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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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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?