Debriefing Process

Debriefing Process

posted by DESTINEE RANKIN on Apr 11, 2018 1:00 pm

I am doing a project for my nurse residency and  trying to create a standardized process for debriefing in order to reduce specimen errors. I was wondering how the process works at other locations. Is there a set time when debriefing is complete? How do you verify specimens on cases where there ae multiple specimens? Are all members involved in debriefing? My group is prosing a debriefing time-out, but we are not sure on the exact time to do it and a good way to verify specimens on big cases and how to make sure the surgeon and all team memebers are actively involved.

Re: Debriefing Process

posted by Jacqueline DeMaio on Apr 11, 2018 10:37 pm

Surgeon states planned specimen at initial case Time Out, and specimen description and details are confirmed when specimen is out.  Our debrief can happen any time near end of procedure, after counts are done. Sometimes while final closing is done, but most often the debrief is when surgeon breaks from sterile field at end of case.  Often surgeon initiates, if not then anyone in room can initiate debrief.  If a surgeon has allowed for a specimen to been taken from room prior to end of case, the details of the specimen(s) sent out are given as well as specimens remaining in room to be sent at end of case.  All specimens are read aloud with name, test, status of specimen, and whether sent to lab, for frozen section, culture, or general pathology.  I keep a written list of all specimens which have left the room, and keep it with any specimen remaining in the room, for review at debrief.  Usually circulator is making sure debrief is done to have all specimen details confirmed and correct and other information is obtained for documentation prior to surgeon leaving room (EBL, local used, cather status, etc.).  All team members in the room are included in the debrief.  

Re: Debriefing Process

posted by Michele Dunne on Apr 12, 2018 8:14 pm

We do it as a "Sign Out Time Out.
After the first count is done the circulator uses a checklist to do the sign out time out.
Among other things, these are documented:
1. Post op diagnosis
2. Procedure performed
3. Any specimens and their disposition
4. Counts are correct
5. Physician notified (Y/N)

Re: Debriefing Process

posted by Sheri McDuffie on Apr 13, 2018 8:19 am

Our debriefing process consists of the following and involves all team members on the field including surgeon, circulator, and anesthesia:
Count verification
Procedure name review and update of any postoperative diagnosis
Review of all specimen(s) and/or cultures
Any postoperative concerns for the patient or issues which arose during the procedure that need to be communicated or reviewed
We also address any issues with equipment or instrumentation to be sure someone is accountable for reporting.

*if we have to send specimens out prior to case end, the surgery is paused to review the specimens by all team members before the tissue leaves the OR.
 

Re: Debriefing Process

posted by Lisa Spruce on Apr 13, 2018 11:33 am

There are some evidence based recommendations in AORNs Guideline for Team Communication for the debriefing process if you want to check that out.
Lisa Spruce, RN, DNP, CNS-CP, CNOR, ACNS, ACNP, FAAN

Re: Debriefing Process

posted by Virginia Guill on Apr 13, 2018 12:10 pm

Hi,

At our hospital we instituted a check out process once the surgeon has broken scrub.  I take collected specimens, my pathology requisition, and we both confere  they are correct.  If any are frozens which were sent earlier we discuss this as well.  This process allows all necessary  parties to stop and discuss this most important patient safety feature.  I find if I catch them as they are breaking scrub, I get their undivided attention before checking messages on their beepers/cell phones distract them. This is also the time we discuss all procedures done and cover any concerns with anesthesia regarding the patient's post op care.  If there is any change in where the patient will go after PACU we discuss this as well.  We really focus on this aspect of the team communication and our MD's are grateful that we have this process in place.  Occasionally, we do find a mislabeled specimen and we have time to correct this with this time out process. All our charting is done electronically now,  even specimen labels.

Hope this helps.
 

Re: Debriefing Process

posted by Angela Ruhter on Apr 13, 2018 2:58 pm

We actullay did a poster on this for the AORN convention. We have a debrief that is usually called for by the surgeon at the end of the case.  they discuss what procedure was actually done, blood loss, anesthesia issues, and verifying specimens. I would list the specimens, the test ordered, and the I verified with the surg tech or surgeon that we see it in the jar. In our research they talked about how important it is that everyone is involved like a time out; the techs should saying if there were trouble with any equipment or supplies, they should talk about the count, they should talk about if there is something to pass on to PACU.
If you can look at the posters ours was called "Be Brief and Debrief"

Re: Debriefing Process

posted by Peggy Mehle on Apr 13, 2018 5:52 pm

Our process is procedure performed, post op do, specimens, concerns for recovery and specimens.  Supposed to happen when the surgeon has “gloves off”.

Re: Debriefing Process

posted by Mary Rivera on Apr 14, 2018 9:24 am

During the Debrief time an important element is to verify the Wound Classification as well. This is often recorded early in the procedure but can change by the end of the case.
Mary Rivera

Re: Debriefing Process

posted by Cheryl Friesen on Apr 14, 2018 6:29 pm

Our time out form has three sections to it. Initial prior to anesthetic induction, just prior to cut and final at the end of procedure, right after final count. The team verifies the specimen at this point.

Re: Debriefing Process

posted by Elizabeth Austin on Apr 14, 2018 6:54 pm

Dear Colleagues,
This is an ever-relevant topic that emphasizes patient safety and optimal outcomes. 
I agree that the Debrief/sign out is the final segment of the TIme Out process.
AORN does have great resources. Here is another-
https://ipassinstitute.com
My contribution to this discussion is buy in-when the surgeons sees that the process adds value to their workflow, their participation is more guaranteed-in my practice/observation. Accountability-as in audits of the process-is another contributor. The Kaiser hospitals have a form that BOTH the surgeon and nurse are required to complete for each case and it follows a check list format. 
Here is a link to the latest Periop Update on hand-off and execs-
https://www.aorn.org/about-aorn/aorn-newsroom/periop-today-newsletter/2018/2018-articles/3-strategies-for-nurse-execs?utm_source=Email&utm_medium=Newsletter&utm_content=04_11_18&utm_campaign=Periop_Today

Keep up the great work, Team!
Elizabeth A. Austin 
DNP, RN, CNOR
 

Re: Debriefing Process

posted by Susan Burroughs on Apr 16, 2018 9:45 am

Hello Everyone.
I do understand that specimens are the reasons why patients are having a procedure done. This will provide a diagnosis to determine what course of action/treament plan for the individual patient. It is such a vital part of the procedure in identifing the compostition of the specimen.  Problems occur will specimens do not reach their appropriate designation for processing by the pathologist, incorrectly labelled/Post-Op diagnosis, or lossed in the OR.  I would like to share the following  process that is untilized at my facility (Academic):
Debriefing - Initation of Clossing: Done at end of the procedure but prior to surgeon leaving
Surgeon and Nurse verbally confirms: name of procedure,site, and laterally
Surgeon verbally gives surgical wound class
Surgeron and Nurse verbally confirm post-op diagnosis
Nurse verbally confirms: Instrument,sponge, needle count complete prior to closing
Surgeon and Nurse verbally confirms: specimen labeling
Concerns or critical events to relay to immediate post-op caregiver
Nurse verbakky confirms: failed equipment out of service with proper labeling and reporting

I hope that this was useful.
S. Burroughs BSN RN

Re: Debriefing Process

posted by Hester Fletcher on Apr 16, 2018 10:52 am

I did a project in the past on specimen retrieval and errors.  I experienced a lot of errors from staff as a manager and I had to deal with the fall out thereafter.  As an educator I always taught that losing or mislabeling a specimen is to me sort of like assault and battery.  "you cut me open for no result".  And we should treat it as if it were the patient it is directly tied to the patients outcomes.  However I also believe there is a lot of red tape between the patient and the specimen all the way to the diagnosis.  It can change hands bunches of times adding to the error.  I think that if the surgeon is directly responsible he should be an intrical part of the labeling and handling.  I tried to develop a cup system that the Scrub nurse and the surgeon during last and final checks could label together and check off it is accurate.  When I ask around everyone felt the responsible person to label the cup was the circulator.  Do most of you feel that way?
 

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