Situation Monitoring

Situation
Monitoring

Teamwork Exercise #2

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Monitoring

Objectives
 Discuss how situation monitoring affects team
processes and outcomes
 List components of the STEP mnemonic
 Explain situation awareness and identify
undermining conditions
 Define a shared mental model and how it is
cultivated within a team

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 Situation
Monitoring

Situation
Monitoring
 Ensures new or
changing
information is
identified for
communication
and decision-
making
 Leads to
effective support
of fellow team
members

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Monitoring

A Continuous Process

Situation
Monitoring Situation
(Individual Skill) Awareness
(Individual
Outcome)

Shared
Mental Model
(Team Outcome)

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Monitoring

Components of
Situation Monitoring:

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Monitoring

Status of the Patient

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

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Monitoring

Team Members

 Fatigue
 Workload
 Task Performance
 Skill Level
 Stress Level

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Monitoring

I’M SAFE Checklist

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

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Monitoring

Environment
 Facility Information
 Administrative Information
 Human Resources
 Triage Acuity
 Equipment

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Monitoring

Progress Toward Goal

 Call a Huddle!
 Status of Team’s Patient(s)
 Goal of Team
 Tasks/Actions That Are or
Need To Be Completed
 Plan Still Appropriate

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Monitoring

Situation Monitoring Exercise

A patient in the ICU has coded, and CPR is in progress.
The Resuscitation Team is busy ensuring that IV access
is available and the ET tube is inserted correctly. Dr.
Matthews, the Team Leader,
is calling out orders for drugs, X-rays, and labs. Judy,
a nurse at the bedside, is inserting an IV. Nancy,
another nurse, is drawing up meds. Judy can tell by
Nancy’s expression that she didn’t get the last order
called out by Dr. Matthews. Judy calls out while
continuing to place the IV, “Nancy, he wants the high-
dose epinephrine from the vial in the top drawer.”

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Monitoring

Situation Awareness is…

The state of knowing the current conditions affecting
one’s work.
Includes knowing…
 Status of the patient
 Status of other team
members
 Environmental
conditions
 Current progress
toward the goal

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Monitoring

Conditions That Undermine

Situation Awareness
Failure to—
 Share information with the team
 Request information from others
 Direct information to specific team members
 Include patient or family in communication
 Utilize resources fully (e.g., status board, automation)
 Maintain documentation
 Know and understand where to focus attention
 Know and understand the plan
 Inform team members the plan has changed

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Monitoring

A Shared Mental Model is…

The perception of, understanding

of, or knowledge about a
situation or process that is
shared among team members
through communication

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Monitoring

Shared Mental Model?

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Monitoring

When and How to Share?

When: How:
 Briefs  SBAR
 Huddles  Call-outs
 Debriefs  Check-backs
 Transitions in Care

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Monitoring

Practical Exercise
Room # Patient Orders VS
1 Jackson EKG, O2, HR 115 R 24
Cardiac B/P 174/98
Enzymes
2 Simmons CBC, UA, HR 132 R 22
HCG, IV B/P 92/76
3 Bailey CXR, neb Rx, HR 120 R 32
CBC, UA, O2 B/P 132/86

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Monitoring

What Do You See?

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Monitoring

How Shared Mental Models

Help Teams
 Lead to mutual understanding of situation
 Lead to more effective communication
 Enable back-up behaviors
 Help ensure understanding of each other’s roles
and how they interplay
 Enable better prediction and anticipation of team
needs
 Create commonality of effort and purpose

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Monitoring

Tools & Strategies Summary

BARRIERS TOOLS and OUTCOMES
 Inconsistency in Team STRATEGIES
 Shared Mental Model
Membership Communication
 Lack of Time • SBAR  Adaptability
 Lack of Information Sharing • Call-Out
 Team Orientation
 Hierarchy • Check-Back
 Defensiveness • Handoff  Mutual Trust
 Conventional Thinking Leading Teams
 Complacency • Brief  Team Performance
 Varying Communication Styles • Huddle  Patient Safety!!
 Conflict • Debrief
 Lack of Coordination and Situation Monitoring
Followup With Coworkers • STEP
 Distractions • I’M SAFE
 Fatigue
 Workload
 Misinterpretation of Cues
 Lack of Role Clarity
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Monitoring

Applying TeamSTEPPS Exercise

1. Is your teamwork issue related to the team’s or

individuals’ skill at monitoring the situation?
2. If yes, what is the situation monitoring issue?
3. Which situation monitoring tools and/or strategies
might you consider implementing to address the
issue?

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