Situational Awareness Flashcards
Situational Awareness (define)
The ways in which an individual collects (perceives), interprets (comprehends) and uses information (projection) from their environment to inform decision-making.
Developed as a skill to prevent errors, detect patient deterioration and improve patient outcomes.
3 Levels of Cognitive Awareness
- Perception - noticing information about what is occurring in the environment.
- Comprehension - processing information to make sense of what is happening in current situation.
- Projection - using information to predict future status and decide what actions need to occur.
Factors influencing SA
Individual - fatigue/sleep deprivation, stress/emotional state, physical distress/ill health, lack of knowledge, inexperience, incompetence, cognitive biases, personality traits.
Team - role confusion, ineffective communication, dysfunctional relationships, unclear/poor leadership.
Environment - interruptions, noise, handovers, time pressures, resource limits, equipment, unfamiliar setting.
‘Smoke-filled Room’ Experiment (explain)
75% of people left room or reported smoke immediately when alone. 90% of people continued working despite detecting the smoke when two actors were present pretending not to notice the smoke.
Demonstrated that peoples’ responses to emergency situations are delayed or absent in the presence of passive others compared to acting alone.
Indicates that individuals rely on the responses of others, even against their own instincts. I.e. if the group acts as if everything is ok then it must be.
IMSAFE Checklist
Illness - do i have any symptoms?
Medication - have i been take prescription or OTC drugs
Stress - am i experiencing psychological pressure from the job or other life matters (e.g. finances, family, health)?
Alcohol - drinking in the last 24hrs?
Fatigue - am i adequately rested?
Eating - am i adequately nourished?
8 Principles of Crisis Resource Management
- Know your environment
- Anticipate, share and review the plan
- Provide effective leadership
- Ensure role clarity and good teamwork
- Communicate effectively
- Call for help early
- Allocate attention wisely and avoid fixation
- Distribute workload and monitor/support team members
Medication Errors (define)
Errors occurring when weak medication systems and/or human factors affect the prescribing, transcribing, dispensing, administering and monitoring practices which can lead to severe harm, disability or death.
E.g. Administration errors - wrong drug, dose, route, patient or time.
E.g. Procedural errors - not checking 3 pts ID, incorrect documentation, not reading expiry dates.
Swiss Cheese Model (Reason, 2000) (explain)
Systems are like a stack of Swiss cheese were each hole represents an opportunity for the process to fail, and each slice is a defensive layer against failure. Holes are either due to active failures or latent conditions. Each step in a system has holes and is therefore susceptible to failure.
An error may allow a problem to pass through a hole in one layer but it should be caught by the next layer as the holes are placed elsewhere. The fewer the holes the more likely an error will be prevented.
Crisis Resource Management (define)
The non-technical (soft) skills required for effective teamwork in a crisis situation.
Know your environment (explain)
- Location/function of equipment and supplies
- Structure/label environment
- Cognitive aids (e.g. equipment maps)
- Regular training
- Role/experience of team members
Anticipate, share and review the plan (explain)
- Plan for contingencies and anticipate delays
- Set priorities dynamically and re-evaluate periodically
- Call and respond checklists
- Think aloud/verbalise goals
- Encourage contribution of team members
Provide effective leadership (explain)
- Least confrontational approach consistent with goal - i.e. participative decision-making vs authoritative/direct in time-sensitive scenarios
- Establish goals and behavioural/performance expectations
- Monitor external/internal environments
- Provide debriefing
Ensure role clarity and good teamwork (explain)
- Allocate team roles
- Explicit handover for role changes
- Active team members - i.e. monitoring events and advocating actions
- Recognise impacts of stress and utilise self-care
- Shared responsibility for patient outcome
Communicate effectively (explain)
- Closed loop communication
- Assertiveness - cf. aggressiveness or submissiveness
- Conflict resolution
- Facilitate collaboration
- Double check
- Avoid unnecessary mitigating language
Call for help early (explain)
- Recognise barriers to seeking help - e.g. fear of losing face, criticism.
- Set predefined criteria for seeking help
- Mobilise all available resources
Allocate attention wisely (explain)
- Avoid ‘fixation error’
- Prioritise tasks according to urgency
- Delegate tasks
- Use all available information
- Ensure periodic assessment of monitors
Distribute the workload (explain)
- Team leader is ‘hands-off’ - i.e. stands back to maintain SA
- Assign tasks according to defined roles
- Team leader supports members
- Reallocate roles as tasks are complete or change in complexity
Closed-Loop Communication (define)
Sender communicates message. Receiver interprets message and communicates it back to the sender. Sender confirms that the intended message is received. Receiver reports back when message has been acted upon.
Swiss Cheese Model (Example)
A nurse is about to administer a schedule 8 drug to a patient. The nurse asks their buddy nurse to accompany them to the drug room. Both nurses check the register and stock and sign the book. However, as the nurse is dispensing the dose, the buddy nurse is distracted by another nurse asking a question. The primary nurse mistakenly dispenses the wrong dose and the buddy nurse does not notice. The patient receives the wrong dose of medication.
Causes of medication errors (WHO)
Clinician - lack of training, inadequate drug knowledge, inadequate risk perception, fatigue/overworked, poor physical health, emotional state, poor communication.
Environment - workload, time pressure, distractions/interruptions, lack of standardised protocols, insufficient resources/staffing, poor physical environment (e.g. lighting).
Systems - naming of drugs, labelling/packaging, repetitive systems for ordering/processing/authorising, inaccurate patient records, systems for generating first prescriptions (drug alerts, default doses).
