Why are high performance teams important
This results in superior performance and timing which can improve survival for patients in cardiac arrest.
Each team member is committed to ensuring the highest-quality performance of the team rather than following orders
To function effectively, a high performance team needs to focus on what (key areas of focus)
- timing
- quality
- coordination
- administration
Key area
Timing
- Time to first compression
- time to first shock
- Chest compression fraction (CCF) ideally greater than 80%
- minimizing pre-shock pause
- early EMS response time
Key area
Quality
- rate, depth, and recoil
- minimizing interruptions
- switching compressors
- avoiding excessive ventilation
- use of a feedback device
Key area
Coordination
-team dynamics: team members working together, proficient in their roles
Key area
Administration
- leadership
- measurement
- continuous quality improvement
- number of code team members
What is the role of the team leader in a high performance group
- organizes the group
- monitors individual performance of team members
- backs up team members
- models excellent team behavior
- trains and coaches
- facilitates understanding
- focuses on comprehensive patient care
- temporarily designates another team member to take over as Team Leader if any advanced procedure is required (ex: advanced airway placement)
The Team Leader should help team members understand why they must perform certain tasks in a specific way, they should be able to explain why it is essential to
- push hard and fast in the center of the chest
- ensure complete chest recoil
- minimize interruptions in chest compressions
- avoid excessive ventilation
High performance team members must be
- proficient in performing the skills in their scope of practice
- clear about role assignments
- prepared to fulfill their role responsibilities
- well practiced in resuscitation skills
- knowledgeable about the algorithms
- committed to success
What is the role of a CPR coach and why is it important
Supports performance of high quality BLS skills. They allow team leaders to focus on other areas. Having a CPR coach has been shown to shorten pause durations (compressions)
- coordinate the start of CPR
- Coach to improve the quality of chest compressions (gives feedback about performance of compression depth, rate and chest recoil)
- state the midrange targets (compression and ventilation recommendation range)
- coach to the midrange targets (gives feedback about ventilation rate and volume
- help minimize the length of pauses in compressions (pauses happen when the team defibrillates, switches compressors and places an advanced airway)
What are the 6 team roles for resuscitation
The Resuscitation Triangle Roles
-compressor
-monitor/defibrillator/CPR coach
-airway
The Leadership Roles
-team leader
-IV/IO/Medications
-Time/recorderClear Roles and Responsibilities
Clearly define all team member roles in the clinical setting
Distribute tasks evenly to all available team members who are sure of their responsibilities
-ask for new tasks or clearer instructions as needed and only accept roles that are within your scope of practice
Knowing you limitations
- call for assistance early rather than waiting until the patient deteriorates
- seek advice from more experienced personnel when the patient’s condition worsens despite primary treatment
- allow others to carry out assigned tasks, especially if the task is essential to treatment
- accept assistance from others when it is readily available
Constructive interventions
-ask that a different intervention be started if it has a higher priority
-reassign a team member who is trying to function beyond his or her level of skill
Suggest an alternative drug or dose confidently
Question a colleague who is about to make a mistake
Intervene if a team member is about to administer a drug incorrectly
Knowledge sharing
-encourage information sharing
-ask for suggestions about interventions, differential diagnoses, and possible overlooked treatments
-look for clinical signs that are relevant to the treatment
Accept information that will improve their roles
Summarizing and Reevaluating
-continuously revisit decisions about different diagnoses
-maintain an ongoing record of treatments and the patients response
-change a treatment strategy when new information supports it
-inform arriving personnel of the current status and plans for further action
Note significant changes in the patients clinical condition
Increase monitoring if patients condition deteriorates
Closed-loop communication steps
- give a message, order, or assignment to a team member
- request a clear response and eye contact from the team member to ensure that he or she understood the message
- confirm that the team member completed the task before you assign him or her another task
Closed loop communications
-after receiving a task, close the loop by informing the team leader when the task be begins or ends
-only give drugs after verbally confirming the order with the team leader
Assign additional tasks to a team member only after receiving confirmation of a completed assignment
Clear messages
-encourages all team members to speak clearly and use complete sentences
Repeat orders, and question them if the slightest doubt exists
Be careful not to mumble, yell, scream, or shout
Ensure that only 1 person talks at a time
Mutual respect
Acknowledge correctly competed assignments by saying “thanks or good job”
Show interest and listen to what others say
Speak in a friendly, controlled tone of voice
Avoid displaying aggression if teammates do not initially understand each other
Understand that when one person raises his voice, others will respond similarity
Try not to confuse directive behavior with aggression
