A well-functioning team is key when performing cardiopulmonary resuscitation. In today’s post, we’re talking all about team dynamics and communication during CPR, in order to maximise patient safety, prevent errors, and maximise patient outcomes. I’m also giving you 5 take-home tips for safer communication and more effective teamwork in CPR.

Team dynamics

Team dynamics are vitally important in CPR. Having a clearly structured CPR team, where a team leader is immediately evident, and ensuring each team member is aware of their role, is essential.

#1: Appoint a team leader

A dedicated CPR team leader significantly improves the flow of CPR. This individual does not take part in any other roles during the resuscitation attempt, but oversees the entire code, organises role rotations and gathers information from members of the CPR team.

There is no evidence to suggest that having a veterinary surgeon or specialist in this role results in better outcomes for the patient. Nurses can absolutely perform this role with sufficient training, and they frequently do. The benefit of a nurse performing this role is that it frees up the veterinary surgeon to call the client and make any medical decisions needed, whilst not having to also focus on running the CPR attempt.

#2: Ensure each team member is aware of their role

Another important factor in CPR team dynamics is ensuring that all team members are aware of their own specific roles. CPR team roles include a compressor, a ventilator, an assistant to administer medications and attach monitoring devices, a scribe, and a team leader.

The compressor performs continuous chest compressions; this is a rotating role, and the compressor switches out with another team member every 2 minutes in order to prevent fatigue, which in turn causes poor compression technique.
The ventilator is responsible for managing the patient’s airway. Their role is to establish and secure a patent airway and begin ventilating the patient. Attaching the capnograph after intubation is often also performed by this role.

The assistant places monitoring equipment (ECG +/- capnograph), secures intravenous access and administers any required medications.

The scribe is responsible for timing the arrest, communicating when the team are near to the end of each 2-minute basic life support cycle, and for documenting the arrest.

The team leader, as detailed above, is responsible for organising the resuscitation attempt, assigning roles to other team members, and generally overseeing the code.

Communication

In addition to a well-structured team, communication skills are vital in successful CPR. The risk of human error is increased in high-pressure situations; by using a few simple communication and situational skills, we can help minimise this risk.

#3: Close the loop

Closed-loop communication is used to confirm instructions have been understood. In closed-loop communication, the team leader asks an individual to perform a task; that individual then repeats back the instruction to confirm they have understood it. 

This highlights any misunderstanding (if there is any) and helps the entire CPR team understand the instructions which have been given to different team members.

#4: Refer to everyone by name

Another important factor in effective communication is ensuring each team member knows which tasks they need to perform. It can be easy to assume that someone else has performed a task, or that a set of instructions are not for you.

By referring to everyone by their name, team members can clearly identify any instructions they must perform, ensuring that all required tasks are completed efficiently.

#5: Monitor the situation, not just your own role

Situational awareness is another key factor in safety during CPR. This is the awareness of the tasks going on around you, not just the awareness of your own role.

If you notice that someone else in the team needs to alter their technique, or is at risk of making an error, anyone in the CPR team should feel empowered to speak up. 

The CPR team work together with the common goal of trying to successfully resuscitate the patient; everyone should support each other in this - and mentioning that someone could be doing something better is supporting your team-mates!

CPR Recording

To accompany this blog post, I’ve created a free CPR recording form which you can download and use in practice! This easy-to-follow form has spaces for recording every 2 minutes throughout CPR, and boxes for all the relevant parameters you need to record, alongside drug administration information and space for notes!

To get your copy, simply enter your email address below and it’ll be sent straight to you.

So as you can see, effective team dynamics and thorough communication is vital to administer effective CPR, and prevent medical errors. Practising these skills is really important, and this is another reason why performing CPR drills in practice is really helpful. Do you perform CPR drills in practice? Let me know below!

References

1. Fletcher, D. et al. 2012. RECOVER evidence and knowledge gap analysis on veterinary CPR part 7: Clinical guidelines. Journal of  Veterinary Emergency and Critical Care, 22 (S1), S102-S131.

2. Yagi, K. 2017. Critical Components to Successful CPR. Today’s Veterinary Nurse, available from: https://todaysveterinarynurse.com/articles/critical-components-to-successful-cpr-the-recover-guidelines-preparedness-and-team/