Section 1: Overview of Key Concepts and Tools

This section provides an overview of the key concepts and tools in the Situation Monitoring Module. More explanations and illustrations are provided in section 2 of this module; methods for teaching the concepts and tools for this module are in section 3. Information about implementing the module's tools, including knowing whether an organization is ready for implementation, is provided in the Implementation Section.

Key Concepts

Situation Monitoring

Situation monitoring is one of the four essential skills that are central to safe, efficient, and patient-centered care.

Situation monitoring is the process of actively scanning behaviors and actions to assess elements of the situation or environment.

Situation monitoring is a continuous process composed of three elements:

• Situation monitoring (an individual skill): The process of continually scanning and assessing a situation to gain and maintain an understanding of what’s going on around you.
• Situation awareness (an individual outcome): The state of "knowing what's going on around you." It assumes the continuous monitoring of the status of:
  • The patient.
  • Other team members.
  • The environment.
  • Progress toward team goals.
• Shared mental models (a team outcome): Results from each team member maintaining situation awareness and communicating to ensure that all team members are in agreement. Shared mental models enable the team to anticipate and predict each other's needs; identify changes in the team, task, or teammates; and adjust the course of action or strategies as needed.

Situation Monitoring Tools

STEP

STEP is a mnemonic tool that can help individuals monitor critical elements of a situation and overall environment:

• Status of the patient: patient history, vital signs, medications, physical exam, care plan, psychosocial issues, patient preferences or concerns 
• Team members: fatigue, workload, task performance, skill, stress level
• Environment: facility information, administrative information, human resources, triage acuity, equipment 
• Progress toward the goal:
  • Status of team’s patients?
  • Established goals of team?
  • Tasks/actions of team?
  • Plan still appropriate?

I'M SAFE Checklist

"I'M SAFE" is a checklist that can be used to determine the ability of you or your team members to perform safely.

Cross-Monitoring

A harm error reduction strategy that involves:

• Monitoring actions of other team members.
• Providing a safety net within the team.
• Ensuring that mistakes or oversights are caught quickly and easily.
• "Watching each other’s back."

STAR

STAR (Stop, Think, Act Review) can be used to elicit and share important information about activities and their consequences. Its key elements include: