Implementation of a nurse facilitated, structured, clinical event debriefing initiative in four neonatal intensive care units.

BACKGROUND

Neonatal intensive care units (NICUs) often experience high acuity clinical events and can benefit from clinical event debriefing. Post-event team debriefs can reinforce success, identify areas for improvement, and support healthcare providers' (HCP) psychological coping. However, barriers exist to debriefing regularly.

OBJECTIVE

To implement and evaluate a structured clinical event debriefing program in four NICUs within a regional neonatal program.

METHODS

We assembled a multi-disciplinary team of clinicians and debriefing specialists, adapted an existing tool, and identified site champions. A database, debrief triggers, and feedback processes were developed. We chose charge nurses as facilitators. Facilitators were trained in 2-h virtual sessions. Debriefs were started and tracked. A post-implementation survey was conducted after 6 months.

RESULTS

Eighty-one HCPs responded to the pre survey. Respondents identified time constraints and skill /availability of facilitators as barriers to clinical event debriefs. Most were comfortable with debriefs prior to implementation. Ninety-five debriefs were conducted over 6 months. Median 7 (IQR 5-8) HCPs attended. Most were led by trained nurse facilitators. Debriefs took a median 12 min (IQR 8-17), and generated recommendations for equipment, teamwork, and process issues. Barriers to implementation included availability of trained facilitators, time constraints and competing quality improvement (QI) priorities. The post-implementation survey showed positive views of structured debriefs. Participants still listed time constraints as the main barrier to debriefs, although less than prior.

CONCLUSION

Nurse-led, structured clinical event debriefing can be implemented in NICUs. Clinical event debriefs allow HCPs to participate in identifying systems issues and solutions.