CRISIS RESOURCE MANAGEMENT Kyle Harrison , MD VA Palo Alto Thomas William Bedard RN-BC, MSN, VHA-CM

Evolution of a Crisis Perceived as: Rapid in onset Requiring immediate intervention Usually involves unanticipated series of precipitating factors

Preceding triggers Latent Errors- lie dormant within system and ,may need catalyst or specific factors to breach the system Design flaws Manufacture defect Maintenance issues Predisposing Factors- factors which create an inherent level of increases risk Patient’s underlying disease state and co-morbidities Environment of delivery of care/The System your within Limited resources/Call IN’s

I’m sick & tired of this place Psychosocial factors I’m tired Human performance Factors Fatigue Illness Attitude/Over confidence Poor staffing I’m sick I’m sick & tired of this place

Crisis Resource Management Goal: To detect and correct evolving problem to prevent adverse outcome Keep incidents from becoming critical incidents Requires dynamic decision making to a rapidly changing situation

Aviation Industry Crew Resource Management In 1970’s, the FAA investigation into multiple airline accidents which showed significant number of lethal incidents due human error of poor teamwork, poor communication, and poor decision making. PLAY U-TUBE Clip: C:\Documents and Settings\vhanflcochrd\Desktop\NOVA Why Planes Crash - YouTube.mht

Elements of Teamwork Leadership Communication Role Clarity Resources Crisis Resource Management identifies controllable factors which can improve teamwork and clinical decision making for improved patient outcomes in an emergency situation

CRM: Know Your Environment Identify strengths and weakness of your environment Know your equipment and how it use it (IO, Zoll) Identify available resources and how to access them quickly (ERT, Code Blue, 6911)

CRM: Anticipate and Plan Be proactive- prepare for high load periods during low load periods Identify patient’s at risk and what resources may be needed to support them in an emergency Use all available information- no one source can give you the full picture MY PLAN: a. b. c.

CRM: Allocate Attention Wisely Eliminate or reduce distractions/Unnecessary staff Avoid getting fixated/Step back and observe big Picture Recruit other to help with tasks or monitoring Be aware of task saturation and data overload

CRM: Use Resources and Cognitive aids Working memory is limited in a crisis Use available checklist, cognitive aids, Recorders Mobilize all resources needed: Equipment Manpower/Team Communications Information

Elements of Effective Teamwork CRM: Establish Clear Leadership Clearly takes command/”Who is in Charge” Sets the tone/Clear/Direct/Calm Prioritizes activities and tasks Focus on problem solving/Critical Thinking/Trouble Shooting/ Not performing tasks Communicate with Staff H’s + T’s.

Elements of Effective Teamwork CRM: Role Clarity Understand clear role and responsibilities Distribution of workload is allocated based upon knowledge, skills, and training Be conscious of task overload Report any redistribution of workload to leader D A B C

Elements of Effective Teamwork CRM: Communication Leader: Declare an emergency early rather than later/ERT vs. Code Blue Speak clearly and concisely Avoid commands such as: “Can Someone……” Make eye contact & ask for confirmation of understanding –closed loop communication/expect repeat of commands Keep voice calm & controlled/Minimize Chaos Foster atmosphere of open exchange in a controlled fashion/Encourages staff to feel Safe and Share

Elements of Effective Teamwork CRM: Communication Team Member: Direct all pertinent information to the leader Ask for assistance , if needed If you must change roles or assist another team member, reassign your role and alert leader If problem occurs- alert leader Keep focus on the patient, rather than individual performance