“I am the leader who are you” LocaL Training Programme at Sligo University Hospital Deirdre Staunton Resuscitation Training Officer

Cardiac Arrest team leadership

January 1st – June 31st 2016 Cardiac Arrest Team Activation Sligo University hospital 22 activation -57 Department Frequency of Events Medical South 2 Medical North 3 Medical 7 1 Orthopaedics ICU 12 Haematology/Onc General Theatre Emergency Dept 22 Delivery CCU 8 AAU

Outcomes Rhythm No ROSC Survival 24hrs Survival to D/C % VF/VT 7 5 3 43% PEA 22 14 2 1 4.5% Asystole 13 6 0% Perfusing Rhythm 15

No clear team leader No clear role allocation No time keeper No clear communication No dynamics No satisfaction Same problems different centuary!

17 yrs on , what has changed in the world of resuscitation The Good Resuscitation Training, 2015 team dynamics & leadership Secured time Financial investment Availability of courses On line materials/courses Instructors Research and results Technical skills The Bad & the Ugly Non technical skills Mutual support Leadership Situation awareness Communication Documentation Debriefing Learning from performance

Ward based unannounced simulations Regular e mails to doctors and CNMs Encourage attendance, …….stalking “I am the leader who are you” 4 classes Why is ACLS not making a difference???

Chong et al 2016 ACLS

2017 Personal Observations at simulation BLS , immediate, poor Defib AED V Manual Airway Leadership SHO v Reg Handover by nurse x 5 Hands off time Delay in Defib Documentation Debrief

Confidence Respectful Fair Integrity Delegation Facilitator Valuable leadership skills include the ability to delegate, inspire and communicate effectively Confidence Respectful Fair Integrity Delegation Facilitator

8 Tips for Team Leaders 1.Make time to lead. 2. Get to know your team. 3. Communicate, communicate, communicate. 4. Lead by example. Think about the behaviors you want and expect from your team members and be sure to exhibit those traits yourself. You’re the role model, so what you say and do will impact the team’s daily work habits and attitudes. That said, it’s important to be yourself and to believe in yourself. If you fake it, you’ll soon be unmasked and you’ll lose credibility and trust. . 5. Reward the good and learn from the bad (and the ugly). If you need to have a challenging conversation, do it in private; no public floggings. And don’t try to win a popularity contest.. 6 Delegate . Be aware of limitations , your own and others 7. Be decisive. 8. Enjoy it!

Lit review Healthcare professionals have problems following international resuscitation guidelines (Andersen et al 2010) CRM Crew Resource Management should be an integral part of training. ACLS 2015 offers a small token. If recommending educational programme in resuscitation with regard to Non Technical Skills (NTS) we must include leadership, communication, mutual performance, maintenance of guidelines & task management

Inexperienced doctors appointed team leaders when more experienced doctors present. The actual team leader often became the doctor with the most authority regardless of local policy , leading to confusion in cardiac arrest team and disrespect from team members. 2010 Danish study – NTS of team could improve treatment of cardiac arrest, barriers exist. Resus training should include considerations regarding team leader experience, structured communication, mandatory use of cognitive aids , avoidance of task overload and mutual performance monitoring to avoid unnecessary interruptions to chest compressions.

How to train the leaders

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2016 Sligo University Hospital Invitation to NCHD on CAT Afternoon 90 min simulation session. Scenario given: Hands on task allocation, decision making, debriefing. Strengths and areas for improvement identified. +ve- opportunity to lead. review local policy regarding who should lead. Opportunity to say the word “I am the leader, who are you.

Things I learned Short term impact only All over after 1 session, need follow up practice, Need time to reflect and consider what style of leader they are. Isolated training, nobody knew it was going on. Need it to be accepted practice , Review leadership skills during event and present findings Time to involve consultants

2017 Sligo University Hospital Local investigation to discover 1. The opinion of doctors and nurses in relation to whom the cardiac arrest team leader should be 2. What doctors & nurses consider their roles to be during an arrest at the hospital 3. Opinions on training in cardiac arrest team leadership.

Completion Doctors 19, Nurses 12.

Who should team lead

Are you prepared to team lead Nurses 16% yes Doctors 42% yes

Are you ACLS certified Nurses: 25% Doctors: 58% Are you BLS certified Would you attend a short programme in relation to team leadership . 100% yes

Plan Official launch of programme involving MMM, Post graduation education co-ordinator, Simm LIG. Identify and work closely with consultants Pre course reading, identify leadership skills and the type of leader they are . Introduction to various types of leaders. Mandatory BLS – team dynamics Involve multidisciplinary Pack , Algorithms and ACLS model Simulation and feed back Increase duration CPD points

Further plans Daily CAT introduction and leadership identification. Circle of trust CAT badges

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