dr. lisa calder & dr. george mastoras · 10/18/2017 · the canadian medical protective...
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The Canadian Medical Protective Association © CMPA
When being present isn’t enough – Improve patient safety through Situational Awareness
Dr. Lisa Calder &Dr. George MastorasOctober 18 2017
Awareness saves lives
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ObjectivesBy the End of This Session...
Define situational awareness – Individual and team
Describe 1 method to acquire situational awareness List 1 teaching technique for
educating healthcare providers on situational awareness
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Human factors overview
Environmental Factors
Human Factors
PerformancePerformance
Humancapabilities
EffectsAnd
behaviours
Humanlimitations
HumanenvironmentTask
Physicalenvironment
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Cognitive Science
(how we think)
Industrial and Organizational
Psychology(how we collaborate)
Systems Safety
Engineering(how we manage risk)
WorkAnalysis
(how we work now)
Credit: Robert Stephens, National Center for Human Factors Engineering in Healthcare, MedStar Health
Human factors engineering
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Situational Awareness
A process whereby information is – Acquired and Perceived
– Understood and Comprehended
– Used to Project
Knowing what is going on around you
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HumanenvironmentTask
Physicalenvironment
Clinical situation
Building blocks to situational awareness
Patient Environment Task Time
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PETT
Patient– Most important element of the
situationEnvironment
– Physical Space, layout, lighting, noise,
temperature, etc...– Human
Staffing, shifts, workload, management, policies, etc.
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PETT (cont’d)
Task – What you are doing (or are supposed to do) Remain constant or change Dependent on the state of the patient and actions
of others involved
Time – Wall clock time– Elapsed time– Projected time
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Process of Situational Awareness
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The Situational Awareness checklist
GET INFORMATION
“G.U.T.”
UNDERSTAND ITUNDERSTAND IT
THINK AHEADTHINK AHEAD
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Developing situational awareness among healthcare teams
Foster a culture of SA Develop Shared Mental Models Use simulation as a tool for deliberate
practice Debrief events
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Putting situation awareness front-of-mind
“Situational awareness is not only potentially life-saving, it is also
everybody’s business.”
~ P. Brindley
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Thinking out loud
Shared mental models promote team situational awareness
Team leader’s role to foster this
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Simulation as a teaching tool
Medical simulation is an effective tool for teaching non-technical skills in health care (aka., Crisis Resource Management)
Opportunity for deliberate practice, coaching & feedback
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Debriefing
Real-life situations offer plenty of learning opportunity
Debriefing focused on team performance (incl. Situational Awareness) crucial to enhancing SA skills among team
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Scenario #1
22yo female brought to ER after a motorcycle crash, low BP & tachycardia ++ Difficulty establishing IV’s, blood
pressure continuing to fall MD starts to work on placing central line Tension pneumo missed
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Scenario #2
82y F POD#1 left hip fracture repair, admitted to over-capped Ortho Ward, two RN’s called in sick
Junior on-call resident covering four different teams, consults piling up in ER
Patient nauseated on rounds at shift change, ward nurse calls requesting order for Gravol
Review of chart shows she c/o nausea at 6am rounds and throughout day
Vitals checked now show hypotension, ECG demonstrates missed STEMI with Q waves
Patient transferred to CCU in cardiogenic shock
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Scenario #3
19y M brought to ER by ambulance for single GSW to right thigh, placed into resuscitation room
10 mins later 21y M presents ambulatory to triage with multiple stab wounds to the back and flanks. Put in a wheelchair and rushed back to neighboring room
Patients recognize each other as rival gang members from same confrontation and become aggressive
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http://www.royalcollege.ca/portal/page/portal/rc/common/documents/canmeds/resources/publications/situational_awareness_patient_safety_preview_e.pdf
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1-800-267-6522
@cmpamembers
© The Canadian Medical Protective Association cmpa‐acpm.ca
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Questions to prompt the audience Does anyone have a clinical case where
situational awareness was lost (please anonymize details)? How do these concepts apply in
ambulatory care? How can technology help situational
awareness? Hinder it? How can you learn from cases where SA
was lost?
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