Teamwork & Non-Technical Skills Catherine Jones October 2017

“ … set of interrelated behaviours, actions, cognitions & attitudes that facilitate the required task work that must be completed..” Teamwork Sevdalis (2013) Non-technical skills & the future of teamwork in healthcare settings. Patientsafety.health.org.uk

An expert team? Attributes of a team what are they? This is an expert team but not a team of experts like we in the medical profession are. What does this team have that others don’t? As ad-hoc teams we don’t have the luxury or the ability of being able the practice the same task with the same people over and over again, So how do these ad-hoc teams come together and function? We require portable skills that we can take anywhere, anytime and function cohesively. Relying on technical and non-technical skills, constantly communicating observed events, concerns & mental models or having situational awareness of everything at once. One of the problems we have in hospitals is that we work in ad hoc teams. Specifically, Situational Awareness...

A Team of experts? Wednesday, 05 December 2018 Does the presence of expert doctors & nurses result in an expert team? Ad – hoc team collaborations eg intubation, rolling patient, cardiac arrest. Varied levels of competence/skill with complex kit In order to make teams work practitioners need Non-technical skills & we need to develop these in order to practice effectively… Jane Roe (Transfer Training ICU) 2015

ANTS model

Team-working Co-ordinating Activities Exchanging Information Using authority & assertiveness Assessing capabilities Team-working Focus here is team mgm rather than task Interesting in the film that the nurses didn’t articulate their concerns effectively despite correctly understanding and anticipating relevant actions .. A couple of comm techniques that may be useful Co-ordinating Activities: Confirms roles/responsibilities within team Co-operates to achieve goals Exchanging Information: Gives updates & reports key events (SBAR) Seeks & confirms shared understanding Communicates plan Using authority & assertiveness: Articulates requirements (PACE) States case & provides rationale Assessing capabilities: Ask for help when needed Aware of co-workers performance & aware when not meeting standards

Task Management Planning & Preparing Prioritising Providing & maintaining standards Identifying & utilising resources Task Management Task mgm is really the bread & butter of ICU nursing – its how we organise ourselves & our environment to provide safe & efficient care Eg Rolling pt – roll to left on my count etcc; abandon roll if ↓↓↓ SpO2 I’ll do this & then I’ll do that… I am going to do ABCDE – I might not get to E – is this a problem? Red book – drug administration guidelines; blue book local guidance; checking meds & Planning & Preparing: Communication of plan to relevant personnel Adapt plan in light of new info Prioritising: Discusses & negotiates priorities with co-workers Articulates sequence of actions in critical situations Providing & maintaining standards: Sticks to published guidance & protocols Checking Emergency equipment Maintaining accurate obs & documentation Identifying & utilising resources : Aware of available resources eg extra personnel/experience Request extra resources as needed Appropriate task allocation & equipment utilisation

Situational Awareness Situational Awareness is the perception of the elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future. Or… Know what’s going on around you….. 3 Good Questions: What's happened? What's happening? What might happen? Situational Awareness

Decision Making 1. Identify Options 2. Balance Risks & Select Options 3. Re-evaluate

Consider these aspects of team work whilst watching the following film Martin Bromley ‘Just a Routine Operation’ You Tube Running Time – 13min 56secs https://www.youtube.com/watch?v=JzlvgtPIof4

Final Thought Busy learning technical competence in ICU but this stuff is very important & helps to avert error.

sbar A tool to improve verbal communication between healthcare professionals in a variety of circumstance – escalating concerns, handove. Consists of standardised prompt questions to provide a structured framework Commonly used for referral processes – Tx – highlighting problem to doc yr working with Aims to get past hinting/hoping by providing clarity around reccommendations WHO RECCOMENDS .. Inpatient or outpatient Urgent or non urgent communications Conversations with a physician, either in person or over the phone         - Particularly useful in nurse to doctor communications         - Also helpful in doctor to doctor consultation Discussions with allied health professionals         - e.g. Respiratory therapy         - e.g. Physiotherapy Conversations with peers         - e.g. Change of shift report Escalating a concern Handover from an ambulance crew to hospital staff

sbar Situation – What is happening? “The patient’s SpO2 & Tidal Volumes have dropped” Background – What is the background? “The patient has just woke up & coughed. The patient had lots of pluggy secretions prior to transfer” Assessment – What do I think the problem is? “I think the patient has plugged off and this is affecting their ventilation” Recommendation – What would I recommend? “I think we should pre-oxygenate & suction” Commonly used for referral processes – Tx – highlighting problem to doc yr working with Aims to get past hinting/hoping by providing clarity around reccommendations Inpatient or outpatient Urgent or non urgent communications Conversations with a physician, either in person or over the phone         - Particularly useful in nurse to doctor communications         - Also helpful in doctor to doctor consultation Discussions with allied health professionals         - e.g. Respiratory therapy         - e.g. Physiotherapy Conversations with peers         - e.g. Change of shift report Escalating a concern Handover from an ambulance crew to hospital staff

GRADED ASSERTIVENESS P A C E

“ Do you know that the patient’s SpO2 & Tidal Volumes have dropped” Probe “ Do you know that the patient’s SpO2 & Tidal Volumes have dropped” Alert “ Can we reassess this situation? I think the patient has plugged off and this is affecting their ventilation ” Challenge “Please stop what you are doing – I will get someone to help you” Emergency “Stop what you are doing it isn’t safe.” Probe: “Do you know that SpO2 & Tidal Volumes have dropped” Alert: “Can we re-assess this situation?” Challenge: ”Please stop what your doing – I will get some one to help you” Emergency: “Stop what your doing – it is not safe”

Non – Technical Skills Cognitive Decision Making Situational Awareness Social Leadership Communication Personal Resources Management & awareness of stress & fatigue Non – Technical Skills Components of team work Sevdalis (2013) Non-technical skills & the future of teamwork in healthcare settings. Patientsafety.health.org.uk