Transcript Team Communication Case Scenario 4

Case Scenario 4
Team Communication
Case & Debrief
Case Scenario 4
• 75 year old patient with Chronic Kidney
Disease was brought to hospital for
breathlessness and suddenly collapses in the
ward. The nurse calls a code.
• The code team arrives
Crisis Resource Management
• CRM
– Adapted from aviation (Crew/Cockpit RM)
– Goals
• To reduce disorganized communication and actions
• Improve patient care
– Training critical to effective implementation
• Infrequent exposure to crisis situations
• Team composition frequently changes
Key principles: CRM
• There is one team-leader
– Ultimately responsible for management
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Allocates roles and tasks
Co-ordinates communication
Checks that tasks are completed correctly
Considers clinical information
– History from patients records/other sources
– Feedback and opinions from team members
Key principles: CRM
• There is one team-leader
• Implements therapeutic strategies
• Assessment and reassessment
• Debriefs team at end of resuscitation
Important
• Team leader
– Should avoid too many, or complex technical
procedures
• This may distract her/him from the responsibilities as a
team leader
Communication
• Closed-loop
communication:
• “Instruction”
• Acknowledge and
• “Repeat back”
Person
initiates
instruction
Initiator
verifies
receipt of
message
Listener
repeats
instruction
and
acknowledges
Communication: an example
Initiator
Adrenaline 1 mg
IV
20 ml saline push
Elevate arm
Yes 1 mg
Adrenaline IV is
correct
Got it,
1 mg IV
Adrenaline
With 20 ml saline
push
20 ml saline push
Elevate arm
Elevate arm
Initiator
Listener
Communication pitfalls
• Failure to communicate clearly
– NOT LOUD ENOUGH!
– Not detailed enough from leader
• PLEASE SHOCK PATIENT!, no defibrillation dose given
• Epinephrine, but no dose or route
– Member acknowledgement but no “repeat back”
• E.g. drug names/doses
• Defibrillation settings
Communication pitfalls
• Failure to communicate clearly
– Team members do not verbalise important clinical
observations and relevant advice “call out”
• Leader too aggressive/intimidating
• Members not assertive enough
– Failure of “report back”
• The team member should report back when task is
completed
Conflict/disagreement
• Concerns about leader’s communication or
decisions may be legitimate and important
– BUT unnecessary challenges may disrupt team
performance
• Graded assertiveness is a method that can be
used in such circumstances
Graded Assertiveness
I am
Uncomfortable
about…
I am Concerned
that …
This…is a
Safety issue,
please pay
attention to
what I say to
you
Are you sure
you wish to …
The escalating comments/questions method (CUS)
“Short Cut” Assertiveness
I am
Concerned
that …
This…is a
Safety
issue,
please
pay
attention
to what I
say to
you
The escalating comments/questions method (CUS)