Situation Monitoring

“Attention to detail is one of the most important details ...” –Author Unknown

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A Continuous Process

Situation Monitoring

(Individual Skill) Situation

Awareness (Individual Outcome)

Shared Mental Model

(Team Outcome)

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Process of actively scanning behaviors and actions to assess elements of the situation or environment Fosters mutual respect and team accountability Provides safety net for team and patient Includes cross monitoring

Situation Monitoring (Individual Skill)

… Remember, engage the patient whenever possible.

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Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errors Mechanism to help maintain accurate situation

awareness Way of “watching each other’s back” Ability of team members to monitor each other’s task

execution and give feedback during task execution

Cross Monitoring is…

Mutual performance monitoring has been shown to be an important team competency.

(McIntyre and Salas 1995)

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Cross Monitoring

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Components of Situation Monitoring:

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Patient History Vital Signs Medications Physical Exam Plan of Care Psychosocial Condition

Status of the Patient

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Situational Awareness and Status of the Patient

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Fatigue Workload Task Performance Skill Level Stress Level

Team Members

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

An individual team member’s responsibility …

I’M SAFE Checklist

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Facility Information Administrative Information Human Resources Triage Acuity Equipment

Environment

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Status of team’s patient(s)? Goal of team? Tasks/actions that are

completed or that need to be done?

Plan still appropriate?

Progress Toward Goal

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Situation Monitoring Recollect examples of situation monitoring, in which

you needed to— Be aware of what was going on Prioritize and focus on different elements of the

situation Share this information with others

Select one or two that best represent the concept of situation monitoring

Share

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Knowing the status of a particular event

Knowing the status of the team’s patients

Understanding the operational issues affecting the team

Maintaining mindfulness

The state of knowing the current conditions affecting the team’s work

Situation Awareness is…

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Shared Mental Model??

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Help ensure that teams know what to expect, so if necessary, can regroup to get on the “same page”

Foster communication to ensure care is synchronized Ensure that everyone on the team has a picture of

what it should look like Enable team members to predict and anticipate better Create commonality of effort and purpose

How Shared Mental Models Help Teams

“ Shared mental models help teams avoid errors that place patients at risk.”

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What Do You See?

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Briefs Huddles Debriefs Transitions in Care

When to Share?

... Share information as soon as possible when a change occurs in the patient’s status.

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Team Effectiveness TOOLS and STRATEGIES

Brief

Huddle Debrief

BARRIERS

Hierarchical Culture Lack of Resources

or Information Ineffective

Communication Conflict Time Distractions Workload Fatigue Misinterpretation

of Data Failure to Share

Information

TOOLS and STRATEGIES

Brief Huddle Debrief

STEP

Cross

Monitoring

OUTCOMES

Situation Awareness

Shared Mental Model

Adaptability

Team Orientation

Mutual Trust

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Teamwork Actions Conduct team exercises to increase situation monitoring skills Share information in a timely fashion Include patient and/or family in communication Use cross monitoring

Utilize resources fully (e.g., status board, automation) Apply the STEP process when monitoring the situation Foster communication to ensure that all members of the team

have a shared mental model Share information during briefs, team huddles, debriefs, and transitions in care