draft pending ahrq final review auditing: briefings & debriefings 1 draft pending ahrq final...
Post on 18-Dec-2015
218 Views
Preview:
TRANSCRIPT
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 1
DRAFT Pending AHRQ Final Review
Auditing your Briefings and Debriefings Process
Dr. Michael Rosen, Ph.D.
CUSP FOR SAFE SURGERY:SURGICAL UNIT-BASED SAFETY PROGRAM (SUSP)
What is your current role?• Surgeon• Quality improvement practitioner• Infection preventionist• OR nurse• OR technician• Anesthesiologist• OR manager• Educator• Other
2
Polling Question
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 3
Learning Objectives
• Re-cap the briefings and debriefings process.• Adapt a briefing and debriefing audit tool for
your OR.• Collect data on participation in OR briefings
and debriefings.• Provide feedback to OR staff and stakeholders.
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 4
Recapping Our ApproachComprehensive Unit- based Safety Program
(CUSP)
1. Educate staff on the science of safety
2. Identify defects
3. Partner with a senior executive
4. Learn from defects
5. Improve teamwork and communication
Translating Evidence Into Practice (TRiP)
1. Summarize the evidence in a checklist
2. Identify local barriers to implementation
3. Measure performance
4. Ensure all patients get the evidence• Engage• Educate• Execute• Evaluate
Reducing Surgical Site Infections
• Emerging evidence• Local opportunities
to improve• Collaborative
learning
Technical Work Adaptive Work
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 5
Why Briefings and Debriefings?
Teams perform better when they…1. Have a high quality plan2. Share that plan3. Learn and improve over time
Briefings and debriefings can help, but they do not guarantee good planning.
Checking the box Mindful engagement≠
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 6
Briefings and Debriefings
• Reduce communication breakdowns and OR delays1
• Reduce procedure and miscommunication-related disruptions and nursing time spent in core2
• Improve communication and teamwork, feasible given current workload3
• Reduce rate of complications, SSI and mortality4
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 7
Auditing Briefing Practices
1. Develop / adapt an auditing tool 2. Train observers3. Collect data4. Provide feedback
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 8
Developing a Briefing Audit Tool
• What are the local expectations for briefings?– What is the policy?– What forms/structures are supposed to be in place?
• What are best practices outside of current expectations?– Developing contingency plans
• Are these reflected in your auditing tool?– Modify ours to fit your local needs– Modify other briefing tools in the literature
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 9
Example briefing audit tool5
• Briefing logistics• Briefing basics• Specific content• Participation
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 10
Train Observers
1. Select observers– Who has time? Who has interest? – How many do you need?
2. Educate on the tool– Walk through the tool with explanations– Explain anything that confuses the observers
3. Conduct a dry run– Score a briefing and discuss any inconsistencies– Use videos if you have them
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 11
Our Experience Training Observers
• We used a wide range of observers– Medical students, RNs, residents, fellows, psychologists
• We achieved high reliability with minimal training• Sections with more explicit items were easier to
obtain higher reliability (mean kappa across 19 cases)– Briefing basics kappa = 0.847 – Specific content kappa = 0.820– Briefing participation kappa = 0.569
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 12
Collect Data
• Set your boundaries– Specific department or service line?
• Create a sampling strategy– Given the boundaries you set, and the resources you have, what
number of observations should you target?– What’s the best way to track observations? By intact team? By
surgeon?
• Define your process roles and responsibilities– Schedule for observations– Data entry
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 13
Briefing Basics
Name introduction
Role introduction
Critial goals
Contingency plans
Expectations for assertiveness
Opportunity for questions
0%10%
20%30%
40%50%
60%70%
80%90%
100%
YesNo
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 14
Specific Briefing Content
Patient
Site
ABX given
Beta blockers
Access issues
Blood availability
Glycemic control
Warmers
Intra-operative imaging (X-rays, ultrasound)
Prep application
0% 20% 40% 60% 80% 100%
YesNo
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 15
Participation:Pausing Other Tasks
Attending surgeon
Surgical Resident
Anesthesia Attending
Anesthesia CRNA
Anesthesia Resident
Circulator
Scrub
0% 20% 40% 60% 80% 100%
Not presentFails to PausePauses other tasks
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 16
Participation: Contributing To Briefing Discussion
Attending surgeon
Surgical Resident
Anesthesia Attending
Anesthesia CRNA
Anesthesia Resident
Circulator
Scrub
0% 20% 40% 60% 80% 100%
Not presentDoes not contributeContributes
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 17
Provide Feedback
• Present data to stakeholders– Share at CUSP team and other staff meetings– Display charts in common areas
• Use data to improve briefings– Coach and reinforce behaviors– Revise and refine expectations
• Policies• Processes• Checklists
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 18
SUSP Website Resources
https://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspxFind a copy of the auditing tool on our website
Look for Module 12
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 19
References
1. Nundy S, Mukherjee A, Sexton JB et al. Impact of preoperative briefings on operating room delays: A preliminary report. Arch Surg 2008; 143(11):1068-1072.
2. Henrickson SE, Wadhera RK, Elbardissi AW, et al. Development and pilot evaluation of a preoperative briefing protocol for cardiovascular surgery. J Am Coll Surg 2009; 208(6):1115-1123.
3. Berenholtz SM, Schumacher K, Hayanga AJ, Simon M et al. Implementing standardized operating room briefings and debriefings at a large regional medical center. Jt Comm J Qual Patient Saf 2009; 35(8):391-397.
4. Haynes AB, Weiser TG, Lipsitz SR, Breizat AH et al. A surgical Safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360(5)491-499.
5. Johnston FM, Tergas AI, Bennett JL, et al. Measuring briefing and debriefing checklist compliance in surgery: A tool for quality improvement. Am J Med Qual 2013.
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 20
KAISER PERMANENTE HAWAII
Elaine Moreno, MSN, CNORManager, Operating Room
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 21
Debriefing Form Two sided form that is placed on the pt’s chart and turned in after the case
PREOPThe front of the form is initiated and used by the Preop RN
It is a communication tool among the Periop team
INTRAOPThe back of the form is used by the OR RN to document debriefing comments such as what went well, good catches, and any room for improvements
Verify Procedure, specimen, post op management, etc.
POSTOPRN performs hand-off communication.Procedure, Meds, etc. and turns in the debriefing form to the OR front desk.
FOLLOW-UPDaily• OR Clerical staff inputs all debriefing
comments into an excel database.• The following day the OR Charge
RN reviews the debriefing comments and documents any follow-up in the same excel database. Notifies OR Management for any urgent or safety matters
Weekly• Reviewed by the OR Charge Nurse &
OR Management• Follow-ups are shared with OR staff
during OR Dept. huddlesMonthly• Reviewed in HRST – Highly
Reliable Surgical Teams. Filter debriefing comments for each specialty.
• Debriefing results posted on Dept communication board
Quarterly• Shared with Regional HRST
Committee
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 22
Examples of Debriefing Comments
What went well, or Good Catches • Labeling of specimen• Procedure name• Patient was Jehovah’s Witness• Staff came in to help• Consent did not match case schedule• Equipment/Instrumentation needed
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 23
Examples of Debriefing Comments
• Debriefing comments: Scheduling Errors• Issues identified – Incorrect procedures in the electronic scheduling system– Laterality errors– Delays, incorrect instruments, supplies were picked – Safety issue
• Follow-up– Met with clinic staff , surgeons– Provided education
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 24
Examples of Debriefing Comments
• Debriefing comments : X-ray Delay• Issues identified: – X-ray changed process to call for a technician.– Answering machine message sent to their pager– Not responsive, with delays upsetting surgeon
• Follow-up:– Filtered all debriefing comments related to x-ray delay– Presented Radiology management with all comments
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 25
Examples of Debriefing Comments
• Debriefing comments: Poor Quality Disposable Light Handles
• Issues identified – Disposable light handles were changed– Surgeons / staff expressed concern for quality and an
increased likelihood for contamination
• Follow-up– Contacted vendor– Changed product
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 26
Examples of Debriefing Comments
• Debriefing comments: Instrument tray problem• Issues identified: – Count sheet did not match number of instruments in tray– Increase possibility of instrument count error
• Follow-up:– Working with Sterile Processing Management regarding
instrument discrepancies– Providing education to SPD staff from Specialty Team
Leads
DRAFT Pending AHRQ Final Review
Auditing: Briefings & Debriefings 27
Examples of Debriefing Comments
• Debriefing comments: Preference Card not updated• Issues identified: – Delay in case– Incorrect supply / instrument
• Follow-up: – OR Charge Nurse assigned follow-up to Specialty Team
Lead
top related