Garden A L, Mills S A, Wilson R, Watts P, Griffin J M, Gannon S, Kapoor I
Sleep Wake Research Centre, Massey University, Wellington, New Zealand.
Anaesth Intensive Care. 2010 Nov;38(6):1038-42. doi: 10.1177/0310057X1003800613.
In response to a successful, although difficult resuscitation in one of our paediatric wards, we developed and implemented an educational program to improve the resuscitation skills, teamwork and safety climate in our multidisciplinary acute-care paediatric service. The program is ongoing and consists of didactic presentations, high-fidelity in situ simulation and facilitated debriefing to encourage reflective learning. The underlying goal, to provide this training to all staff over a two-year period, should be achieved by late 2011. In this preliminary report we describe teamwork difficulties that are commonly found during such training. These included inconsistent leadership behaviours, inadequate delegation of areas of responsibility, failure to communicate problems during the execution of technical tasks (such as difficulty opening the resuscitation trolley) and failure to challenge inadequate or inappropriate therapy (such as poor chest expansion during bag-mask ventilation). In addition, we unexpectedly discovered seven latent errors in our clinical environment during the first nine months of course delivery. The most disturbing of these was that participants repeatedly struggled to identify and overcome the locking-mechanism and tamper-proof device on a newly introduced resuscitation trolley.
针对我们儿科病房一次成功但艰难的复苏案例，我们制定并实施了一项教育计划，以提高我们多学科急性护理儿科服务中的复苏技能、团队协作和安全氛围。该计划正在进行中，包括理论授课、高仿真现场模拟以及促进反思学习的总结汇报。在两年内为所有员工提供此项培训的基本目标应在2011年底实现。在这份初步报告中，我们描述了在此类培训中常见的团队协作困难。这些困难包括领导行为不一致、责任领域的授权不足、在执行技术任务期间（如打开复苏推车困难）未能沟通问题以及未能对不充分或不适当的治疗提出质疑（如面罩气囊通气时胸廓扩张不良）。此外，在课程开展的前九个月里，我们意外地在临床环境中发现了七个潜在错误。其中最令人不安的是，参与者反复难以识别并克服新引入的复苏推车上的锁定装置和防篡改装置。
