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CRM u zbrinjavanju kritično obolelog pacijenta - da li sestra može biti kopilot?
CRM in the critically care medicine: Can nurse be a co-pilot?
aUniverzitet u Beogradu, Medicinski fakultet, KBC 'Dr Dragiša Mišović'
bKlinički centar Srbije, Beograd
Sažetak
Menadžment članova posade ili upravljanje članovima kokpita (Crew Resource Management, Cockpit Resource Management-CRM) je skup postupaka obuke za primenu u sredinama gde ljudska greška može imati fatalne posledice. Pre svega, koristi se za poboljšanje bezbednosti u vazduhu i fokusira se na interpersonalne komunikacije, liderstvo i donošenje odluka u pilotskoj kabini, ali je svoju primenu našao u svim sferama gde se donose kritične odluke: kontrola letenja, rukovanje brodom, protivpožarna zaštita, a u medicini se koristi u operacionim salama i službama za urgentno zbrinjavanje. Nakon 20 godina uspešne primene u avio industriji, zdravstveni sistem se za CRM zainteresaovao kada je američki Institut za medicinu preporučio korišćenje ovog modela kako bi se unapredila bezbednost i smanjio rizik od greške. Iako se ulažu značajni napori za poboljšanje bezbednosti pacijenata kroz unapređenje timskog rada, ne postoji potvrđeni alat za naučno merenje timskog rada u medicinskom timu. U radu će biti prikazana publikovana istraživanja o timskom radu i primeni CRM u zdravstvenom sistemu. Takođe, biće prikazane metode i tehnike merenja timskog rada kao i efikasnog treninga kojima se aktivno uključuju svi članovi zdravstvenog tima (sastanci, ček liste, komunikacione tehnike koje podstiču sredinu uzajamnog poštovanja). Da bi unapredili CRM u operacionoj sali, razvijeni su i drugi alati kojima se poboljšava bezbednost pacijenata, poput 'crne kutije'. U ovom slučaju patentirana 'crna kutija' je digitalni sistem za arhiviranje kompletnog operativnog procesa i okruženja uključujući monitoring nad aparatima, koja ima za cilj da omogući analizu svih podataka i potencijalne studije operativnog učinka, intraoperativnih grešaka, timskog rada i komunikacije. Zaključak sprovedenih istraživanja je da postoje značajne razlike u percepciji timskog rada u operacionoj sali, sa stanovišta lekara i stanovišta medicinskih sestara. Izvrsni pojedinci, iako visoko stručni u svojoj disciplini, ne moraju posedovati veštine timskog rada i samim tim ne mogu biti korisni članovi tima, iako su neretko hijerarhijski postavljeni upravo na lidersku poziciju. Stoga bi treninzi po CRM metodologiji omogućili sticanje važnih komunikacionih veština ovakvim pojedincima, ali i ohrabrili ostale članove tima da sa njima komuniciraju služeći se nekonfliktnim alatima.
Abstract
Crew Resource Management, Cockpit Resource Management - CRM is a set of a training procedures used in environments where human error can cause fatal consequences. It is used to improve security of the aircraft and focuses on interpersonal communication, leadership and decision-making in the cockpit. Today, CRM is applicable in all fields where critical decisions are being made: air traffic control, ship handling, firefighting, as well as in medicine where CRM is being practiced for operating room staff and all emergency services. After 20 years of its successful usage for the airline personnel, the healthcare system became interested in CRM when the US Institute of Medicine specifically suggested use of this model, to improve Patient's safety and reduce the risk of mishaps. Despite the significant efforts to improve safety through the promotion of teamwork, there was no scientifically validated tool for measuring teamwork in the health care services. The paper will present published studies about teamwork and application of CRM in the healthcare system. It will also present methods and techniques on how the teamwork is valued and efficiency of training which actively joins all members of the healthcare team (briefings, checklists and communication techniques that can foster an environment of mutual respect). For these purposes, the patented 'black box' is a digital system used for recording and archiving all data related to operating procedures and working environment including screening and monitoring, which is followed by complete analysis of all collected data. It also provides an opportunity for implementing studies on operating outturn, potential intraoperative errors, teamwork output and communication. The conclusion of the conducted studies is that there are distinctions in the perception of teamwork in operating room, considering doctors and nurses standpoint. Excellent individuals, although highly skilled in their discipline, may not perform well in teams and therefore can not be useful team members, even though they are often hierarchically set as leaders. Therefore, the training by CRM methodology would enable the acquisition of important communication skills of these individuals and, also, encourage other team members to communicate among each other using non-conflict tools.
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