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

2. Cardiac Arrest team leadership

3. January 1st – June 31st 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

5. 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

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

9. 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

10. 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???

11. Chong et al ACLS

12. 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

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

14. 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
Be decisive.
Enjoy it!

15. 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 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

16. 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.

17. How to train the leaders

18. *

19. 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.

20. 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

21. 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.

22. Completion Doctors 19, Nurses 12.

23. Who should team lead

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

25. 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

26. 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

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

29. V