SITUATIONAL AWARENESS Dr Paula Foran Copyright Dr Paula

SITUATIONAL AWARENESS Dr Paula Foran Copyright Dr Paula

SITUATIONAL AWARENESS Dr Paula Foran Copyright Dr Paula Foran SITUATIONAL AWARENESS Objectives Some definitions Why is this SO important Some research

Some new ideas SITUATIONAL AWARENESS Situational Awareness is the ability to identify, process, and comprehend the critical elements of information about what is happening to the team with regards to the mission. More simply, it's knowing what is going on around you (UNITED STATES COASTGUARD 2016)

HUMAN FACTORS Human factors may be defined as the environmental, organisational and job factors, and human and individual characteristics which influence behaviour at work in a way which can affect health and safety (Health and Safety Executive United Kingdom 2016) SITUATIONAL AWARENESS

Gillespie, B & Davies, M 2016, 'The perioperative team and interdisciplinary collaboration', in L Hamlin, M Davies, M Richardson-Tench & S Sutherland-Fraser (eds), Perioperative Nursing - an introductory text, Elsevier Sydney, Australia. SITUATIONAL AWARENESS Perianaesthesia and perioperative nursing are team sports To maximize survival rates and improve prognosis, advanced non-technical skill competency of the entire perioperative team is required, including both cognitive (decision making and situation awareness) and interpersonal (communication and teamwork) skills (Komasawa 2016)

In the operating room, the importance of establishing perioperative team training is essential from the viewpoints of crisis management and resuscitation (Komasawa 2016) Situational awareness is used and well-understood in organizations, such as aviation, air traffic control, and nuclear power; however, the same use of the term is not as prevalent or well-understood in nursing SITUATIONAL AWARENESS This is changing and situational awareness is taking centre stage in perioperative research and practice Surgical complications are estimated at between 50% and 75 %

of all adverse medical events (Pinney et al. 2010) In Australian literature an adverse event may be defined as an unintended injury or complication which resulted in disability, death or prolongation of hospital stay, and is caused by healthcare management rather than the patients disease (Kable et al. 2002) More recent research has reported that surgical adverse events occur in 3.6% of all hospital admissions representing 65% of all reported adverse events (Zegers et al. 2011) SITUATIONAL AWARENESS

These surgical adverse events were severe in nature and 41% were considered to have been preventable (Zegers et al. 2011) Whilst the mortality in surgical patients has fallen in the last decade, mainly due to effective recognition and treatment of such patient deterioration, failures in this process are still occurring (Helling 2014) Recent studies indicate that the main cause (70%) of adverse events can be attributed to the lack of team members' non-technical skills, such as; poor poor poor poor

poor communication teamwork leadership decision-making situational awareness (Green, Tsiroyannis & Brennan 2016) TYPES OF NON-TECHNICAL SKILLS IN PERIOPERATIVE

PRACTICE Non-technical skills for surgeons NOTTS Scrub practitioners list of intraoperative nontechnical skills SPLINTS (FLIRT, MITCHELL & MCLEOD 2014; MITCHELL, FLIN, YULE, MITCHELL, COUTTS & YOUNGSON 2013) Anaesthetic non-technical skills ANTS Nurse anaesthetists non-technical skills NANTS (RUTHERFORD, FLIN, IRWIN & MCFADYEN 2015) Anaesthetic nurses in development (RUTHERFORD ET AL. 2015)

DISTRACTIONS Australian research observed 160 planned & unplanned surgeries over 10 specialities to observe relationships between perioperative interruptions, team familiarity, miscommunications During 107 procedures, 243 interruptions occurred In 91 procedures there were 175 miscommunication events There was statistical significance between interruptions, time teams had worked together, & miscommunications (GILLESPIE, CHABOYER & FAIRWEATHER 2012)

ON-CALL MOBILE PHONES FACEBOOK NOISE REDUCTION http://www.belowtenthousan Smith, P & Gibbs, J 2016, ''Below ten thousand': An effective behavioural noise reduction strategy?', The Journal of Perioperative Nursing in

Australia, vol. 29, no. 3, pp. 2932. Smith, PJ & Gibbs, J 2016, 'A pathway to clinician-led culture change in the operating theatre', British Journal of Perioperative Nursing, vol. 26 no. 6, pp. 134-7. PRIOR PROPER PLANNING PREVENT POOR PERFORMANCE (THE 6 PS) BE PREPARED FOR AN EMERGENCY

At the start of a shift in PACU when you know you are going to have a paediatric ENT list, look at the ages of all the children Imagine possible airway problems start thinking about what to do - get prepared have everything ready to go PRIOR PROPER PLANNING PREVENT POOR PERFORMANCE (THE 6 PS) HAVING A LEADER AND BEING PREPARED FOR AN EMERGENCY SUCH AS CPR Management of CPR in the operating suite things to

consider Simulation training as a team with team leaders Allocation of jobs in CPR at the start of a shift (like you do for cases) in charge senior nursing staff to take charge of arrest and do defibrillation ventilation chest compression scribe FATIGUE Fatigue, in broad terms, is a state of mental and physical

exhaustion (SAFE WORK AUSTRALIA 2013) There is overwhelming evidence that long work hours, heavy workloads & staff shortages contribute to adverse events and impact on patient safety (REGISTERED NURSES ASSOCIATION OF ONTARIO 2011; TRINKOF, JOHANTGEN, STORR, GURSES, LIANG & HAN 2011) The federal aviation administration (1999) reported that fatigue is not a mental state that can be willed away or overcome through motivation or discipline, thereby implying comments such as using determination to allow you to work long shifts are incorrectly based (REGISTERED NURSES ASSOCIATION OF ONTARIO 2011)

FATIGUE Long working hours by staff pose the greatest threat to patient safety because fatigue: Slows reaction time, Diminishes attention to detail, Decreases energy, Contributes to errors (American Society of Registered Nurses 2010) A study by Rodgers found that nurses who work more than 12 hour shifts tripled their chance of making an error (Rogers 2004)

Working 17 hours shifts is similar to having a blood alcohol concentration of 0.05% and working 24 hours straight to 0.1% (ASSOCIATION OF PERIOPERATIVE REGISTERED NURSES 2013) FATIGUE An Australian study showed that less sleep not only led to an increased likelihood of errors but also a decreased likelihood of noticing an error made by a colleague (DORRIAN, LAMOND, VAN DEN HEUVEL, PINCOMBE, ROGERS & DAWSON 2006) In addition to causing problems at work, fatigue

can also undermine personal and home life (REGISTERED NURSES ASSOCIATION OF ONTARIO 2011) Many of us may not even realise how fatigue impairs our ability to enjoy life and meet home and family obligations (REGISTERED NURSES ASSOCIATION OF ONTARIO 2011) FATIGUE Research also suggests that many health professionals are managing their fatigue and sleep disturbances with prescription

medication and alcohol (AUSTRALIAN COLLEGE OF OPERATING ROOM NURSES 2018; DORRIAN ET AL. 2006) ACORN fatigue guideline states that health care facilitys and managers at a unit level should establish rostering guidelines which limit shifts to 12 hours inclusive of overtime (ACORN 2018) COMMUNICATION Why are we now

going to spend time looking at communication? COMMUNICATION & SAFETY Communication is defined as the transfer of information and understanding from one person to another (Australian Medical Association 2006 as cited in Gillespie, Chaboyer, Longbottom & Wallis 2010, p. 733)

MESSAGES FROM THE VMIA INSURANCE AGENCY Contributing factors driving insurance claims (patients who sued) Poor communication with the patient Poor communication between staff Poor documentation Failure to escalate Failure to refer Inexperience Poor culture

(Stephen Grant - Senior Claims Specialist 2016) COMMON THEMES FROM THE CORONER Poor documentation Inadequate handover Poor communication Inadequate risk assessments (English 2015) UNDENIABLE LINK BETWEEN

BEHAVIOURS / SAFETY Behaviou rs Safet y COMMUNICATION & SAFETY Poor teamwork is a symptom of a structural fault line in medicine and surgery, where persistent autocratic practices shape inflexible work hierarchies that stifle

effective communication (Bleakley, Bligh & Browne 2011) For years I have asked people to be nice to each other for social reasons Now there is irrefutable evidence that poor behaviours lead to poor communication and this is linked to poor patient safety This is a new platform from which to attack this problem THE COURAGE TO CARE Do you know

Mean Mary? THE COURAGE TO CARE Do you know Nasty Norm? RESEARCH HAS NOW SHOWN THAT: Poor communication is the single biggest cause of medical error (Bethune et al. 2011)

Effective communication and teamwork are a fundamental skill within the operating suite to promote patient safety and prevent adverse events (Carney, West, Neilly, Mills & Bagian 2010) Outcome measures to assess teamwork include, morbidity mortality, technical errors, operating time, delays & communication failures (Nurok, Sundt & Frankel 2011) Failures of communication are the most common cause of sentinel perioperative events & wrong site surgery (Makary et al 2006) Inadequate teamwork behaviours were also associated with increased death & complications (Nurok, Sundt & Frankel 2011) Medical errors cause between 44000 98000 deaths in the USA per year and the single biggest cause is poor communication between health professionals (Bethune et al. 2011)

SALIENT POINTS (BLEAKLEY, ALLARD & HOBBS 2012) Good teamwork reduces surgical error Surgical cultures historical legacy of hierarchy frustrates effective teamwork Modelling good teamwork requires a designed and sustained educational intervention Establishing collaborative teamwork, as a cultural change, requires a precondition of attitude change Sustaining an educational intervention can result in an incremental, positive valuing of teamwork and safety by

practitioners (Bleakley, Allard & Hobbs 2012) IMPROVING BEHAVIOUR It is time to stop doing nothing and ignoring or tolerating bad behaviour Speak up if you see bullying or bad behaviours if you can If you do not feel able to speak up at least report the behaviour to your manager Consider above and below line behaviours and enforce these The Department of Health and Human Services has released a statement Our pathway to change: eliminating bullying and harassment in healthcare - Creating a culture and environment that

supports both patient and staff safety in healthcare settings (Department of Health and Human Services 2016) Food for thought!!!!!! Discussion Questions

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