinproduktion. Den efferenta komponenten är den hjälpinsats som den afferenta komponenten tillkallar vid aktivering av RRS när avvikande vitalparametrar är observerade och genererar hög poängsumma i ett track- and triggersystem alternativt på inrådan av sjuksköterskans instinktiva känsla av att patientens tillstånd försämrats. Syftet var att belysa sjuksköterskans upplevelser av att arbeta utefter ett rapid response system och belysa dess påverkan på patientsäkerheten. Metoden som användes var litteraturöversikt. Databassökningar gjordes i PubMed, CINAHL och Web Of Science, vilket resulterade i att 16 artiklar inkluderades i studien. Inklusionskriterier som användes var att artikeln skulle vara publicerad på engelska, ’peer- reviewed’ och publicerade i vetenskapliga tidskrifter mellan år 2006–2016. En integrerad analysmetod användes för att finna likheter och skillnader i resultatet. I resultatet framkom det att RRS ökade identifieringen av kritiskt sjuka patienter och flertalet artiklar konstaterade att RRS minskade antalet hjärtstopp och oväntade dödsfall. I resultatet framkom svårigheter och begränsningar med att arbeta utefter RRS så som otillräcklig kompetens, hög arbetsbelastning och hierarki. Avvikande vitalparametrar togs mer på allvar jämfört med ”tysta” förändringar. Sjuksköterskorna aktiverade systemet på grund av oro relaterat till klinisk erfarenhet, trots att vitalparametrarna var normala RRS var till hjälp att hantera kritiskt sjuka patienter och fungerade som sjukhusets 112. Avdelningssjuksköterskorna upplevde att de mestadels fick stöttning av det medicinska akutvårdsteamet men tillfällen då sjuksköterskan upplevde otrevligt bemötande påverkade det beslutsfattandet av aktivering av RRS negativt framöver. Slutsatsen av denna litteraturöversikt tyder på att RRS främjar patientsäkerheten och hjälper sjuksköterskan i sitt dagliga arbete genom att främja säker vård. Sjuksköterskans upplevelser belyser gynnsamma omständigheter och upplevda svårigheter med RRS som kan användas till vidare forskning för att utveckla systemet. / The role of the emergency nurse is to provide immediate care to patients or to perform a nursing intervention that can prevent an emergency. They should lead, initiate and coordinate patient care. Factors that affect patient safety could be leadership, working in teams, evidence-based work, communication, training, or patient-centered work. Rapid response system (RRS) was developed to improve patient safety in emergency care. There are four units that are essential for the system to function. The afferent component includes the nurse who is responsible to identify warning signs if the patient is deteriorating and activate RRS. A track-and trigger system based on the patient’s vital signs is used to assist the nurse to identify deteriorating patients on wards. The most common vital signs in emergency care are: respiration, temperature, blood pressure, heart rate, consciousness and urine production. The efferent component is the relief effort that the afferent component calls for by activating RRS when abnormal vital signs are observed and generate a high score in the track-and trigger system. Alternatively, on the advice of the nurse's instinctive feeling that the patient's condition has deteriorated. The aim of this study was to highlight nurses' experiences of applying rapid response system in their work and illustrate its impact on patient safety. The method used was a literature review. Database searches were made in PubMed, CINAHL and Web of Science, which resulted in 16 articles being included in the study. Inclusion criteria used were English language, ’peer-reviewed’ and published in scientific journals between the years 2006-2016. An integrated analysis was used to find similarities and differences in the results. The result showed that RRS increased identification of critically ill patients, resulting in reduced number of cardiac arrests and unexpected deaths and led to more patients being moved to a higher level of care. Difficulties or limitations that emerged were inadequate skills, high workload and hierarchy. Abnormal vital signs were taken more seriously compared to "silent" changes. The nurses sometimes activated the system due to concerns based on their clinical experience, despite vital signs being normal. RRS was a help to manage critically ill patients and served as the hospital's Department 112. The emergency medical team mostly supported the nurses, but sometimes they experienced negative attitudes, which affected the future activations negatively. The conclusion of this literature review indicates that RRS for patient safety could help nurses in their daily work by promoting safe care. The nurse's experiences highlight the favorable circumstances and perceived difficulties with the RRS, which could be used for further research to develop the system.

Prevention of in-hospital cardiac arrest (IHCA) is critical to reducing morbidity and mortality as both the rates of return to pre-hospital functional status and overall survival after IHCAs are low. Early identification of patients at risk and prompt clinical intervention are vital patient safety strategies to reduce IHCA. One widespread strategy is the Rapid Response System (RRS), which incorporates early risk identification, expert consultation, and key clinical interventions to bedside nurses caring for patients in clinical deterioration. However, evidence of RRS effectiveness has been equivocal in the patient safety literature. This study utilized a holistic Realistic Evaluation (RE) framework to identify important clinical environment (context) and system triggers (mechanisms) to refine our understanding of an RRS to improve local patient emoutcomesem and develop a foundation for building the next level of evidence within RE research. The specific aims of the study are to describe a RRS through context, mechanism, and outcome variables; explore differences in RRS outcomes between medical and surgical settings, and identify relationships between RRS context and mechanism variables for patient outcomes. Study RRS data was collected retrospectively from a 397-bed community hospital in the Midwest; including all adult inpatient RRS events from May 2006 (2 weeks post-RRS implementation) through November 2013. RRS events were analyzed through descriptive, comparative, and proportional odds (ordinal) logistic regression analyses. The study found the majority of adult inpatient RRS events occurred in medical settings and most were activated by staff nurses. Significant differences were noted between RRS events in medical and surgical settings; including patient status changes in the preceding 12 hours, event trigger patterns, and immediate clinical outcomes. Finally, proportional odds logistic regression revealed significant relationships between context and mechanism factors with changes in the risk of increased clinical severity immediately following at RRS event. RE was utilized to structure a preliminary study to explore the complex variables and relationships surrounding RRSs and patient outcomes. Further exploration of settings, changes in clinical status, staffing and resource access, and the ways nurses use RRSs is necessary to promote the early identification of vulnerable patients and strengthen hospital patient safety strategies.