Watch the Each Baby Counts human factors video and read the themes below for information on how to address issues within your unit
- 00:46 Situational awareness
- 02:29 Handover resources
- 03:25 Interruptions and distractions
- 04:10 Delegation
- 04:53 Task-fixation, helicopter view & closed-loop communication
- 05:22 Ask for help
The video outlines the background to Situational Awareness and the key areas to consider when addressing how this impacts on patient care: Perception (01min 15s), comprehension (01min 38s), projection (1min 52s)
Levels of situational awareness (2min 10s)
Signs you are losing situational awareness (6min 42s)
The importance of comprehensive, multidisciplinary handovers assists in ensuring that the team form a shared mental model (2min 41s) particularly in situations where there is lack of a fixed team (2min 55s) due to the nature of staffing on a delivery suite. Use safety huddles (6min 57s) throughout the shift to update team members on new developments and ensure situational awareness.
The following tools can facilitate the handover process:
Improving Patient Handover – SBAR
Keep handover boards up to date with all relevant information as they are a key resource in maintaining situational awareness
Interruptions and distractions
Given that our working memory (4min 20s) typically can only hold 5 things and this reduces further when we are stressed or tired it is important that we minimise interruptions and distractions.
Many hospitals have adopted visual barriers to prevent interruptions during safety-critical tasks, for example by displaying written “Do not interrupt the drug round” messages during medication administration.
Consider how this could be implemented during handovers or technical tasks to minimise distractions.
When staff are performing a technical task, they need to concentrate on it. When about to undertake something technical (caesarean section, fetal blood sampling, vaginal breech delivery), staff should actively delegate the job of maintaining a ‘helicopter view’ to someone else. This could be another doctor or another midwife, either onsite or offsite.
Task-Fixation, helicopter view & closed loop communication
In an ideal situation, one has a complete ‘helicopter view’ of the overall picture in any given situation and can share it with colleagues. However when engaged with technical tasks this can become difficult as you become increasingly task focused. Through multi-disciplinary training the whole team should be engaged to speak up (6min 5s) when they notice situational awareness being lost.
Multidisciplinary training can facilitate this eg. PROMPT http://www.promptmaternity.org/
Ask for help
A safety trigger should be created to make sure that the system does not rely on the team on delivery suite realising they have lost situational awareness; instead, there should be a fixed, forced trigger for the consultant to be contacted. Calling out a second theatre team could be trigger to the response of informing the on-call consultant to come and adopt a helicopter view whilst other team members are concentrating on tasks.
Consider what fixed, forced triggers might be appropriate in your unit.