locally at the institution level or the state, county, and city-wide level. Leadership at all levels will provide direction to individual responders in disasters that involve more than one institution. The City of Boston instituted many levels of disaster responses during the Boston Marathon bombing. Each hospital that had casualties implemented its disaster plan, and the city itself implemented a city- and statewide response to move all injured to appropriate facilities. Self-Assessment Quiz Question #3 What must be done to ensure effective leadership if the leader is the only person competent to perform a procedure? a. The charge nurse must verify the credentials of the leader to perform the procedure. b. All team members are consulted to choose the new leader. c. The leader must identify a replacement leader and announce the change in leadership to the team. d. The leader continues in the leadership role while performing the procedure. Staff education on their role in various scenarios is necessary to assess and respond to the situation appropriately. Often, emergency response teams are activated when current resources may not provide the bandwidth to accomplish the necessary tasks. Local staff nurses must understand when to call for assistance and the appropriate level of help needed. The level of help will vary depending on intrinsic factors, such as the situation itself, location, time of day, levels of experience of caregivers/ responders, situational complexity and institutional limitations. For example, a teaching hospital may have more resources available during the day when attending MDs and more support services are present. At night, resources are scarcer, often consisting of less experienced staff, and a call for help should be initiated sooner to allow for resource mobilization. Several persons should be trained in each role to allow for absences during an emergency situation. Some institutions have layers of responses, and all staff must be educated on the appropriate response at a given time. Communication Communication is vital in any situation where multiple responders converge to remedy a situation. Human error is a common contributing factor in communication failures during emergent situations. When an error leads to an adverse event, a root cause analysis may be performed. A root cause analysis is the process used by an institution to find the cause of an adverse event and identify potential solutions. Root cause analyses of adverse events related to emergent situations often find either a lack of or ineffective communication as the cause. Emergent situations, by nature, are often chaotic. Often, multiple conversations occur simultaneously as responders attempt to either obtain or share pertinent information. Research on the effective attributes for team leaders ranks communication as the most important aspect in the successful management of an event (Mo et al., 2018). A leader’s ability to communicate needs/directions concisely with closed-loop techniques increases success (El-Shafy et al., 2018). Closed-loop communication is the technique when the person making the request clearly states all elements of the request to a specific person who confirms that the request is received and, after completing the task, states it back to the leader or person who initially gave the request. A leader shouting orders into the room without identifying the recipient can lead to unattended tasks or over- allocation of resources to one task, leaving another important role unattended. For medication requests, the best practice is to request the medication, including all pertinent elements – medication, dose, concentration, and route. The person preparing and administering the medication should restate the medication, dose, concentration, and route to prevent errors. It is also important for medication administration to verify that the medication is still needed before administration as most emergent responses are dynamic, and the patient’s condition may have changed.
When a patient is decompensating, does the situation require a response from a physician, a rapid response level team, or the full response for an impending life-threatening event? This varies depending on the institution’s policies and responding teams available. For example, if a patient is having increased work of breathing and the institution’s rapid response activation brings a respiratory therapist and critical care nurse, this may be the appropriate team. However, if an imminent airway collapse occurs, the need for an anesthesiologist would require the activation of the cardiac arrest team, which includes the anesthesiologist, respiratory therapist, and critical care nurses. In the event of a disaster, the call for assistance may extend to external resources given the extent of the crisis. Knowledge of the institution’s policies on when to utilize internal versus external resources is important. Evidence-based practice! Since the implementation of rapid response teams, a level of team activations called at the first sign of patient decompensation, there has been a demonstrated decrease in cardiac arrests (Jackson, 2017). Implementation of a special team to respond to patients presenting with signs of sepsis has been shown to reduce mortality rates from sepsis (Simon et al., 2021). Healthcare Professional Consideration: Responders to an emergent event need to either verbally state their role in the response or solicit from the leader what their role should be. Self-Assessment Quiz Question #4 Emergency response teams are often called when current resources may not provide the bandwidth to accomplish the tasks needed. Therefore, local healthcare professionals must
understand when to call for assistance and: a. The location of the nearest telephone. b. The level of help needed. c. The increased cost to the patient. d. When the family typically visits.
One example of effective closed-loop communication is the following exchange between the Licensed Independent Provider (LIP) and the nurse treating a patient who is experiencing an anaphylaxis type event: LIP : Nurse, please prepare a dose of epinephrine 0.3mg of the 1mg in 1 mL, for IM administration. Nurse : Preparing epinephrine 1 mg./ mL 0.3 mg for IM administration. Nurse : Epinephrine 0.3 mg is ready to be administered IM. Do you want me to administer now? LIP : What is the concentration? Nurse : 1 mg in 1 mL. Physician : Yes. Please administer now. Nurse : Epinephrine 0.3 mg of 1 mg/1 mL has been administered IM at 3:10 p.m. Documenter records time of administration: Epinephrine (1mg/1 mL) a dose of 0.3 mg IM administered at 3:10 p.m. In the example above, all the elements of a safe medication administration were addressed during the exchange, preventing an error of the wrong dose, concentration, or route. Epinephrine is one medication that is prepared based on concentration and administered differently depending on the situation – anaphylaxis versus cardiac arrest and supplies on hand. Closed-loop communication should also be used when asking for tasks to be accomplished. For example, when needing to assign a new role: Leader : I need someone to contact the cardiac cath lab. Joe, can you contact them? Joe ( medical student ): Yes.
Book Code: ANCCUS2423
EliteLearning.com/Nursing
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