Coming to the Table: Debriefing for Patient Safety NYSPQC - - PowerPoint PPT Presentation

▶
coming to the table
SMART_READER_LITE
LIVE PREVIEW

Coming to the Table: Debriefing for Patient Safety NYSPQC - - PowerPoint PPT Presentation

Feb 17, 2023 515 likes •905 views

Coming to the Table: Debriefing for Patient Safety NYSPQC Educational Webinar April 24, 2013 Christine Arnold, RNC, MS Rita Dadiz, DO Joanne Weinschreider, RN, MS Faculty Christine Arnold, RNC, MS Project Director, Center for OB/GYN

slide-1
SLIDE 1

Coming to the Table: Debriefing for Patient Safety

NYSPQC Educational Webinar April 24, 2013 Christine Arnold, RNC, MS Rita Dadiz, DO Joanne Weinschreider, RN, MS

slide-2
SLIDE 2

2

Christine Arnold, RNC, MS Project Director, Center for OB/GYN Simulation Department of Obstetrics & Gynecology Rita Dadiz, DO Assistant Professor of Pediatrics Director, Simulation-Based Emergency and Safety Training Program Division of Neonatology Joanne Weinschreider, RN, MS Nursing Simulation Lab Director, School of Nursing Saint John Fisher College

Faculty

slide-3
SLIDE 3

3

Disclosures

  • The presenters have no financial relationships to disclose or

conflicts of interest to resolve.

  • This webinar was made possible by the NY State Perinatal

Quality Collaborative and the Health Resources and Services Administration (grant # T21MC18129-03-00).

slide-4
SLIDE 4

4

Learning Objectives

  • Discuss the significance of establishing a debriefing

program in healthcare

  • Present different debriefing models and potential

applications in obstetrics and neonatology

  • Identify the key components of a debriefing program
  • Describe the process for tracking opportunities for

improvement after debriefing

  • Identify strategies to overcome barriers when

establishing a debriefing program

slide-5
SLIDE 5

5

2004 2003 2005

Patient Safety and Quality Improvement Act Joint Commission National Patient Safety Goals

2007 2001 1999

Adapted from: www.ahrq.gov.teamsteppstools/instructor/fundamentals/module1/igintro.htm

2010 2009

Patient Safety Movement

slide-6
SLIDE 6

6

Annual Deaths in the United States

www.census.gov; www.cancer.org; Kohn L et al (1999). To Err is Human: Building a Safer Health System.

20,000 40,000 60,000 80,000 100,000

AIDS Motor Vehicle Accidents Breast Cancer Medical Errors

slide-7
SLIDE 7

7

Root Causes: Perinatal Deaths & Injuries

www.jointcommission.org (2004-First Quarter 2012)

slide-8
SLIDE 8

8

AHRQ Hospital Safety Scores

www.ahrq.gov/qual/hospsurvey12 (2012)

slide-9
SLIDE 9

9

Debriefing

From left to right: www.PSQH.com; www.defense-update.com; www.sales-getters.com;

slide-10
SLIDE 10

10

Why Debrief?

  • 1. Staff identify ways to improve patient care and
  • utcomes.
  • Crew Resource Management: Blend technical and human skills

to support safe and efficient patient care.

  • 2. Learning is relevant and timely, focused on actual

patient care events.

  • 3. Debriefing elicits learner-centered feedback.
  • Self-reflection and discovery.
  • Enhanced retention of learned ideas.

Driskell JE and Adams RJ (1992). FAA Handbook.

slide-11
SLIDE 11

11

Debriefing Models:

Structured and Supported Debriefing

slide-12
SLIDE 12

12

Plus Delta

What was done well? What are some areas for improvement?

Plus-Delta Model

slide-13
SLIDE 13

Crew Resource Analysis & Evaluation Line Operations

Emotions Analysis Application Summary

Debriefing Models

Gather Analyze Summarize Reactions Understanding Summary Diffusing Discovering Deepening Summary 3D Model

slide-14
SLIDE 14

14

  • How did staff feel about the patient

event?

Emotions

  • What was done well?
  • What are some areas for improvement?

Analysis

  • What are the main take away points?

Application

  • How can patient care be improved next

time?

Summary

Elements of Debriefing Models

slide-15
SLIDE 15

15

Feedback Debriefing

Giving information or input to an individual or team with the intention of modifying future behavior INSTRUCTOR, SUPERVISOR, etc. STAFF Facilitating a structured form of feedback that allows individual and team reflection to understand issues and discuss areas for improvement FACILITATOR STAFF

slide-16
SLIDE 16

16

Facilitator Instructor

  • Provides
  • All-knowing
  • Hierarchical
  • Inflexible
  • Teacher-centered

16

  • Assists
  • Co-learner
  • Same level
  • Flexible
  • Staff-centered

Knowledge Relationship to staff Structure Focus Role in learning

slide-17
SLIDE 17

17

Roles and Traits of the Facilitator

  • Establishes ground rules for debriefing
  • Creates a safe debriefing environment for staff
  • Stays focused on primary goals & objectives
  • Suspends own opinions and biases
  • Engages in active listening
  • Clarifies or elaborates on discussion points
  • Ensures balanced staff participation
  • Asks open-ended questions
slide-18
SLIDE 18

18

Frames Actual Actions Desired Actions Performance Gap

Rudolph JW et al (2007). Anesthesiol Clin.

Assessing Frames to Reveal Improvement Opportunities

slide-19
SLIDE 19

19

Debriefing with Good Judgment

Judgmental Debriefing with Good Judgment

How facilitator views staff Staff makes mistakes Staff takes certain actions based on knowledge and assumptions Role of the facilitator Provides directed feedback with the intention to change behavior Tries to understand frames and creates a context for learning and change Typical message

  • f debriefing
  • “Here’s how you messed up.”
  • “What do you think you

could have done better?” “I noticed X. I was concerned with that because of Y. Tell me what you were thinking at that time.”

Rudolph JW et al (2007). Anesthesiol Clin.

slide-20
SLIDE 20

20

When does your staff debrief on your unit?

Please check all responses that apply. a. We have not had the opportunity to debrief b. After a sentinel event (e.g. a maternal or infant death) c. After an unexpected emergency (e.g. shoulder dystocia, post-partum hemorrhage, etc.) d. After extensive neonatal resuscitation e. After medical errors or near misses f. After most uncomplicated deliveries or patient events

Polling Question #1

slide-21
SLIDE 21

21

Steps in Building a Debriefing Program

  • 1. Obtain leadership buy-in
  • 2. Secure frontline champions
  • 3. Create a safe environment
  • 4. Introduce the concept

− Simulation − Team training education

  • 5. Secure and train debriefing facilitators
  • 6. Roll-out the program

Salas et al (2008). Jt Comm J Qual Patient Saf.

slide-22
SLIDE 22

22

Identify

  • pportunity to

debrief Interdisciplinary team debrief Capture, implement and track action items Improve systems, communication and education

Building a culture of safety

slide-23
SLIDE 23

23

Share, implement & track opportunities Capture opportunities for improvement Debrief Secure time, location & personnel Identify participants / teams involved Notify facilitators Identify case

Setting Up A Debriefing

slide-24
SLIDE 24

24

Quality Improvement Opportunities

Improve

  • rganization
  • f emergency

c-section cart. Clarify with nursing and residents when to institute chain of command. Educate staff on implementing team huddles for high-risk patients.

slide-25
SLIDE 25

25

Tracking Tool

Identified Opportunity Point Person Plan of Action Date Started Tracking

Obstetric team: Organize emergency cesarean section tote L&D nurse leader

  • Secure funds for new cart
  • Purchase new cart
  • Stock cart
  • Educate staff

4/1/10

  • Use by staff
  • Feedback from

staff about the cart NICU team: Clarify who and how many people should respond to an overhead STAT delivery page NICU nurse manager

  • Check current policy
  • Obtain consensus from

delivery room team

  • Inform all NICU staff
  • Revise policy, if needed

4/1/10

  • Staff who respond

to overhead pages

  • Feedback from

staff

slide-26
SLIDE 26

26

What do you see as the most important barrier to establishing a debriefing program in your unit/department? Please select up to 3 choices.

a. Establishing buy-in from administrators & staff b. Finding time for staff to debrief because of patient care duties c. Alleviating staff anxiety of being evaluated or blamed d. Addressing the presence of inter-professional conflict e. Identifying and training facilitators

Polling Question #2

slide-27
SLIDE 27

27

Establishing Buy-In

General principles:

  • Start small
  • Identify what success looks like
  • Be clear about the goals of the debriefing program
  • Share identified areas for improvement and changes

implemented with frontline staff and hospital leadership

  • Celebrate small wins
slide-28
SLIDE 28

28

Establishing Buy-In

From administrators & unit leaders:

  • Create a sense of urgency
  • Compile data from institutional safety surveys,

events reporting, root cause analyses and malpractice claims

  • Identify potential patient safety outcomes
  • Discuss cost benefit analysis
  • Draw from experiences of other units and

institutions

slide-29
SLIDE 29

29

Establishing Buy-In

From staff:

  • Empower staff to influence change
  • Create a safe learning environment
  • Introduce debriefing during educational programs
  • r simulation-based training exercises
  • Reassure staff that purpose is to improve patient

safety rather than focus on any individual

  • Ask nursing and physician leaders to participate

during debriefings

slide-30
SLIDE 30

30

Making Time to Debrief

  • Identify a point person to set-up the debriefing
  • Ask nurse leaders or physician supervisors to provide

temporary patient coverage

  • Give core participants time to decompress, stabilize

patients and hand-off patient care

  • Establish a length of time for

debriefing, alert staff and stick to it

  • If timing is right, build it into

scheduled staff meetings

  • Keep it short and simple
slide-31
SLIDE 31

31

Alleviating Staff Anxiety

  • Establish a safe debriefing environment
  • Reassure staff that purpose is for quality improvement,

rather than be punitive

  • Reassure staff that discussions during debriefings are

not discoverable

slide-32
SLIDE 32

32

Addressing Inter-Professional Conflicts

  • Establish “ground rules” of debriefing at beginning
  • Acknowledge known internal conflicts
  • Redirect focus/purpose of debriefing to patient safety,

rather than to individuals

  • Highlighting the importance of individual contribution

to the team

  • Highlight “ground rules” to

promote effective debriefing

  • Speak to individuals separately
slide-33
SLIDE 33

33

Identifying & Training Facilitators

  • Start by identifying champions
  • Safety nurse, nurse or physician educators
  • Train several individuals to become facilitators
  • Identify individuals from day and night shifts
  • Tie debriefing to work responsibility and clinical

advancement

  • Enroll individuals in training courses
  • Keep the debriefing simple
  • Script debriefings with key questions
slide-34
SLIDE 34

34 Kotter J and Rathgeber H (2006). Our Iceberg Is Melting, Changing and Succeeding Under Adverse Conditions.

slide-35
SLIDE 35

35

  • Establishing a debriefing program is an effective

method to identify opportunities for improvement.

  • Implementing changes identified during debriefings

can improve patient safety.

  • Debriefing improves interprofessional collaboration

and communication, which leads to a team culture that further promotes patient safety.

Summary

slide-36
SLIDE 36

36

Future Webinars… Coming Soon!

  • June 28, 2013

Improving Team Function through Simulation-Based Learning

  • October 29, 2013

Linking Simulation and Debriefing to Quality Improvement

slide-37
SLIDE 37

Thank You!

Christine_Arnold@URMC.Rochester.edu Rita_Dadiz@URMC.Rochester.edu JWeinschreider@SJFC.edu

37