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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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.

10. 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

11. 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

12. 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.

13. 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

14. 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

15. 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