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The importance of non-technical skills during cardiopulmonary resuscitation

The winners of the cardiopulmonary resuscitation competition at last year’s European Resuscitation Congress in Iceland discovered effective team work was as important as clinical skills
Resucitation

The winners of the cardiopulmonary resuscitation competition at last years European Resuscitation Congress, in Iceland, discovered how effective team work is as important as clinical skills.

Picture: iStock

Last September, a team from our trust were chosen by the Resuscitation Council (UK) (RCUK) to represent the UK in a simulation-based cardiopulmonary resuscitation (CPR) competition at the annual European Resuscitation Congress, in Iceland.

During the first round of the competition, teams were asked to manage a critically unwell adult patient and, in the final, teams had to treat a critically unwell child. Assessment was on the quality of CPR and non-technical skills displayed, in line with current resuscitation education.

Non-technical skills, which are also known as human factors, are defined as the cognitive, social and personal skills which complement technical skills and contribute to safe and efficient task performance (RCUK 2016). They tend to come

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The winners of the cardiopulmonary resuscitation competition at last year’s European Resuscitation Congress, in Iceland, discovered how effective team work is as important as clinical skills.


Picture: iStock

Last September, a team from our trust were chosen by the Resuscitation Council (UK) (RCUK) to represent the UK in a simulation-based cardiopulmonary resuscitation (CPR) competition at the annual European Resuscitation Congress, in Iceland.

During the first round of the competition, teams were asked to manage a critically unwell adult patient and, in the final, teams had to treat a critically unwell child. Assessment was on the quality of CPR and non-technical skills displayed, in line with current resuscitation education.

Non-technical skills, which are also known as human factors, are defined as the ‘cognitive, social and personal skills which complement technical skills and contribute to safe and efficient task performance’ (RCUK 2016). They tend to come under four categories:

  • Situational awareness.
  • Decision making.
  • Teamworking, including leadership.
  • Task management.

Team members are exposed regularly to cardiac arrests in clinical and training situations as individuals, but before the competition we decided we needed to practise arrest management skills together.

Our team, consisting of advanced practitioners, resuscitation officers and a consultant in emergency medicine from Shrewsbury and Telford Hospital NHS Trust, met only once to train but it was a useful exercise because we were given roles that played to our strengths as a team.


Left to right: consultant in emergency medicine Dodiy Herman, lead resuscitation officer Helen Venn,
resuscitation officer Nicola Ljewky, night practitioner Maria Johnson,
trainee advanced clinical practitioner Kim Humphreys, and resuscitation officer and author Thomas Wood

The training scenario was observed by the lead resuscitation officer, who suggested in a debrief some ways to improve our management of the situation. The main point we took away from this session was that the team leader does not have to be the most senior medic, but the person most comfortable in the role. This enabled communication to flow more freely between team members during the scenario and the medic could contribute to specific elements of treatment while the team leader ran the arrest.

Competition

Expecting to be given a complicated, obscure event to manage, during our flight to Iceland we had our noses buried in our various advanced life support manuals, revising the chapters on special circumstances.

However, contrary to expectations, the scenarios we were given did not involve hypothermic patients who had washed up on the shores of Iceland after taking a mixed overdose to which they had had an anaphylactic reaction. Instead, the patients were an adult in diabetic ketoacidosis and a septic child, both common presentations in EDs.

At the end of each scenario, the teams were led in a debrief of events by the European Resuscitation Congress instructors, who also offered feedback.

Four teams made it to the final and we were announced as the winners at the closing ceremony. It was an honour for our relatively small trust and encouraging that the skills we displayed were those we teach and practise on an a daily basis.

Reaffirmation

Two important points, related to the practice and teaching of resuscitation, have been reaffirmed by this experience.

The first is to ensure that each team member can perform the technical aspects of their designated role competently in resuscitation scenarios. This reinforces the importance of making sure staff can access education and practise clinical skills regularly, so they are prepared and competent to manage ‘real-life’ emergencies.

The second is that a strong emphasis must be placed on the non-technical skills related to resuscitation. As a team, we found that meeting and preparing together before this high-pressure situation, being aware of team members’ individual strengths and allocating roles accordingly, led naturally to the performance for which we won the award. We also learned that debriefing together after the event highlighted areas where we could improve and reinforced good areas of practice.

In our trust, we hold daily cardiac arrest team huddles so we can meet, familiarise ourselves with each other and allocate roles. We are also trying to make time to debrief after emergencies to reflect on our performance.

Before we return to defend our title at this year’s congress, to be held in Freiburg, Germany, we are looking at how we can advance these learning points in our trust, for example by introducing real-time simulated arrests in clinical environments. This will enable staff to practise their clinical skills in a realistic environment, and enhance their non-technical skills by allowing them to reflect on team interaction during the simulation.

Improving non-technical skills is an ongoing development programme, but taking part in this competition has reinforced that it is not all about what we do when it comes to resuscitation; how we do it can support teamwork and improve patient outcomes.

How to improve non-technical skills
  • Use daily team meetings or huddles to introduce team members, allocate roles according to competencies and prepare for exceptional events, such as simultaneous emergencies.
  • Have one delegated team leader who has good knowledge and communication skills.
  • Encourage communication and input from team members during resuscitation, and include them in decision-making processes.
  • Encourage non-judgemental team debriefs after resuscitation attempts, during which suggestions for improvement can be made, good practice is reinforced and team members are thanked for their efforts.
  • Hold regular, observed, scenario training in clinical areas so that resuscitation team members can practise technical and non-technical skills in their usual working environment.

  • Resuscitation Council UK (2016) Advanced Life Support. Seventh edition. RCUK, London.

Thomas Wood is a resuscitation officer at the Princess Royal Hospital, Telford, Shropshire

 

 

 

 

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