Situational Awareness

Question 1

Situational Awareness (define)

Answer 1

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.

Question 2

3 Levels of Cognitive Awareness

Answer 2

1. Perception - noticing information about what is occurring in the environment.
2. Comprehension - processing information to make sense of what is happening in current situation.
3. Projection - using information to predict future status and decide what actions need to occur.

Question 3

Factors influencing SA

Answer 3

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.

Question 4

‘Smoke-filled Room’ Experiment (explain)

Answer 4

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.

Question 5

IMSAFE Checklist

Answer 5

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?

Question 6

8 Principles of Crisis Resource Management

Answer 6

1. Know your environment
2. Anticipate, share and review the plan
3. Provide effective leadership
4. Ensure role clarity and good teamwork
5. Communicate effectively
6. Call for help early
7. Allocate attention wisely and avoid fixation
8. Distribute workload and monitor/support team members

Question 7

Medication Errors (define)

Answer 7

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.

Question 8

Swiss Cheese Model (Reason, 2000) (explain)

Answer 8

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.

Question 9

Crisis Resource Management (define)

Answer 9

The non-technical (soft) skills required for effective teamwork in a crisis situation.

Question 10

Know your environment (explain)

Answer 10

• Location/function of equipment and supplies
• Structure/label environment
• Cognitive aids (e.g. equipment maps)
• Regular training
• Role/experience of team members

Question 11

Anticipate, share and review the plan (explain)

Answer 11

• 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

Question 12

Provide effective leadership (explain)

Answer 12

• 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

Question 13

Ensure role clarity and good teamwork (explain)

Answer 13

• 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

Question 14

Communicate effectively (explain)

Answer 14

• Closed loop communication
• Assertiveness - cf. aggressiveness or submissiveness
• Conflict resolution
• Facilitate collaboration
• Double check
• Avoid unnecessary mitigating language

Question 15

Call for help early (explain)

Answer 15

• Recognise barriers to seeking help - e.g. fear of losing face, criticism.
• Set predefined criteria for seeking help
• Mobilise all available resources

Question 16

Allocate attention wisely (explain)

Answer 16

• Avoid ‘fixation error’
• Prioritise tasks according to urgency
• Delegate tasks
• Use all available information
• Ensure periodic assessment of monitors

Question 17

Distribute the workload (explain)

Answer 17

• 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

Question 18

Closed-Loop Communication (define)

Answer 18

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.

Question 19

Swiss Cheese Model (Example)

Answer 19

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.

Question 20

Causes of medication errors (WHO)

Answer 20

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).