TEAM CONCEPT ON CPRDr. TSRTR. Rajab MBBS, MBA Base hospital, Akkaraipattu, Srilanka. 17.12. 2016

Team Together with a common purpose

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Successful teams not only have medical expertise and mastery of resuscitation skills,but they also demonstrate effective communication and team dynamics

Team Leadergood situational awareness

• Organizes the group • Monitors individual performance of team members • Backs up team members • Models excellent team behavior • Trains and coaches • Facilitates understanding • Situational awareness-paying attention what is going around, not fix on one problem

• Members of the team must respect their authority and be prepared to carry out the instructions of the leader.

• poor leadership may induce frustration and anxiety, having a negative impact on the team and its future performance.

Team MembersFocusing on Individual task

• Team leader focus on comprehensive patient care • Whereas team members should focus on their individual tasks.

• Clear about role assignments • Prepared to fulfill their role & responsibilities • Well practiced in resuscitation skills • Knowledgeable about the algorithms • Committed to success

Team Dynamics The operating forces within the team

• Closed loop communication• Clear messages• Clear roles and responsibilities• Knowing limitations• Knowledge sharing• Constructive intervention• Reevaluation & summarizing• Mutual respect

CommunicationListen-Understand-Talk

• Effective communication is essential – • Especially in times of high stress

• An experienced anesthetist putting their hand out –

• Expecting to be handed the laryngoscope by their assistant • Without actually asking for it• ”Tactic communication”• More chances to have errors

• Specifically ask and allowing questions to be asked, • “Explicit communication”• Errors and critical incidences can be avoided.

Closed loop communication

• Visam, I want you to insert a large-bore IV, ’ 'You want me to insert a 16-gauge IV?’• 'Correct.’ “Ok large bore IV is In”.

• It reduces error rates by removing ambiguity.• Allowing questions if the instruction was not heard clearly.• It allows others to be aware of the proposed course of action.

• Team leader asked for a procedure by naming the member • Member reconfirm it by asking • Member doing the procedure and acknowledge to team leader explicitly.

Clear messages Propofol ? Propranolol?

• Clear consisted messages in a controlled tone of voice.• Orders in a calm and direct manner • No yelling , shouting or barking.

• Unclear communication ? delays in treatment or to medication errors.

• Farees “give Adrenaline” - Not a clear message• Instead ask him, • “farees give Adrenaline 1;10000, 1mg IV push” • “adrenaline 1mg IV push given”

Clear roles and Responsibilities• Unclear roles?

• Performing the same task more than once

• Missing essential tasks

• Freelancing of team members

To avoid inefficiencies

Team leader clearly delegate tasks

break down boundaries between individuals with varying levels of experience.

• Unsure of their responsibilities? ----- Do not assign!

• Need additional responsibilities? --- Communicate team members

Team Leader

ScribeVascular access

Compression

Airway & breathing

Defibrillation

6 Team members in CPR

Knowing limitations

• Unsuccessful in establishing the IV access?• Stop trying again and again and ask for help. • Do not delay , it’s a patient life.

• Dot confident on Endo tracheal intubation ?• Continue AMBU mask ventilation till an experienced doctor come.

• Early advice before the situation gets out of hand.

Fixation Error & Knowledge sharing

• Fixation error -Sudden stuck on skills or knowledge, when working with stress

• Unable to progress - brain won't let you move on until you remember a piece of information.• Team leaders may become trapped in a specific treatment or diagnostic approach

• Solving Fixation Error- Sharing Knowledge• Getting contributions from everyone in the team can solve the fixation error.

• When resuscitative efforts are ineffective, go back to the basics and talk as a team. • The team leader ask for differential diagnosis, identifying reversible causes (5H & 5T)• Do not ignore others suggestions for treatment. • Do not fail to examine signs that are relevant to the treatment.

Constructive intervention

• Health care errors can be deadly• During a resuscitation an action inappropriate at the time ??

• Attempt to stop• tactful and professional when correcting a personal.

• Incorrectly drug administration ?• Suggest an alternative drug or dose in a confident manner .

• Debriefing afterward if constructive criticism is needed. - learning.

Briefing & Debriefing

Reevaluation & Summarizing• Summarize by the Team leader-periodic update to the team.

• The patient’s status• Interventions that have been performed • Assessment findings

• Reevaluate • Status of the resuscitation attempt and • Announce the plan for the next few steps.

• Patient’s condition can change anytime. • Remain flexible to changing treatment plans and revisiting the initial differential

diagnosis.

- ISBAR- A Framework for Communication

• ISBAR - a vehicle for individuals to speak up in a concise manner.• ISBAR - ensuring clarity and completeness of information in verbal communication.• ISBAR - using a structured approach, and one can avoid missing vital information.

• I- Identity-- Introduce your self and patient identity • S-Situation—What is going on with the patient?• B-Background—What is the clinical background?• A-Assessment—What do you think the problem is?• R-Recommendation—What would you recommend?

Mutual Respect• The best teams - work together in a collegial & supportive manner. • Must abandon ego and Over confident

• regardless of any additional training or experience • that the team leader or specific team members may have.

• Speak in a friendly, controlled tone of voice • Avoid shouting or displaying aggression.

• Acknowledge by saying,

• “Thanks—Good job!”

TEAM BUILDING

• The majority of cardio respiratory arrests in the hospital should be classified as a “failure to rescue” rather than as an isolated, unexpected, random occurrence.

• Doing so it requires a system which contains effective health care emergency team members.

• Implementing any type of emergency management system will require a significant cultural change in most hospitals.

• The system must pay particular attention to issues that may prevent the system from being used effectively.

• Examples of such issues are insufficient resources, poor education, fear of calling the team, fear of losing control over patient care, and resistance from team members.

No fears, No Resistancewith Continues learning and confident lets Start….

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