Question What are some other examples of CRM other than communication demonstrated in the case study? Discussion Other examples of CRM within the case study: ● Identification of a leader : The MD leader assumed the role and stated out loud that he was assuming this role; he also communicated this with all staff responding to the emergency response call. ● Role assignment : Some team members began assuming tasks while others were directed to tasks. Liz started with compressions but was relieved of this role when more staff responded to the situation. The MD acknowledged that as an RN, Liz’s talents may be better utilized elsewhere on the team. The MD leader assigned other less skilled members (medical students) to assist with the compressions. The RT and anesthesiologist fulfilled the task of maintaining the patient’s airway as appropriate to their clinical skill set. The MD leader potentially reassigned airway management to the ICU MD as needed when he was aware of complications. Theresa also assigned roles by asking Jo to place a backboard under the patient and place defibrillator pads on the patient. Theresa also assigned the unit coordinator to guide the responding team members and asked the nursing assistant to call a code and monitor patient call lights. The pharmacist assumed a role at the code cart in preparation of medications. ● Cognitive aids : The MD leader was using an ACLS evidence-based algorithm card as a cognitive aid to guide his management of the situation and all interventions. The pharmacist and Theresa used an emergency medication guideline for dose verification. ● Situational awareness : The MD leader did not perform any tasks but maintained close observation of all activities taking place including the patient’s status throughout. He used clear communication and noticed when the airway team was having an issue. He anticipated that there may be a need for another form of action, by asking the ICU MD if he was able to secure the airway if needed. The MD leader or the anesthesiologist could have become fixated on the failed intubation attempt but did not. The MD leader remained focused on the next timely steps by asking Liz if she was ready to administer epinephrine and the next 2-minute pulse check. priority in ensuring minimal adverse outcomes and patient safety. The healthcare provider should understand the CRM components such as delegation, resource utilization, effective communication techniques, and the use of cognitive aids. They should be aware of the protocols, policies, and procedures for emergency responses in any care setting in which they work. Training and practice drills on how to respond to an emergency using the CRM framework helps prepare all care team members to respond to emergencies and maximize patient safety and outcomes. • Cammarano, C., Jiang, X., & Schnatz, P. F. (2016). Implementing Team-Based Care: It’s Our Duty. Healthcare Transformation , 1 (4), 240-247. • Corey, P. J. (2016). The Effectiveness of Adult and Pediatric Code Blue Simulation-Based Team Trainings (Doctoral dissertation, Walden University). • Corey, P., & Canelli, R. (2018). Crisis Resource Management. In K.P. Lewis, R. J. Canelli, & R. A. Ortega (Ed.) Ok to proceed: What every healthcare provider should know about patient safety . (pp. 182-187). Kirkwood • DeBoer, S., Seaver, M., & Broselow, J. (2005). Color coding to reduce errors: The Broselow– Luten system streamlines pediatric emergency treatment. AJN The American Journal of Nursing , 105 (8), 68-71. • Edwards, W. (1962). Dynamic decision theory and probabilistic information processing. Human Factor,s 4 , 59-73. • El-Shafy, I. A., Delgado, J., Akerman, M., Bullaro, F., Christopherson, N. A., & Prince, J. M. (2018). Closed-loop communication improves task completion in pediatric trauma resuscitation. Journal of surgical education , 75 (1), 58-64. • Fanning, R. M., Goldhaber-Fiebert, S. N., Undani, A. D., & Gaba, D. M. (2013). Crisis Resource Management. In A.I. Levine, S. DeMaria Jr., A. D. Schwartz, & A. J. Sim (Ed.) The Comprehensive Textbook of Healthcare Simulation . (pp.95-109). Springer Science & Business Media. • Ferguson, K., Wilson, J., Gendron, B., Rio, M., Verbyla, S., & Vincent, W. (2019). 1359: Optimization of the pharmacist role for thrombolytic therapy in inpatient code stroke. Critical Care Medicine, 47(1), 656.
● Collateral communication : There was an example of collateral communication between the RT and the anesthesiologist. Their conversation about the inability to secure the airway was important to the overall care of the patient. This needed to be shared with the MD leader. The MD leader demonstrated situational awareness in that he was aware that the anesthesiologist had not confirmed a secure airway and there was a discussion occurring at the head of the patient’s bed. Theresa and the pharmacist also had a conversation, but the MD leader did not need to be involved as they were utilizing cognitive aids to solve their dilemma of dosing of the Epinephrine. If the medication had been needed, they would need to ask in closed loop format the dose required from the MD and then dose prepared before administration for verification by the leader. Question What other team roles were demonstrated in this case study? Discussion Other Team roles demonstrated in the case study: ● Anesthesiologist : Secured the airway through endotracheal tube placement in collaboration with the Respiratory Therapist. ● Respiratory Therapist : maintained the airway providing ventilation. ● Bedside nurse : Liz, the nurse caring for the patient, filled this role and appropriately remained in the room, and performed cardiac compressions. ● Medication nurse : Theresa filled this role and prepared and administered the epinephrine. ● Pharmacist : Assisted in preparation of medication and as a resource for doses of medication. ● Circulating nurse : Jo filled this role. She placed the patient on the backboard and prepared the patient for defibrillation. She also administered the electrical shock. ● Scribe : This role was filled also by Liz. She documented the situation by recording times of treatments, and medications that were administered throughout the code. ● Bed manager : The nursing supervisor facilitated obtaining a bed for the patient in a higher level of care to which the patient would be transferred following the resuscitation. Conclusion Crisis resource management is a concept that all healthcare providers should understand and know when and how to employ its elements during an emergency. This concept has been adapted and refined from other industries to provide a framework for effective and efficient management of crisis situations. Healthcare providers are often responders in medical emergencies and environmental disasters, and knowledge of CRM behaviors is vital for safe practice and efficient responses. Healthcare providers can serve as responders to an event as team members and team leaders. The ability to effectively communicate data, instructions, and delegation of tasks is a References • Abualenain, J. (2018). Hospital-wide interprofessional simulation-based training in crisis resource management. Emergency Medicine , 17 (3), 93-6. • Al Harthi, M., Al Thobaity, A., Al Ahmari, W., & Almalki, M. (2020). Challenges for nurses in disaster management: A scoping review. Risk management and healthcare policy , 13, 2627. • Alidina, S., Goldhaber-Fiebert, S. N., Hannenberg, A. A., Hepner, D. L., Singer, S. J., Neville, B. A., ... & Berry, W. R. (2018). Factors associated with the use of cognitive aids in operating room crises: A cross-sectional study of US hospitals and ambulatory surgical centers. Implementation Science , 13 (1), 50. • Alsabri, M., Boudi, Z., Lauque, D., Roger, D. D., Whelan, J. S., Östlundh, L., ... & Bellou, A. (2020). Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: A systematic review. Journal of Patient Safety, 8( 1), e351-e361. https://doi.org/10.1097/PTS.0000000000000782 • Bracco, F., De Tonetti, G., Masini, M., Passarelli, M., Geretto, F., & Celleno, D. (2018). Crisis resource management in the delivery room: Development of behavioral markers for team performance in emergency simulation. International journal of environmental research and public health , 15 (3), 439. • Brindley, P.G., & Cardinal, P. (2017). Optimizing crisis resource management to improve patient safety and team performance: A handbook for all acute care health professionals . Royal College of Physicians and Surgeons of Canada. • Bolt, J., Semchuk, W., Loewen, P., Bell, A., & Strugari, C. (2015). A Canadian survey of pharmacist participation during cardiopulmonary resuscitation. The Canadian journal of hospital pharmacy , 68 (4), 290.
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