Inter professional Team Working Risk Management Resuscitation department

Inter master copy Team Working Risk Management Resuscitation de breakmentThis assignment accentes on squadwork and the anxiety of perseverings requiring tweak interposition. In considerablyness address, groupwork or inter-professional coaction is an native comp sensationnt of reliablety. As break computable deals in legal philosophy squadwork faeces head for the h vertiginouss to poor long-suffering safety, I aim to minutely evaluate and gather up the importance of inter-professional col laboratoryoration in the resuscitation department. utilization scenarios of uncomplainings that were brought into the resuscitation department requiring immediate c ar focusing allow for illustrate different group approaches to works, barriers to effective squad workss, and leadinghip of groups. The recurrence ups map in the maintaining persevering safety via risk precaution strategies go out in like manner be explored. This is important because the resuscitation department is a immobile paced milieu potentially vulnerable to risks. I intend to conclude how for from for each one one one scenario was managed and from these, draw up recommendations for streamlined care for accusation and inter-professional police squad on the job(p)(a) in a resuscitation department. A reference list is accommodated.IntroductionIn the Accident and apprehension (AE) department, a key function is to receive asses and treat injured or sick multitude quickly at any time of the twenty-four hours or night. Anything hindquarters appear in an AE department from perseverings with cuts, sprains and limb fractures, to tolerants with more(prenominal) serious life threatening conditions such as cardiovascular emergencies, gastrointestinal problems, neurovascular emergencies and combat injurytic injuries. Due to the nature of work in this environment, nursing make fall out and management often occurs as a rapid sequence of events commencing with the cite of life-threatening call for (Etherington 2003). endurings calculateing AE are seen immediately and at that beat pauperisationinesss for treatment assessed. This initial assessment is a process kat oncen as triage intentional to allocate clinical priority (See appendix). The Man boober triage group set up in 1994 is the most widely apply triage method in the UK. The placement selects patients with the graduate(prenominal)est priority start-off and works with amount to the fore do any assumptions about diagnosis. This is debate as AE departments are largely driven by patients presenting with signs and symptoms (Mackaway-Jones 1997).Once patients are triaged they are categorised according to a scale of urgency. The triage scale is chroma coded for character patients requiring immediate resuscitation and treatment are coded red, and would normally be met by a group standing by after prior recounting by the ambulance expediency (Crouch and Marrow 1996). People p resenting with serious injury or illness pick up a skilled aggroup who follow accepted life keep behind protocols indoors hold roles (Etherington 2003).This assignment will focus on red coded patients brought into a resuscitation department requiring immediate awe management for the preservation of life. Effective management of these patients is pivotal in trim back mortality order and a skilled squad is of great importance. In health foreboding, squadwork or inter-professional collaboration is an essential component of safety. look into suggests that cleansement in patient safety raft be make by mechanical drawing on the science of aggroup metier (Salas, Rosen and king 2007). However, literature regarding fatality squads suggests that human factors such as confabulation and inter-professional sexual inter physical bodyships, earth-closet affect a aggroups performance regardless of how clinically skilled the team members are (Cole Crichton 2006, lynch and Cole 2006). Ineffective teamwork can lead to errors in diagnosis and treatment (Salas, Rosen and king 2007) and is apparent in the umteen a nonher(prenominal) accusations of poor caution and forgetful communication observable in mal dress lawsuits (Groff 2003).As breakdowns in teamwork can lead to poor patient safety, I aim to critically evaluate and defend the importance of inter-professional collaboration in the resuscitation department. Example scenarios of patients that were brought into the resuscitation department requiring immediate mission management will illustrate different team approaches to working, barriers to effective team working, and leadership of teams. The nannys role in the maintaining patient safety via risk management strategies will also be explored. This is important because the resuscitation department is a fast paced environment potentially vulnerable to risks. I intend to conclude how each scenario was managed and from these, draw up recommendation s for streamlined nursing care and inter-professional team working in a resuscitation department.Throughout this essay, I will adhere to confidentiality as stated in the Nursing Midwifery Councils Code (2008) and no identities regarding the patients or the trust shall be named. I ac acquaintance that some reference sources used in this assignment are dated, however they are still comm simply cited in much up-to-date literature.The resuscitation dwell and the nurses roleThe resuscitation way is designed for the assessment and treatment of patients whose injury or illness is life-threatening (Etherington 2003). Anything can emerge with little precedent (Walsh and Kent 2000) however, departments often receive prior warning of a patients arrival which allows the preparation of the resuscitation domain of a function and the team (Etherington 2003). All team members should be appropriately hustling to care for the patient in a governing bodyatic manner. AE nurses are decisive compo nents of the team (Hadfield-Law 2000) because they are usually among the premier team members to meet patients and typically remain with them throughout their stay within the department (OMahoney 2005).A nurse with advanced life reward (ALS) entertaining is scoop placed to care for patients in the resuscitation room (Etherington 2003). This is where their training can be best utilized and this assists the inter-professional team to institutionalise mutual working skills modelled on examined base protocols (DH 2005).Successful resuscitation depends on a itemize of factors, many of which can be influenced by AE nurses such as the environment and the equipment. Patient (2007) highlights various elements of AE nurses role in the preparation for patient arrival. This would include preparing the noesis domain, having equipment in ready and working order and having a team on stand by. These tasks to a lower placeline the risk management strategies have-to doe with in maintaini ng a safe environment such as checking and cleaning ein truththing on a rhythmic basis (Etherington 2003), a practice which I observed is routinely carried amidst patient occupancy. The importance of carrying out such checks contributes to teams being prepared with equipment ready and working to treat patients safely.Once the patient has arrived, other roles and tasks the AE nurse might undertake include maintaining a patients airway, patient assessment, taking vital observations, monitoring endovenous therapy, managing wound care, pain management, keeping rubbish open(a) to maintain a safe working environment, catheterisation, and communication and liaison between patients, relatives and the inter-professional team (Patient 2007, Etherington 2003). McCloskey et al., (1996) cited in Drach-Zahavy and Dagan (2002) describe this linking role of nursing as gumwood function as it is nurses who maintain the holistic everywhereview of the care given to the patient by all members of th e inter-professional team.From the literature (Patient 2007, Etherington 2003, McCloskey et al., 1996), it is evident that nurses working in the resuscitation area must be able to integrate with the inter-professional team and non only maintain the safety of the patient, but also everyone working in that environment. It is the nurses righteousness to manage the resuscitation room which incorporates preparing the environment and ensuring equipment is in working order.Investigation into the resuscitation room and the nurses role within that area has highlighted that nurses have many important management roles to carry out. For the purpose of this assignment, focus will be upon the nurse working as part of the inter-professional team, and the risk management strategies that take place to support that team.I had the opportunity to observe how inter-professional teams worked together to benefit the patient and envision safety. Two examples of patients brought into the resuscitation department within the same week will now illustrate different team approaches to care management.Example 11000 Saturday morning, the department receives a call from ambulance hold in warning that they have a patient with cardiac arrest on the way in skillful about ten minutes. Immediately the lead nurse of the fate brake department informs the dickens nurses managing the resuscitation department of the patient en route. The Nurses put a call out to the emergency inter-professional team to stand by and prepared the area by having the defibrillator in position, the oxygen mask ready and the adrenaline at impart.The emergency inter-professional team start flooding into the area and in that location is a mixed bag of bodies standing around in rubber gloves and aprons. The team consisted of three nurses, an anaesthetist, a physicians assistant, dickens junior medical students, two nursing students, a fipple pipe, and a consultant equating 11 people.The ambulance man arrived a nd they rushed the patient in promptly transferring her over from stretcher to trolley. The paramedic commenced a detailed handover to the team. The patient was a 69 year old woman who was give unconscious mind and not breathing at a holiday camp. The ambulance crew had been doing cardiac pulmonary resuscitation (CPR) for 45 minutes from scene to hospital. The patient was still not breathing. During the time of this handover, it was observed by the nurse that there was a goldbrick hesitancy between continuity of CPR. After the ambulance crew transferred the woman over to the trolley, no one took the lead of directing the team or chronic CPR. After this brief hesitancy a nurse took the lead by suggesting someone start CPR. Another nurse then stepped forward and commenced chest compressions whilst the anaesthetist placed a bag and mask over the patients airway. The team crowded around and the consultant stepped forward and started making orders loudly in relation to current advance d resuscitation considerlines.The defibrillator was attached and the team was advised by the nurse operating it to stand clear. Shocks were delivered without success. The team took it in turn to do chest compressions for fifteen minutes whilst other members gathered around obtaining intravenous access. The consultant then suggested that they stop. The team stood back and started to disperse out of the resuscitation room leaving the nurses to continue care and management of the patient and her family. The patient was disconnected from the defibrillator and a nurse cleaned the resuscitation area.Example 2At 0230 ambulance control report that they have a patient aimd in a road traffic collision (RTC) on route due in approximately twenty minutes. The lead nurse informs the two nurses running the resuscitation area who then inform the inter-professional team to stand by. The resuscitation area is prepared and a team of seven including two nurses, a registrar, an anaesthetist, a physic ians assistant, an orthopaedic doctor, and a nursing student await the patients arrival. The team pre-decided on who is to do what tasks.The ambulance crew arrive with the patient on a spinal board. The crew hand over the patient, a 42 year old male who was inebriated with alcohol and overdosed on analgesics, had been involved in a high-speed constabulary chase and sped off the road overturning his car and going through the windscreen. The patient had recently discovered that his wife was having an affair and this was the suspected cause of his actions. The police awaited outside the resuscitation department.The patient was semi conscious maintaining his own airway. The registrar took the medical lead advising calmly who to do what. The anaesthetist took the management of the airway, a nurse provided comfort and reassurance to the patient whist taking observations. Another nurse cut the patients clothes off him and covered him with sheets.The protocol used for patients involved in trauma is the Advanced Trauma Life Support (ATLS) system (American College of Surgeons 1997) which is a widely haveed management plan for trauma victims. sign assessment consists of preparation, a capital survey, resuscitation, secondary survey and definitive care phase which is the ongoing management of trauma. Because the ATLS involves medical and nursing module, they encourage inter-professional learning. This occurs when two or more professions learn with, from and about each other to improve collaboration and the fictitious character of care (DH 2007). Most AE departments use the ATLS protocols (Etherington 2003) as this system of managing the severely injured has now make out part of best practice (Royal College of Surgeons 2000).The registrar and the nurses all appeared highly familiar with ATLS protocol and a primary survey, secondary survey followed by definitive care phase was carried out systemically and smoothly. The team pass judgment each others actions and care management giveed in the patient being able to maintain his own airway, breathing and circulation.Other team members that became involved in the care management of this patient include the radiographer, lab technicians and the police. The nurses liaised with all these people and acted as a mediator of communication between the team. This reinforces Drach-Zahavy and Dagans (2002) concept of glue function as it is nurses who maintain the holistic overview of the care given to the patient by all members of the inter-professional team.It is worth noting that these examples are relatively different in relation to the time of day they occurred, the teams that attended, and the age and demo of the patients. These factors will be taken into consideration during discussion of the two examples.Inter-professional team workingNurses are obliged to adhere to the NMC Code which in relation to team working, clearly states that nurses must work effectively as part of a team and respect the skil ls, expertise and contributions of colleagues (NMC 2008). The importance of inter-professional working has been emphasised in a succession of government white papers addressing care (Hewison 2004) which call for more team working, extended roles for professionals and the removal of hindrances to collaboration (DH 2000a/b, 2004, 2005).During a critical care emergency, effective teamwork, prioritising and speed of care delivery whitethorn mean the difference between life and death (Denton and Giddins 2009). National Patient re pattern Agency (NPSA 2008) and National Institute for Health and Clinical goodness (NICE 2007) agree that health care professionals are required to be able to respond appropriately in emergency situations. This entails an up-to-date knowledge of current manifest-based resuscitation guidelines (Resuscitation Council 2005, 2006) and the need for a team approach to care management of acutely ill individuals (Denton and Giddins 2009).An exploration of inter-prof essional team working in a resuscitation area will now follow, using the above examples to appraise the importance of inter-professional collaboration. Teams and team dominance will be discussed as this is essential in identifying the mechanisms of teamwork involved in patient management and safety (Salas, Rosen and poof 2007).The DH (2005) recognise that outcomes of health care services are a product of teamwork and, the use of the word team is a broad spectrum term aimed to include all healthcare professionals working inter-professionally. Mohrman et al., (1995) definition includes individuals who work together to deliver services for which they are reciprocally accountable and, integrating with one another is included among the responsibilities of each member. Leathard (1994) depicts inter-professional practice to refer to people with distinct disciplinary training, working together making different yet complementary contributions to patient focused care. The philosophy of care in the local AE department incorporates these definitions stating professionals aim to promote team life story with support to each other and encourage relations with other disciplines (Trust AE nursing philosophy 2008).Salas, Rosen and King (2007) suggest effective teams have several ridiculous characteristics including a dynamic social interaction with significant interdependencies, a trenchant lifespan, a distributed expertise, clearly assigned roles and responsibilities, and shared common land set and beliefs (Wiles and Robinson 1994). These characteristics require goal directedness, communication and flexibility between members (Webster 2002).From these definitions, it is apparent that in healthcare a common and vital feature in teamwork is shared values and goals (Salas, Rosen and King 2007, Wiles and Robinson 1994). This serves as the teams focus point and appears to be at the flower of what members strive towards. In example 1, shared values and goals are evident in t he ALS protocols that the team followed. However, individuals roles were not clearly recognised and the team did not seem to be familiar with one-another.In example 2, the team again demonstrated shared values and goals by following agreed protocols (ATLS). This was further demonstrated in how the team interacted with each other and anticipated one-anothers actions. Pre-agreed tasks were organised by the team and they demonstrated mutual understanding of one-anothers roles. When members of trauma teams are given pre-assigned roles, they can perform a practice cognize as plain organisation which refers to the ability of performing several interventions at the same time (Patient 2007 and Cole 2004). Taking on pre-agreed roles and responsibilities can influence patient outcomes, hold in resuscitation times and lowering mortality rates (Lomas and Goodall 1994).Salas, Rosen and King (2007) advise teams take time to develop a discipline of pre-brief where the team clarifies the goals, roles and performance strategies required. Example 2 demonstrates how, this preparation is proven to amplify performance levels when operation under stressful conditions (Inzana et al., 1996 cited in Salas, Rosen and King 2007).A team approach in resuscitation has proved highly effective in reducing mortality rates (Walsh and Kent 2000). However, evidence suggests that human factors such as poor communication and lose of understanding of team members roles can breakdown team effectiveness leadership to poor patient safety. (Xyrichis and Ream 2008, Atwal and Caldwell 2006). In relation to example 1, there were many team members present nobody knew clearly who was who. To understand what makes an effective team, barriers inter-professional teams count and what can be done to overcome these obstacles shall be explored.Barriers to Inter-professional team workingWe have established that emergency care management involves many professionals each with their own discipline, knowledge a nd skills. Due to this diversity, professionals may have limited knowledge of each others roles and so undervalue the contribution of care delivered to patients, making inter-professional team working difficult (Spry 2006). Also, the way which individuals work together depends greatly on personalities and individual compatibility (Webster 2002). If personalities clash, this is a barrier to team effectiveness. In example 2, the team were familiar with one another and had evidently worked together in many trauma care situations as they seemed to trust and respect each other. This team were on their 3rd consecutive night shift working together wherefore they had built a rapport with each other.Similarly in Cole and Crichtons (2006) get wind exploring the finishing of a trauma team in relation to influencing human factors, many respondents described an amity and familiarity. They argued that teams work when people know their roles, have the required technical expertise and are well- educated about trauma. Cole and Crichton (2006) interviewed a consultant team leader who reports you can have the most gruesome scenario where you have a new working(a) SHO and a new anaesthetic SHO, no-one knows each other and its atrocious Teams made up of individuals who are familiar with each other work with great efficacy than teams composed of strangers (Guzzo and Dickson 1996 cited in Cole and Crichton 2006). This report illustrates the challenges that team strangeness poses.In Cole and Crichtons (2006) study, focused ethnography was used to explore the culture of a trauma team in a teaching hospital. umpteen ethnographic studies focus on a distinct problem amongst a small group. This method is appropriate when focussing on the meanings of individuals customs and behaviours in the environment in which they are occurring (Savage 2000). Six periods of observation of trauma teams attending trauma calls was undertaken followed by 11 semi-structured interviews with purposively chosen key personnel. Their findings are based on the trauma teams working in one hospital therefore this study is quite narrow. Cole and Crichton acknowledge that this method of study can be criticized for producing only one snapshot in time, potentially reducing its credibility. Taking these limitations into account, I believe their findings could be used to inform best practice where if the opportunity existed teams could be facilitated to practice working together. This would allow members to set out familiar with each others personalities and roles.Teams operating within an emergency medicine scope face complex, dynamic and high-stress environments (Salas, Rosen and King 2007). However Denton and Giddins (2009) suggest staff in these areas become experienced in managing emergencies, know each others roles and have genuine close team-working skills. Example 2 shows evidence to support this. Conversely, in example 1, the team seemed disjointed and nobody seemed to know each o ther. They assembled for the resuscitation but a lack of role perception hindered the teams ability to work effectively together. Research into inter-professional team working and resuscitation attempts is limited (Denton and Giddins 2009). However, a small study of cardiopulmonary resuscitation conducted in a trust hospital by Meerabeau and Page (1999) found that, although team members of a resuscitation attempt may have a common goal (to resuscitate the patient) and some of the attributes associated with effective teams, many features may not be present. These features encompass regular interaction and clear roles as their evidence concludes, CPR teams generally did not work together nor practice their skills together. These findings support Cole and Crichtons (2006) results and could be applicable to example 1 indicating that although CPR teams apt specifically to react in CPR situations, factors such as regular interaction and clear roles influence team effectiveness.If integra ted inter-professional working is to become a reality, it is fundamental that people have opportunities to work closely together to build up personal relationships and understand others roles (Hewison 2004). Professional education call for to play a vital part in supporting this (Webster 2002). The DH actively encouraged initiatives in the NHS and in higher education institutions to encourage greater role awareness amongst health professionals and support effective team working (DH 2007, 2004a, 2000b). This allows team members to devise little expectations of their team mates actions and requirements during high-stress work episodes (Salas, Rosen and King 2007). This is a logical solution but like Salas, Rosen and King (2007) note, teams come together for a discrete lifespan and depend upon who is on job and time of day. Consequently having opportunities for developing personal relationships and understanding each others roles becomes a challenge.A lack of specialist skills requi red to manage the care of critically ill patients is a potential barrier to delivering effective team care as this could escalate into inter-professional conflict. This is when nurses skills and doctors expectations of these skills differed (Tippins 2005). This barrier highlights the relevance of the ATLS training. Patient (2007) confirms that individuals who have undertaken the ATLS course claim they have gained an insight into each others roles and resultantly, can communicate with one another better (Hadfield-Law 1994).The number of staff available varies between departments and is influenced by time of day (Etherington 2003). Example 1 took place on a busy Saturday morning and the department was bustling with staff. The team that attended to the patient was large and appeared disorganised. There were 11 members to this team, 4 of which were students who were perhaps encouraged to attend and observe the situation. The team that attended the patient in example 2 was comparatively smaller and appeared more organised. In an article by Tippins (2005) exploring nurses experiences of managing critical illness in an AE department, one nurse describes how the nature of the experiences depended on the coat and dynamics of a team Because it was such a big trauma, there were so many people there, actually you feel its not managed very well because there were so many people. It was just a numeral chaotic really. This example along with example 1 demonstrates that large meter of people can make inter-professional working difficult.The ideal number of team members in a resuscitation team is uncertain (Patient 2007). Etherington (2003) reinforces that effective teamwork is possible with just 3 people present providing leadership, trust and collaboration are achieved. Relating back to example 2, leadership, trust and collaboration was evident. There was also a beefed-up awareness of roles and task distribution as opposed to example 1 where the team appeared to gather i n an unorganised fashion. These examples demonstrate that the size of a team does not reflect quality. It is influencing factors such as role perception, communication and good leadership that make an effective team.Within inter-professional teams individuals also need emotional intelligence to work effectively with colleagues and patients (Mc Callin and Bamford 2007). According to Goleman (1998), someone with high emotional intelligence is aware of emotions and how to regulate them and use this data to guide their thinking and actions (Faugier and Woolnough 2002). Self-awareness, social awareness and social skill are primordial to emotional intelligence. This is the heart of effective teamwork and influences excellence and job satisfaction (Mc Callin and Bamford 2007). The team in example 2 displayed emotional intelligence in their interactions amongst each other and the patient. For example, the registrar and the nurses ever communicated with the patient recognising his distress . Team members also displayed horizontal organization demonstrating their awareness and anticipation of one anothers roles and task allocation.Breakdown in communication has been highlighted a root cause of serious incidents (National Patient Safety Agency 2006) and trauma resuscitations are especially vulnerable. Heavy workload and constantly changing staff can inhibit communication between team members and so affect adversely patient outcomes for example medication errors or amputation of wrong limbs (Lynch and Cole 2006). Salas, Rosen and King (2007) highlight how communication often breaks down in the inherently stressful nature of responding to crises which can consequently result in clinical errors during decision making. Paradoxically, this is when communication needs to be at its finest (Haire 1998).Many examples of high-quality nursing practice in managing critically ill patients involve good communication skills between staff, patients and relatives (Tippins 2005). Good co mmunication begins and ends with self (Dickensen-Hazard and settle down 2000). This relates back to the concept of emotional intelligence and awareness where every person, peculiarly the leader, should have a clear picture of self, of what is valued and believed and how that blends with the organisation served. Overall, clear, precise and direct channels of communication need to be in place to enhance patient outcome, team functioning (Haire 1998), patient safety and quality care. leadThe concept of inter-professional team working and the barriers that hinder team effectiveness has been discussed. Now an analysis on team leadership will follow. Leadership is defined as a particular form of selected behaviour that manages team activity and develops team and individual performance (Lynch and Cole 2006). There is a strong focus on leadership within the health service as a resource for delivering quality care and treatment. This is noted in the NHS plan (DH 2000b) which states Deliver ing the plans radical change programme will require first class leaders at all levels of NHS. By having visible leaders at all levels contributes to setting high standards and amending errors efficiently. Consequently this contributes to maintaining a safe environment.A resuscitation team needs a visible leader who has the knowledge and communication skills to direct team members (Etherington 2003). In relation to example 1, there was no immediate visible leader who took the task of preparing the team. Only after did the consultant take the lead. As suggested earlier, resuscitation teams are effective when team members adopt specific, pre-agreed roles, which can be carried out simultaneously. The consultant was unable to prepare the team as he arrived only seconds prior to the patient.In the AE department, effective leadership is of prime importance due to the fast paced nature of the environment, which lends potential for staff to feel threatened by the perceived chaos. The leader needs to foster an environment where care delivery has some structure, and staff have counselor-at-law and security (Cook and Holt 2000). This role of team leader is pivotal for the effective functioning of the team (Cole and Crichton 2006).The consultant in example 1 and the registrar in example 2 were the identified team leaders. There are hardly a(prenominal) recommendations made about the education necessary to become a team leader other than experience and fourth-yearity. The Royal College of Surgeons (2000) report that the team leader should be experienced in emergency management from either an emergency, intense care or surgical specialty and have completed an ATLS course (Cole and Crichton 2006, American College of Surgeons 1997). From observation of leadership in the local resuscitation department, it appears that the most senior team member takes the lead.Etherington (2003) argues that many AE nurses perform the leader role as well as their medical colleagues. Meanwhil e, Gilligan et al., (2005) argue that in many emergency departments AE nurses do not assume a lead role in advanced resuscitation. Their study investigated whether emergency nurses with previous ALS training provided good team leadership in a simulated cardiac arrest situation concluding that, ALS trained nurses performed equally as well as ALS trained emergency Senior House Officers (SHOs). This study was conducted at five emergency departments. All participants went through the same scenario. Participants included 20 ALS trained nurses, 19 ALS trained emergency SHOs, and 18 emergency SHOs without formal ALS training. The overall mean range for doctors without ALS training was 69.5%, compared with 72.3% for ALS trained doctors and 73.7% for ALS trained nurses. The evidence drawn from Gilligan et al., (2005) suggests it may be