1.1 - Crisis Resource Management & WCC - Exam Flashcards
What is CRM
crisis resource management
Rall and Gaba (2005) have identified the followed 15 key principles:
Know the environment
Anticipate and plan
Call for help early
Exercise leadership and followership
Distribute the workload
Mobilise all available resources
Communicate effectively
Use all available information
Prevent and manage fixation errors
Cross (double) check
Use cognitive aids
Re-evaluate repeatedly
Use good teamwork
Allocate attention wisely
Set priorities dynamically
Exam: Examine the potential impact of communication, leadership, situational awareness and teamwork on clinical outcomes
Situational awareness
1. Know your environment
2. Notice cues and make sense of them and ability to see big picture
Barriers
1. Fixation on errors
2. Interruptions
3. Unfamiliar environment
Communication
1. The transfer of information and sharing of meaning
Attributes of effective communication
1. Formulated
2. Addressed
3. Delivered
4. Heard
5. Understood - closed loop
Communication breakdown
1. Failure to direct
2. Lack of clarity
3. Assumptions
4. Distraction
5. Open disagreements
Exam: Explain how the effectiveness of the multi disciplinary team influences clinical outcomes
Team Player Attributes:
Clear identified roles
Support team
Adaptable
Clear communication
Speaks up
Feeds back
Objectively review own performance
Prioritises and focus on task at hand
Exam: Identify contributing causal factors of adverse outcomes
- junior staff
- not esclating in a timely manner
- communciation
- not knowing their enviroment
- situation awareness
Exam: What is the skill set you need to be a confident team player
- knowledge
- ability to follow instructions
- flexible
- work well within a team being a team player
- giving your all
What percentage of maternal deaths are avoidable
5 deaths per 100000 in 2018
What are the recurring causation themes of suboptimal outcomes
Exam: List 4 attributes that make a good team
Exam: List 4 attributes that make a good leader
Organise team
Helicopter view
Set clear goals
Delegates
Communication clear and concise
Respects expertise of team members
Willing to listen
Anticipate and plans ahead
Exam: Have you been exposed to any of the improvement strategies in your clinical practices. If so,
reflect on the impact it had on your practice.
PPH guideline paperwork
this documentation is required to be filled out every two hours during the admission to the bs.
there are different ratings of the potential cause for a PPH
ie previous pph before
induction
multi
preeclampsia
there are three catergories with the evidence bassed practice
I found this tool helped me when identiying the best method of third stage. each one has a criteria they we must adhered too.
this makes me think about the third stage management instead of doing what has been done before hand.
Exam: Consider the communication strategies, which are you comfortable using. Do you practice closed loop communication
- i tired to use closed loop communicaiton in the approiate sitution
- verbal
- nonverbal
- written
- listeing active and passive
- visual communcation (read the room)
Exam: Describe a scenario where you may not be able to obtain consent. What is the legality of this
situation?
uterine abruption
witness collapse
would you have someone try to contact NOK etc
if unable what happens implied consent if they came to the clinic or bs not feeling well this can be taken as implied consent
Exam: From the reading ‘informed consent’, consider this approach. How comfortable would you be if
this was adopted at your health service? What are some pros and cons to this approach?
- informed consent is neccessary for all medical surgical & obstetric intervention
- ok with elective procedures
- challenging in an emergency sitution
- foster realistic delivery expectations
- is a process of shared understanding and decision-making between the patient & clinician
- The process should take place over a period of time
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Exam: Reflect on an emergency situation you have been involved in. Did you see or provide WCC in this
situation? How could this have been managed with the woman at the centre of care?
- massive pph 1 hour post birth
- I saw some WCC in the situation
- however i felt the woman really did not understand what was going on. she knew her blood pressure was extremely low but wasnt aware of emeregency sitution she was in.
- blood was given some critical processess where not followed ie checking name etc when giving meds etc
- small debrief post
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Exam: It can be argued that all women should be offered a debrief following their birth and early PN
experiences. Regardless, after an unexpected outcome debrief is an integral part of care. What is
your role as a midwife in this context?
- Postnatal debriefing was commonly a meeting with a midwife, at which women discuss their birth events with reference to the medical notes.
- What is a birth debrief? A birth debrief is the opportunity for a woman or a couple to discuss the birth of their child at length with a trained professional, i.e. specialist midwife, obstetrician or mental health professional.
