• Immediate Debriefing after Pediatric Critical Incidents

      Laboy, Yvette; Simone, Shari (2019-05)
      Background: Critical incidents are described as events that induce strong emotional responses that can increase stress levels thereby impeding a nurse’s ability to provide good care. Nurses working in the pediatric environment are frequently exposed to critical incidents that affect their well-being. This repeated exposure may result in burnout and eventually leading to compassion fatigue. Local Problem: Nurses working in a community hospital expressed a need for immediate debriefings after pediatric critical incidents. Debriefings were occurring days to weeks after the critical incident. The purpose of this quality improvement project was to implement an immediate debriefing program for the interprofessional care team, after pediatric critical incidents to decrease stress associated with critical incidents and increase overall staff satisfaction. Examples of critical incidents include resuscitation of patients after cardiac or respiratory arrest, patient death, sudden or acute clinical changes requiring transfer to the Pediatric Intensive Care Unit (PICU), and conflicts with patients’ and/or their family members. Interventions: The quality improvement project was implemented on the pediatric unit at a community hospital in Baltimore, Maryland. Project implementation was conducted over a 14-week period. During the first two weeks, charge nurses who served as project champions attended a 30-minute training session led by the project leader on critical incident stress debriefing and conducted debriefings on the unit. Participants completed a pre- and post-implementation critical incident debriefing survey. All debriefing sessions were identified by the charge nurse and held during the same shift as the critical event. After each debriefing session, staff completed a post critical incident debriefing survey. Data collection included elements from the post critical incident debriefing survey. Responses to pre- and post-implementation surveys were compared to assess the impact of the debriefing sessions in decreasing staff stress and increasing satisfaction following a critical incident. Results: Eleven critical incidents occurred, with a debriefing session conducted after each incident. A total of 51 team members participated in these sessions, of which 13 participated in more than one session. Critical incidents included patients with sudden or acute clinical changes requiring transfer to the PICU, conflicts with patients, and patients at end of life. Post critical incident debriefing survey results revealed 94% of staff strongly agreed or agreed the debriefing session was held at an appropriate time, 81% strongly agreed or agreed debriefings helped decrease feelings of stress and unease, 77% strongly agreed or agreed debriefings were meaningful, and 81% strongly agreed or agreed debriefings improved satisfaction with debriefing session. Post-implementation survey results revealed the implementation of debriefing sessions immediately postcritical incidents decreased staff stress associated with critical incidents most of the time (74%) and increased overall staff satisfaction most of the time (61%). Conclusion: Critical incidents in Pediatrics/PICU can cause a significant amount of staff stress. Implementation of a debriefing process was found to be helpful in decreasing stress associated with critical incidents and increasing overall staff satisfaction with the debriefing process. The debriefing process also helped identify barriers to patient care, discuss patient and staff safety concerns, and identify potential solutions.