• 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.
    • Let’s Talk: Post Critical Incident Debriefing Project

      Wiseman, Tamara L.; Wise, Barbara V. (2020-05)
      Problem and Purpose: Structured debriefings inconsistently occur in a level IV Neonatal Intensive Care Unit (NICU). Lack of a structured debriefing process negatively impacts provider physical/emotional health and patient outcomes. Lack of debriefing conversations leads to unconstructive feedback and unidentified areas for team and patient outcome improvement. The purpose of this quality improvement (QI) project is to implement, the Team Strategies and Tools to Enhance Performance and Patient Safety Debriefing Tool (TeamSTEPPS) following high-risk deliveries in infants 22-32-week gestation and emergency/resuscitation codes in a 52 bed, level IV NICU in the mid-Atlantic region. The goal is to facilitate debriefings after 100% of the critical events and enhance positive team communication during debriefings. Methods: The project was implemented for 12 weeks. The population included a multidisciplinary NICU staff. The project involved training staff on the use of the standardized debriefing tool, documenting high-risk deliveries, frequency of debriefing guided by the TeamSTEPPS debriefing tool, and evaluating debriefing outcomes using the REFLECT Tool. The primary QI metrics included the number of staff trained and educated, patient gestational age, high-risk delivery and emergency codes, occurrence of debriefing, debriefings guided by TeamSTEPPS Debriefing Tool, and staff assessment of the debriefings using the REFLECT Tool. Data was analyzed using descriptive statistics to identify trends in the percentage of debriefings that occurred following 22-32 weeks gestation deliveries and emergency/resuscitation codes. Results: During implementation phase, twenty percent of the NICU staff were trained/educated in the debriefing process. A total of four debriefings occurred using the TeamSTEPPS Debriefing Tool. Post critical events debriefings increased from one percent to fifteen percent. Team communication, role delineation, and patient stabilization time improved during a subsequent critical event. Conclusions: This QI project demonstrated the feasibility of implementing a structured debriefing tool in a high acuity NICU, to improve team communications and patient outcomes following critical events. Increased nursing and provider staff engagement, and ongoing training would enhance debriefing facilitation. Future considerations include expanding debriefing after all emergent deliveries, including the labor and delivery team, and piloting in smaller NICUs.