Crisis Resource Management for Code Blue and Rapid Response Teams Simulator Course Objectives

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Crisis Resource Management for Code Blue and
Rapid Response Teams Simulator Course Objectives

• Upon completion of this course, each participant
  will be able to
• 1. display their ability to use the acronym
  ABCD as an
• assessment and treatment model, in order
  to stabilize and/or
• resuscitate an acutely ill patient.
• 2. perform the duties of each team member role,
  within the confines
• and expectations of their own
  professional discipline, including
• the roles of Team Leader,
  Airway/Breathing, Circulation/Meds,
• and Documentation, in a manner which
  best utilizes available
• team resources.
• 3. incorporate professionalism into their team
  interactions, including
• closed-loop communication, respect for
  patient and family, safe
• patient hand off, debriefing as a means
  of assessing team
• effectiveness, and accurate
  documentation.

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Small Group Teamwork Principles for Success

• Nathan White, MD

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The Challenge

• How to best evaluate and stabilize acutely ill
  hospitalized patients
• How to best accomplish this task in an academic
  teaching hospital type environment

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The Rapid Response Team

• A small group of healthcare professionals which
  responds to acutely unwell non-ICU patients
• Performs rapid assessment and stabilization
• Physician (med resident or hospitalist), nursing
  supervisor, critical care nurse, nurse
  anesthetist, respiratory therapist, and
  pharmacist, and patients nurse

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The Code Blue Team

• A larger team of healthcare professionals which
  responds to resuscitate patients in cardiac
  arrest
• Several physicians (med residents), nursing
  supervisor, respiratory therapist, anesthetist,
  pharmacist, and patients nurse

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Keys to Teamwork Success

• Leader established
• Team structure established
• Roles assigned to team members
• Team members provide feedback to team leader
• Roles and tasks are adjusted and reassigned by
  team leader, based on feedback

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Conclusion Leaders must build a structure
within a resuscitation team in order for them to
perform effectively. An emergency leadership
training programme is essential to enhance the
performance of leaders and their teams.
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Absence of leadership behaviour and absence of
explicit task distribution were associated with
poor team performance. Failure to translate
theoretical knowledge into effective team
activity appears to be a major problem.
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Specific Team Member Roles

• Team Leader
• Airway/Breathing
• Circulation/Medications
• Documentation

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Team Leader
Patients Nurse
Documentation
Circulation/Meds
Airway/Breathing
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Feedback!Communication is Key

• Information should flow freely both directions to
  and from the team leader
• The team members assigned specific tasks must
  provide direct feedback to the team leader
  concerning their task status
• All team members must actively participate in
  evaluating and treating the patient

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Team Leader

• Can be
• 1st to arrive on scene
• Most experienced person
• Person who assumes leadership role
• May be any hospital/medical personnel
• May be reassigned as team members with more
  experience arrive on scene

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Team Leader

• Initiates Team Structure
• Assigns Team Member Roles/Tasks
• Reassigns roles as appropriate
• THANKS person who called the Team

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Team Leader

• Avoids performing specific tasks concentrates
  on big picture - (lighthouse)
• Establishes differential diagnosis and treatment
  plan
• Makes final recommendations to primary team and
  disposition decisions
• Conducts debriefing at end of event
• Assures Record is faxed to QA Office

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Role Assignment

• Be specific (identify person and task)
• Based on rapid assessment and stabilization
  principles

• Remember the ABCDs
• Airway/Breathing
• Circulation/Meds
• Documentation

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Airway/Breathing

• Assesses Airway and intervenes as appropriate
• Measures Pulse Ox
• Applies supplemental Oxygen
• Suctions as needed
• Listens to breath sounds
• ABG/Labs
• Relays Airway/Ventilation assessment to team
  leader

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Circulation/Meds

• Checks pulse
• Connects patient to bedside monitor
• Performs full set of vital signs
• Establishes IV access
• Queries Team leader for type of fluids
• Draws blood for labs
• Administers medications
• Relays IV/Circulatory assessment to team leader

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Documentation

• Verifies ID band, correct chart, resuscitation
  status
• Documents assessment and interventions
• Asks Team Leader to review and sign Record
• Fill out QA Form - asks entire Team for feedback
• Faxes Record and QA Form to QA Office
• Places Record in patient chart destroys QA Form

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RRT Response Algorithm
Feedback Loop
Patient Assessment And Stabilization
Airway/ Breathing
Role/Task Assignment
Team Leader
Diagnosis And Disposition
Circulation/ Meds
Role/Task Assignment
Role/Task Assignment
Documentation
Feedback Loop
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Review

• Thank the person who called the Team
• Establish Team Leader
• Establish Team Structure
• Airway/Breathing
• Circulation/Medications
• Documentation
• Feedback, feedback, feedback!

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Questions?