TeamSTEPPS Fundamentals Course: Module 5. Situation Monitoring

Classroom Slides

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.


  Slide 1: Situation Monitoring

Situation Monitoring

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  Slide 2: Teamwork Exercise #2

Teamwork Exercise #2

Image: A penguin on a workout bicycle with the caption 'Exercise'.

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  Slide 3: Objectives


  • Discuss how situation monitoring affects team processes and outcomes.
  • List components of the STEP mnemonic.
  • Explain situation awareness and identify undermining conditions.
  • Define a shared mental model and how it is cultivated within a team.

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  Slide 4: Situation Monitoring

Situation Monitoring. TeamSTEPPS logo. For details, go to [D] Text Description.

  • Ensures new or changing information is identified for communication and decisionmaking.
  • Leads to effective support of fellow team members.

Image: The TeamSTEPPS logo. [D] Select for Text Description.

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  Slide 5: A Continuous Process

A Continuous Process

  • Situation monitoring (an individual skill).
  • Situation awareness (an individual outcome).
  • Shared mental models (a team outcome).

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  Slide 6: STEP

STEP: Components of Situation Monitoring

The components of Situation Monitoring:

  • Status of the patient.
  • Team members.
  • Environment.
  • Progress toward the goal.

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  Slide 7: Status of the Patient

Status of the Patient

  • Patient history.
  • Vital signs.
  • Medications.
  • Physical exam.
  • Plan of care.
  • Psychosocial condition.

Select the link below to access the video.

STEP (Flash video 38 sec.; 3.9 MB)

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  Slide 8: Team Members

Team Members

  • Fatigue level.
  • Workload.
  • Task performance.
  • Skill level.
  • Stress level.

Select the link below to access the video.

Cross-Monitoring (Flash video, 18 sec.; 1.9 MB)

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  Slide 9: I'M SAFE Checklist

I’M SAFE Checklist

  •  I  =  Illness.
  • M  =  Medication.
  • S  =  Stress.
  • A  =  Alcohol and Drugs.
  • F  =  Fatigue.
  • E  =  Eating and Elimination.

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  Slide 10: Environment


  • Facility information.
  • Administrative information.
  • Human resources.
  • Triage acuity.
  • Equipment status.

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  Slide 11: Progress Toward Goal

Progress Toward Goal

  • Call a huddle.
  • Status of the team's patients.
  • Goal of the team.
  • Tasks/actions completed or that need to be completed.
  • Continued appropriateness of the plan.

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  Slide 12: Situation Monitoring Exercise

Situation Monitoring Exercise

A patient in the ICU has coded, and CPR is in progress. The Resuscitation Team is busy ensuring that IV 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."

Image: A penguin on a workout bicycle with the caption 'Exercise'.

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  Slide 13: Situation Awareness is...

Situation Awareness is…

The state of knowing the current conditions affecting one's work.

Includes knowing...

  • Status of the patient.
  • Status of other team members.
  • Environmental conditions.
  • Current progress toward the goal.

Image: 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 14: Conditions That Undermine Situation Awareness

Conditions That Undermine Situation Awareness

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).
  • Maintain documentation.
  • Know and understand where to focus attention.
  • Know and understand the plan.
  • Inform team members the plan has changed.

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  Slide 15: A Shared Mental Model is...

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.

Image: Four penguins all thinking about the same fish.

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  Slide 16: Shared Mental Model?

Shared Mental Model?

Image: 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 17: When and How to Share?

When and How to Share?


  • Briefs.
  • Huddles.
  • Debriefs.
  • Transitions in Care.


  • SBAR.
  • Call-outs.
  • Check-backs.

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  Slide 18: Practical Exercise

Practical Exercise

Room # Patient Orders VS
1 Jackson EKG, O2, Cardiac Enzymes HR 115 R 24 B/P 174/98
2 Simmons CBC, UA, HCG, IV HR 132 R 22 B/P 92/76
3 Bailey CXR, neb Rx, CBC, UA, O2 HR 120 R 32 B/P 132/86


Image: A penguin on a workout bicycle with the caption 'Exercise'.

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  Slide 19: What Do You See?

What Do You See?

Images: Three images of optical illusions with multiple interpretations are shown: American Indian and Alaska Native, old woman/young girl, and duck/rabbit.

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  Slide 20: How Shared Mental Models Help Teams

How Shared Mental Models Help Teams

  • Lead to mutual understanding of situation.
  • Lead to more effective communication.
  • Enable back-up behaviors.
  • Help ensure understanding of each other's roles and how they interplay.
  • Enable better prediction and anticipation of team needs.
  • Create commonality of effort and purpose.

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  Slide 21: Tools & Strategies Summary

Tools & Strategies Summary


Barriers Tools and Strategies Outcomes
  • Inconsistency in Team Membership
  • Lack of Time
  • Lack of Information Sharing
  • Hierarchy
  • Defensiveness
  • Conventional Thinking
  • Complacency
  • Varying Communication Styles
  • Conflict
  • Lack of Coordination and Followup With Coworkers
  • Distraction
  • Fatigue
  • Workload
  • Misinterpretation of Cues
  • Lack of Role Clarity
  • Communication
    • SBAR
    • Call-Out
    • Check-Back
    • Handoff
  • Leading Teams
    • Brief
    • Huddle
    • Debrief
  • Situation Monitoring
    • STEP
    • I'M SAFE
  • Shared Mental Model
  • Adaptability
  • Team Orientation
  • Mutual Trust
  • Team Performance
  • Patient Safety!!

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  Slide 22: Applying TeamSTEPPS Exercise

Applying TeamSTEPPS Exercise

  1. Is your teamwork issue related to the team's or individuals' skill at monitoring the situation?
  2. If yes, what is the situation monitoring issue?
  3. Which situation monitoring tools and/or strategies might you consider implementing to address the issue?

Image: A penguin on a workout bicycle with the caption 'Exercise'.

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Page last reviewed March 2014
Page originally created September 2012
Internet Citation: TeamSTEPPS Fundamentals Course: Module 5. Situation Monitoring. Content last reviewed March 2014. Agency for Healthcare Research and Quality, Rockville, MD.