1. Teamwork & Non-Technical Skills
Catherine Jones
October 2017

2. “ … set of interrelated behaviours, actions, cognitions & attitudes that facilitate the required task work that must be completed..”
Teamwork
Sevdalis (2013) Non-technical skills & the future of teamwork in healthcare settings. Patientsafety.health.org.uk

3. An expert team? Attributes of a team what are they?
This is an expert team but not a team of experts like we in the medical profession are.
What does this team have that others don’t?
As ad-hoc teams we don’t have the luxury or the ability of being able the practice the same task with the same people over and over again,
So how do these ad-hoc teams come together and function?
We require portable skills that we can take anywhere, anytime and function cohesively.
Relying on technical and non-technical skills, constantly communicating observed events, concerns & mental models or having situational awareness of everything at once.
One of the problems we have in hospitals is that we work in ad hoc teams. Specifically, Situational Awareness...

4. A Team of experts? Wednesday, 05 December 2018
Does the presence of expert doctors & nurses result in an expert team?
Ad – hoc team collaborations eg intubation, rolling patient, cardiac arrest.
Varied levels of competence/skill with complex kit
In order to make teams work practitioners need Non-technical skills & we need to develop these in order to practice effectively…
Jane Roe (Transfer Training ICU) 2015

5. ANTS model

6. Team-working Co-ordinating Activities Exchanging Information
Using authority & assertiveness
Assessing capabilities
Team-working
Focus here is team mgm rather than task
Interesting in the film that the nurses didn’t articulate their concerns effectively despite correctly understanding and anticipating relevant actions ..
A couple of comm techniques that may be useful
Co-ordinating Activities:
Confirms roles/responsibilities within team
Co-operates to achieve goals
Exchanging Information:
Gives updates & reports key events (SBAR)
Seeks & confirms shared understanding
Communicates plan
Using authority & assertiveness:
Articulates requirements (PACE)
States case & provides rationale
Assessing capabilities:
Ask for help when needed
Aware of co-workers performance & aware when not meeting standards

7. Task Management Planning & Preparing Prioritising
Providing & maintaining standards
Identifying & utilising resources
Task Management
Task mgm is really the bread & butter of ICU nursing – its how we organise ourselves & our environment to provide safe & efficient care
Eg Rolling pt – roll to left on my count etcc; abandon roll if ↓↓↓ SpO2
I’ll do this & then I’ll do that… I am going to do ABCDE – I might not get to E – is this a problem?
Red book – drug administration guidelines; blue book local guidance; checking meds &
Planning & Preparing:
Communication of plan to relevant personnel
Adapt plan in light of new info
Prioritising:
Discusses & negotiates priorities with co-workers
Articulates sequence of actions in critical situations
Providing & maintaining standards:
Sticks to published guidance & protocols
Checking Emergency equipment
Maintaining accurate obs & documentation
Identifying & utilising resources :
Aware of available resources eg extra personnel/experience
Request extra resources as needed
Appropriate task allocation & equipment utilisation

8. Situational Awareness
Situational Awareness is the perception of the elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future.
Or… Know what’s going on around you…..
3 Good Questions:
What's happened?
What's happening?
What might happen?
Situational Awareness

9. Decision Making
1. Identify Options
2. Balance Risks & Select Options
3. Re-evaluate

10. Consider these aspects of team work whilst watching the following film
Martin Bromley ‘Just a Routine Operation’
You Tube
Running Time – 13min 56secs

12. Final Thought
Busy learning technical competence in ICU but this stuff is very important & helps to avert error.

13. sbar
A tool to improve verbal communication between healthcare professionals in a variety of circumstance – escalating concerns, handove.
Consists of standardised prompt questions to provide a structured framework
Commonly used for referral processes – Tx – highlighting problem to doc yr working with
Aims to get past hinting/hoping by providing clarity around reccommendations
WHO RECCOMENDS ..
Inpatient or outpatient
Urgent or non urgent communications
Conversations with a physician, either in person or over the phone
        - Particularly useful in nurse to doctor communications         - Also helpful in doctor to doctor consultation
Discussions with allied health professionals
        - e.g. Respiratory therapy         - e.g. Physiotherapy
Conversations with peers
        - e.g. Change of shift report
Escalating a concern
Handover from an ambulance crew to hospital staff

14. sbar Situation – What is happening?
“The patient’s SpO2 & Tidal Volumes have dropped”
Background – What is the background?
“The patient has just woke up & coughed. The patient had lots of pluggy secretions prior to transfer”
Assessment – What do I think the problem is?
“I think the patient has plugged off and this is affecting their ventilation”
Recommendation – What would I recommend?
“I think we should pre-oxygenate & suction”
Commonly used for referral processes – Tx – highlighting problem to doc yr working with
Aims to get past hinting/hoping by providing clarity around reccommendations
Inpatient or outpatient
Urgent or non urgent communications
Conversations with a physician, either in person or over the phone
        - Particularly useful in nurse to doctor communications         - Also helpful in doctor to doctor consultation
Discussions with allied health professionals
        - e.g. Respiratory therapy         - e.g. Physiotherapy
Conversations with peers
        - e.g. Change of shift report
Escalating a concern
Handover from an ambulance crew to hospital staff

15. GRADED ASSERTIVENESS P A C E

16. “ Do you know that the patient’s SpO2 & Tidal Volumes have dropped”
Probe
“ Do you know that the patient’s SpO2 & Tidal Volumes have dropped”
Alert
“ Can we reassess this situation? I think the patient has plugged off and this is affecting their ventilation ”
Challenge
“Please stop what you are doing – I will get someone to help you”
Emergency
“Stop what you are doing it isn’t safe.”
Probe:
“Do you know that SpO2 & Tidal Volumes have dropped”
Alert:
“Can we re-assess this situation?”
Challenge:
”Please stop what your doing – I will get some one to help you”
Emergency:
“Stop what your doing – it is not safe”

17. Non – Technical Skills Cognitive Decision Making Situational Awareness
Social
Leadership
Communication
Personal Resources
Management & awareness of stress & fatigue
Non – Technical Skills
Components of team work
Sevdalis (2013) Non-technical skills & the future of teamwork in healthcare settings. Patientsafety.health.org.uk