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DEBRIEFING IN EVERYDAY PRACTICEMara McErlean, MD
Patient Safety and Clinical Competency Center, Albany Medical Center
Acknowledgments
Mary Carey Heather Frenz Cathy Manjunath Dan Shovlin Standardized Patients
PSCCC
Albany Medical Center Serves the educational needs of the
Center Standardized patients, task training and
simulation Opened in 2011
Debrief
Definitions Practical applications Simulation video review Small group discussion Large group discussion Summary
Definition
de·brief To question someone, typically a soldier
or spy Details about a completed mission or
undertaking Synonyms: cross-examine, interview,
interrogate, question, probe, examine, grill or pump
Originally used for soldiers returning from a battlefield, for commanders to fully understand a situation on the front line
Done as soon as possible to get the freshest information
Communication largely from subordinate to superior
Became apparent that there was a benefit to other soldiers to share experiences
Greater understanding of what happened when shared as a group
Bolstering of individual and group identity Now 1,060,000 results on Google
Many additional benefits
Clearer understanding for all Identification of future pitfalls Reinforces lessons learned through
experience May decrease anxiety of experience Improves group dynamic and
functioning Eases transition back into normal
work duties
American Counseling Association Seven Stages, 3-5 days post event, 2-3
hours Introduction Facts Thoughts Reactions Symptoms Teaching Re-entry
Critical Incident Stress Debriefing 1983 Same seven steps Meant to help staff through
significant, stressful incidents Also delayed from time of
incident
Simulation Debrief
Discussion after a simulated event
Designed to improve understanding
To enhance future performance
Traditional Simulation Debrief Facilitated by someone with competence Done in a safe environment Facilitated by someone who witnessed
the experience Based on a structured framework Congruent with outcomes and objectives
International Nursing Association
for Clinical Simulation and Learning
Four Es
Debriefer encourages conversation about patterns of behavior by asking learners to describe the events that happened, the emotions around these events, potential alternative viewpoints to empathize and explanations for actions and emotions.
Mayville 2011
GAS
Ten minute approach designed to gather information about how learners think and feel about the session, analyze their actions and summarize lessons learned.
O’Donnell 2009
Understand the “frame”
Assumptions Feelings Goals Knowledge Situation Awareness
All drive individual behavior but sometimes are not obvious to others.
“Good Judgment”
Advocacy Observation, statement
Inquiry Question
“I noticed when the nurse asked if we needed to intubate, you responded by asking for lab results. What were you thinking?”
Rudolph et al.
Good Judgment
Assume there is a reason for everything, even if it is not apparent to you
Be genuinely curious about why someone else did what he/she did
Assume everyone wants to do the “right” thing
Rudolph
All day, every day
Every resuscitation Every code Every family conflict Every difficult encounter Maybe even some of the easy
ones
In fact….
Debriefing is a critical component to continuous quality assessment and improvement
Necessary for new staff Equally necessary for seasoned staff Useful in long term retention Necessary for long term job satisfaction Should be employed every day
Critical Elements of the Debrief Safe Respectful Goal to understand a system Goal to improve functioning Goal to decrease hardship
Start with yourself
Assess your own reaction- identify your personal frame
What did you witness What problems do you identify Who is the correct person to address What do you want to be the outcome Decide the right time and place
Deal with others
Acknowledge the emotions first Then work toward a shared
understanding of what actually happened
Assume the best intentions Keep it personal- your observations and
assessment Keep it professional Summarize often Make an action plan
What we will do
Show you a simulation that demonstrates a clinical encounter
It is created, not real Illustrates issues in daily clinical
encounters Your small groups will be asked to
identify issues Then a representative will talk about
what you saw
Individual Debriefs
Medical care (Covering MD-On-call MD) Equipment (MD-RT supervisor) Family dynamics (Bedside RN-Daughter) Inter-professional communication (Bedside
RN-Charge RN) Inter-professional communication (Bedside
RN-MD) Inter-professional communication (Bedside
RN-RT) Crisis recovery (Charge RN-Bedside RN)
Prepare your debrief
Choose your issue Choose your participants Prepare your opener Be ready to report to the group You have ten minutes
Simulation Video
Summary
Debriefs do not have to be formal or comprehensive
Good managers and co-workers use debrief techniques to process everyday occurrences
A great method for continuous improvement for patient care, the work environment and job satisfaction
THANK YOU!
Special thanks to: Pat Cumiskey Mark Dalton Kevin Gardner Lisa Taub Angie Potrikus Erin Waterhouse