National Nursing Ebook Continuing Education

a crisis (Gaba et al., 2001). As this topic gained more attention through continued analysis of unexpected adverse events that negatively impacted patient outcomes, it was revealed that all teams who responded in crisis situations needed to be educated and trained in the behaviors that lead to improved and effective responses. Although crisis resource management (CRM) in healthcare first started in complex areas, such as operating rooms and emergency departments, these skills apply to all healthcare team members. For example, educational programs that focus on CRM and team interactions have been used in obstetrics training for emergent delivery and maternal cardiac arrest (Bracco et al., 2018). CRM training has improved team dynamics and performance in pediatric rapid response teams (Siems et al., 2017) and improves leadership, problem-solving, situational awareness, and communication in trauma and emergency teams (Parsons et al., 2018). CRM is defined as a set of behaviors that can reduce adverse events during emergencies when combined with skills and evidenced-based knowledge (Corey & Canelli, 2018). When teams incorporate teamwork and communication interventions in response to emergencies, this core set of behaviors results in an effective and improved response, including improved patient High-acuity and low-volume crises are areas where healthcare providers have historically demonstrated gaps in knowledge and practice necessary to respond efficiently and effectively. The Institute of Medicine report “To Err is Human: Building A Safer Health System,” published in 2000, prompted health systems to look at internal response processes, identify areas where human factors could cause patient harm, and strategize for implementing training and systems improvements to prevent Components of the CRM framework There are multiple components in the CRM framework that, when combined and implemented, lead to an effective team response. The behaviors are classified in multiple realms: ● Team management - Leadership and followership, role clarity, and workload distribution. ● Communication - Task-oriented and information sharing. ● Resource allocation and environmental awareness. ● Dynamic decision-making. ● Cognitive aids. The team management realm of behaviors includes identifying the situation leader, identifying other responding team members, and clarifying roles among all who are on the responding team. Also included in this realm are workload distribution of all the tasks needed (what needs to be done and who will do it) and the ability to get help promptly. When all responding team members are aware of the importance of these behaviors, there is cohesiveness to the response. Effective, concise communication, including information sharing, are behaviors that allow for safe and effective team responses. There are multiple communication techniques used during team responses that allow members to communicate needs and address inquiries effectively. Situational or environmental awareness requires that the healthcare provider anticipates and plans for all possible trajectories. Knowledge of the environment and the ability to effectively mobilize resources allows all members of the responding team to perform at their highest level. Utilization of these behaviors reduces delays in care, leading to the ability to improve outcomes. Another integral concept within the CRM framework is making decisions in a dynamic and evolving situation. The behaviors specific to this concept include awareness of the situation Team management The team management realm includes the behaviors that assist the responding team in having a coordinated, effective response that leads to an outcome. The main concepts are leadership and followership, role clarity, workload distribution, and requesting timely help.

safety and a reduction in adverse events (Alsabri et al., 2020; Moffatt-Bruce et al., 2017). Knowledge of these behaviors can assist the healthcare provider who responds to the inevitable crises that occur in all areas of practice. Evidence-based practice! Crisis resource management (CRM) is a set of behaviors derived from evidence-based practice that can decrease the incidence of adverse events during an emergency response (Fanning et al., 2013). Teamwork and communication training and interventions improve patient safety to improve patient outcomes by reducing adverse events, including medical errors (Alsabri et al., 2020). Self-Assessment Quiz Question #1 Aviation research from the ’70s and ’80s found that many adverse events were related to: a. Mechanical failure. b. Weather. c. Human Factors. d. Terrorism. further harm (Kohn et al., 2000). In the aftermath of this report, the healthcare education field started exploring ways to teach all healthcare disciplines the necessary skills and behaviors to reduce preventable adverse outcomes. CRM training became one method to increase knowledge and skill for those responders to high-acuity, low-volume clinical situations. By definition, a low volume crisis, such as a hospital evacuation, rarely occurs but involves extreme risk to the patient. and using that knowledge to identify and use all available information in real-time decision-making. Within this concept, a key behavior taught in CRM education is to avoid fixation. Fixation is a situation in which a specific idea is the only driving decision-making concept. When a team gets fixated on one aspect of the response, there is an increased potential for an adverse response. Teams need to be aware of all factors influencing the situation. Fixation can delay the correct treatment because of misdiagnosis or the missing of key data to drive decisions and cause adverse patient outcomes. The final concept includes the use of cognitive aids. Some examples of cognitive aids that will be discussed later include advanced cardiac life support (ACLS) algorithms, emergency medication dose cards, and prepared evacuation plans. These tools can assist all healthcare team members in remembering specific information without relying on memory during an intensely stressful moment. Knowing what aids are available and familiarity with the content is valuable during an emergency, allowing staff to respond more effectively (Goldhaber-Fiebert & Howard, 2013). When all the concepts and behaviors are trained together, teams can respond to the best of their abilities, and patient outcomes are improved. Self-Assessment Quiz Question #2 The team management realm of the CRM framework includes identifying the leader, identifying other team members and:

THE CRM FRAMEWORK

a. Clarifying roles. b. Rotating roles.

c. Allocating resources. d. Coordinating data.

What defines a team? A team is a group where individuals bring varied strengths, and a common goal can be attained when combined. Teams can be permanent/ dedicated or temporary. Some hospitals have dedicated code response teams where they train together and master their skills as a team. Many hospitals have temporary code response teams where the team comes

Book Code: ANCCUS2423

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