TeamSTEPPS Fundamentals Course: Module 4. Situation Monitoring

TeamsTEPPS Fundamentals Course

TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety.

TeamSTEPPS® Fundamentals Course: Module 4. Situation Monitoring

Situation Monitoring: Classroom Slides

Slides:

 

Slide 1: Situation Monitoring

A seal is trying to catch a penguin using fish as bait. The seal is thinking about eating the penguin, and the penguin is thinking about eating the fish.

"Attention to detail is one of the most important details ..."

—Author Unknown

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Slide 2: Objectives

  • Define situation monitoring
  • Define cross monitoring
  • Discuss the components of the STEP process
  • Define situation awareness (SA), and identify conditions that undermine SA
  • Discuss the importance of a shared mental model
  • Discuss when to share information
  • Recognize the barriers, tools, strategies, and outcomes of situation monitoring

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Slide 3: Scenario

A patient in the ICU has coded, and CPR is in progress. The Resuscitation Team is busy ensuring that intravenous access is available, and the ET tube is inserted correctly. Dr. Matthews, the Team Leader, is calling out orders for drugs, X-rays, and labs. Judy, a nurse at the bedside, is inserting an IV. Nancy, another nurse, is drawing up meds. Judy can tell by Nancy's expression that she didn't get the last order called out by Dr. Matthews. Judy calls out while continuing to place the IV, "Nancy, he wants the high-dose epinephrine from the vial in the top drawer."

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Slide 4:TeamSTEPPS

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Slide 5: A Continuous Process

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Slide 6: Situation Monitoring (Individual Skill)

Process of actively scanning behaviors and actions to assess elements of the situation or environment

  • Fosters mutual respect and team accountability
  • Provides safety net for team and patient
  • Includes cross monitoring

Remember, engage the patient whenever possible.

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Slide 7: Cross Monitoring Is...

Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errors

  • Mechanism to help maintain accurate situation awareness
  • Way of "watching each other's back"
  • Ability of team members to monitor each other's task execution and give feedback during task execution

Mutual performance monitoring has been shown to be an important team competency.
(McIntyre and Salas 1995)

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Slide 8: Cross Monitoring

A penguin wearing scrub top reads a patient's vital signs out loud “SVT… 180 bpm… pressure… 98…50.” A second penguin in scrub top is thinking, “mmm… might need the crash cart?”

Female nurse and two male doctors in discussion.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Cross Monitoring (Flash video, 18 sec.; 1.9 MB) (Download Flash)

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Slide 9: STEP

STEP: Status of the patient; Team members; Environment; Progress toward goal.

Components of Situation Monitoring: Status of the Patient, Team Members, Environment and Progress Toward Goal

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Slide 10: Status of the Patient

STEP diagram using stacked ice blocks, emphasizing Status of the patient. Text box: patient history, vital signs, medications, physical exam, plan of care, psychosocial condition.

Status of the Patient

  • Patient History
  • Vital Signs
  • Medications
  • Physical Exam
  • Plan of Care
  • Psychosocial Condition

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
STEP (Flash video, 38 sec.; 3.9 MB)

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Slide 11: Team Members

STEP diagram using stacked ice blocks, emphasizing Team members. Text box: fatigue, workload, task performance, skill level, stress level.

Team Members

  • Fatigue
  • Workload
  • Task Performance
  • Skill Level
  • Stress Level

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Slide 12: I'M SAFE Checklist

I = Illness

M = Medication

S = Stress

A = Alcohol and Drugs

F = Fatigue

E = Eating and Elimination

An individual team member's responsibility.

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Slide 13: Environment

STEP diagram using stacked ice blocks, emphasizing Environment. Text box: Facility information, administrative information, human resources, triage acuity, equipment.

Environment

  • Facility Information
  • Administrative Information
  • Human Resources
  • Triage Acuity
  • Equipment

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Slide 14: Progress Toward Goal

STEP diagram using stacked ice blocks, emphasizing Progress toward goal. Text box: Status of team’s patient(s)? Goal of team? Tasks/actions that are completed or that need to be done? Plan still appropriate?

Progress Toward Goal

  • Status of team's patient(s)?
  • Goal of team?
  • Tasks/actions that are completed or that need to be done?
  • Plan still appropriate?

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Slide 15: Situation Monitoring

  • Recollect examples of situation monitoring, in which you needed to:
    • Be aware of what was going on
    • Prioritize and focus on different elements of the situation
    • Share this information with others
  • Select one or two that best represent the concept of situation monitoring
  • Share

Exercise icon: Penguin on a stationary exercise bicycle.

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Slide 16: Situation Awareness Is...

The state of knowing the current conditions affecting the team's work

  • Knowing the status of a particular event
  • Knowing the status of the team's patients
  • Understanding the operational issues affecting the team
  • Maintaining mindfulness

A seal is trying to catch a penguin using fish as bait. The seal is thinking about eating the penguin, and the penguin is thinking about eating the fish.

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Slide 17: Conditions that Undermine Situation Awareness (SA)

Failure to-

  • Share information with the team
  • Request information from others
  • Direct information to specific team members
  • Include patient or family in communication
  • Utilize resources fully (e.g., status board, automation)
  • Document

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Slide 18: A Shared Mental Model Is...

The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication.

"Teams that perform well hold shared mental models."
(Rouse, Cannon-Bowers, and Salas 1992)

Four penguins all thinking about food.

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Slide 19: Shared Mental Model?

Four people in a group are wearing hazard suits and masks and searching the ground. A fifth person in shorts and polo shirt stands by apparently unconcerned.

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Slide 20: Practical Exercise


Room #PatientOrdersVS
1JacksonEKG, O2, Cardiac EnzymesHR 115 R 24 B/P 174/98
2SimmonsCBC, U/A, HCG, IVHR 132 R 22 B/P 92/76
3BaileyCXR, neb Rx, CBC, UA, O2HR 120 R 32 B/P 132/86

Exercise icon: Penguin on a stationary exercise bicycle.

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Slide 21: How Shared Mental Models Help Teams

  • Help ensure that teams know what to expect, so if necessary, can regroup to get on the "same page"
  • Foster communication to ensure care is synchronized
  • Ensure that everyone on the team has a picture of what it should look like
  • Enable team members to predict and anticipate better
  • Create commonality of effort and purpose

"Shared mental models help teams avoid errors that place patients at risk."

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Slide 22: What Do You See?

Three images of optical illusions with multiple interpretations: face in profile/rear view of seated man, old woman/young girl, and duck/rabbit.

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Slide 23: When to Share?

  • Briefs
  • Huddles
  • Debriefs
  • Transitions in Care

... Share information as soon as possible when a change occurs in the patient's status.

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Slide 24: Situation Monitoring


BARRIERSTOOLS and STRATEGIESOUTCOMES
  • Hierarchical Culture
  • Lack of Resources or Information
  • Ineffective Communication
  • Conflict
  • Time
  • Distractions
  • Workload
  • Fatigue
  • Misinterpretation of Data
  • Failure to Share Information
  • Brief
  • Huddle
  • Debrief
  • STEP
  • Cross Monitoring
  • Situation Awareness
  • Shared Mental Model
  • Adaptability
  • Team Orientation
  • Mutual Trust

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Slide 25: Teamwork Actions

  • Conduct team exercises to increase situation monitoring skills
  • Share information in a timely fashion
  • Include patient and/or family in communication
  • Use cross monitoring
  • Apply the STEP process when monitoring the situation
  • Foster communication to ensure that all members of the team have a shared mental model
  • Share information during briefs, team huddles, debriefs, and transitions in care

"Teams do not seek consensus; they seek the best answer."
—Katzenbach and Smith

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Proceed to Module 5

Current as of November 2008
Internet Citation: TeamSTEPPS Fundamentals Course: Module 4. Situation Monitoring: TeamsTEPPS Fundamentals Course. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module4/slsitmonitor.html