The following themes are the key issues outlined by the EBC Human Factors video and how they relate to things you can do to address these issues within your own unit (time stamped for your reference):
The video outlines the background to situational awareness and the key areas to consider when addressing how this impacts on patient care: Perception (01min15), Comprehension (01min38), Projection (1min52)
Levels of situational awareness (2min10)
Signs you are losing situational awareness (6min42)
The importance of comprehensive, multidisciplinary handovers assists in ensuring that the team form a shared mental model (2min41) particularly in situations where there is lack of a fixed team (2min55) due to the nature of staffing on a delivery suite. Use safety huddles (6min57) 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 (4min20) 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 (6min5) 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.
Learn about simulations you can do with your team