This conversation does not need to be shared with the leader but is necessary for the responder’s role. The participants must assess collateral conversations as to their necessity and whether they need to be brought to the entire team and leader’s attention. Patient safety is the goal in emergent situations, and effective communication skills directly impact patient outcomes. Closed-loop communication combined with verbal read back of medication and procedural orders from the leader ensures that the entire team is aware of the progression of care in an often-chaotic situation. Followers are integral members of the response team, and their communication throughout the situation can add to successful outcomes and reduction of adverse events. Evidence-based practice! Universal time-outs are an example of safe communication practices that ensure all systems are in place to prevent adverse outcomes. These protocols allow for equalization of all team members in providing for patient safety (Van et al., 2017). Resource allocation and environmental awareness Knowledge of the environment is crucial for effectively managing an emergency. All team members who respond or can be involved in an emergency must know where equipment, medications, or supplies are located and how to use them. Many institutions provide the orientation to environments at the start of employment; however, periodic refresher training is essential. All staff should learn where the crash/code cart is for cardiac arrest response. Staff should be aware of the location of fire extinguishers and oxygen shut-off valves in case of a fire, as this is necessary for effective responses and part of their role. Healthcare providers in hospital and non-hospital settings should know the evacuation route, fire safety plan, and medical emergency equipment (AED, for example). All staff should also be aware of the internal and external disaster plans and their roles in the response. Knowing how to access response teams is another component of resource allocation. Knowledge includes understanding how the response team activation changes at different times (weekends, holidays, and off-shift times). CRM behaviors include anticipation and planning for all potential outcomes of an emergent situation. An example of the variable nature of CRM is how the response to a cardiac arrest within a hospital has different steps than a similar situation in an outpatient or other setting. Outpatient cardiac arrests or medical emergencies may include the stabilization for external transport. Staff must know the steps to follow in these low-volume, high- Dynamic decision-making in a crisis Dynamic decision-making occurs when decisions are made related to the information presented and responses to actions performed and environmental factors. These complex decisions must occur in real-time and are influenced by the experience level of the decider (Edwards, 1962). The elements of dynamic decision-making include situational awareness, implementation of all available resources, use of cognitive aids, and avoiding fixation errors. Responding to an emergency is stressful, and the stress and urgency can impact the ability to function effectively during the situation. When the responder uses all available resources during a crisis, it improves their ability to make effective decisions during an ever-changing event (Fanning et al., 2013). This section will explore the concepts of dynamic decision-making as used in team settings. A team, as defined by Salas (1992), is “two or more people who interact dynamically, interdependently and adaptively toward a common and valued goal/object/mission, who each have been assigned specific roles or functions to perform, and who have a limited lifespan of membership” (p. 4). Teams that respond to codes, rapid response, medical emergencies, and disasters all fit this description. The teams must function effectively to meet the shared goal. Each individual who is part of a team in healthcare brings their specialty-specific knowledge and training to the situation to achieve the desired outcome. The leader of the team
Healthcare Professional Consideration: Healthcare providers must ensure that all verbal orders for interventions and medications are communicated in a closed-loop format, using a verbal read-back format to the ordering provider to verify the correct order. Self-Assessment Quiz Question #6 The participants must assess collateral conversations regarding their necessity and: a. Whether or not they delayed treatment. b. If they need to be documented. c. If the patient’s family should be included. d. Whether they should be brought to the leader’s attention.
acuity situations. For example, staff in an outpatient setting should know the procedure for contacting the ambulance service – is the policy to call them directly or activate the community 911 service? Training for this type of situational response should include earlier activation to enhance better patient outcomes in the hospital setting. Resource allocation includes the appropriate use of trained and untrained personnel and the use of all available equipment. An example of using untrained staff may be asking the clinic’s non- medically trained receptionist to go to the main entrance and show the EMS responders to the correct room. Inadequate use of available resources is a significant cause of adverse events in healthcare in CRM research (Abualenain, 2018). Team members’ knowledge of how to access the resources and understanding potential barriers or reasons for personnel or equipment delays can make a difference in patient outcomes. Self-Assessment Quiz Question #7 Knowledge of the protocols for responding to a fire is an example of: a. Collateral communication. b. Shared mental model. c. Closed loop communication. d. Resource allocation. uses knowledge of the individual members’ skills to achieve a positive patient outcome. Situational Awareness An individual’s situational awareness is the perception of critical information and data from the environment based on both past experiences and expectations. Each team member must be able to perform their specific tasks. The information utilized during the situational awareness process comes from the person’s working memory, leading them to decide on the actions best suited to the event at hand (Salas et al., 2017). When applying situational awareness to a team, the process becomes more complex as both communication and information sharing affect all members present. As the central point person, the leader integrates all the data collected from the members and then communicates to the team their decision-making process to achieve the shared goal. The process is dynamic as there is a constant reassessment of the situation and adjustment of actions based on the data perceived. An example of this would be sharing of information related to a patient’s current status during a pulse check during a cardiac arrest. RN : Patient is still without pulse and lab just called up a potassium of 2.1. MD : The current rhythm is still PEA.
Book Code: ANCCUS2423
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