Improving Sedation Management in Mechanically Ventilated Patients

Abstract In the intensive care unit (ICU), sedation management of the critically ill, mechanically ventilated patient is a source of concern. Optimal sedation management is integral to critical care practice, yet optimal levels of sedation are not consistently applied. Suboptimal sedation carries significant risks for patients, as inadequate sedation or oversedation may lead to prolonged ventilator days, ventilator-associated pneumonia (VAP), extended length of ICU stay, and costs. The purpose of this quality improvement (QI) project was to improve sedation management of mechanically ventilated patients by improving staff nurses’ knowledge of and attitudes toward sedation management, ultimately achieving a zero-ventilated associated pneumonia rate. The Institute for Healthcare Improvement QI model provided the framework for the study. The practice focused question guiding the project concerned whether nurses’ knowledge and attitudes would improve after participation in an educational module, and whether implemented strategies would improve outcomes in the cardiovascular ICU. An online education module with face-to-face debriefing aimed at addressing sedation management was used. Pre- and posttest results demonstrated a change in knowledge acquisition (t = 9.251, df = 29, p=.000). A positive change in attitudes was indicated in the qualitative debriefing as nurses appreciated the value of preventing VAP without oversedation and brainstormed ways to overcome barriers. Most importantly, there were zero incidents of VAP in the 8 weeks following the educational process and debriefing discussions. Clinical implications of this QI project are that an educational process can help nurses find the means to provide optimal sedation management and to prevent negative consequences of oversedation, which would constitute positive social change

Postpartum Hemorrhage: Improving Patient Outcomes With Improved Communication and Post-Drill Debriefing

Abstract Background: A woman is at risk of dying from postpartum hemorrhage every four minutes. Maternal hemorrhage is found to be the direct cause of maternal mortality, overall accounting for 27% to 75% of maternal deaths worldwide. In the United States, 54% to 93% of maternal mortality could have been prevented. Postpartum hemorrhage remains among the top causes of pregnancy-related deaths worldwide. The purpose of this project is to educate providers of obstetrical care regarding best practices for effective communication during a postpartum hemorrhage by implementing a debriefing educational tool during postpartum hemorrhage mock code drills. Methods: The postpartum hemorrhage team review and debriefing form were implemented during mock postpartum hemorrhage code drills to improve debriefing after critical events. Five educational sessions which lasted ten minutes each along with a pre-survey for recruitment were offered prior to mock postpartum hemorrhage code drills about debriefing. The communication was evaluated after the mock postpartum hemorrhage code drills using the Clinical Teamwork Scale (CTS). Results: Twenty-five nurses participated in the pre-brief survey (n = 25). There were 3 groups of nurses for the 3 mock postpartum hemorrhage code drills, which included 11 nurses (n = 11). The groups rated their performance/teamwork using the itemized tasks after the mock code trainings. Conclusion: Structured debriefing was shown to improve skills and increase knowledge concerning interventions in an emergency. Improved knowledge and confidence with debriefing can lead to improved performance during an actual postpartum hemorrhage. Communication and collaboration during an emergency were shown to improve patient outcomes. Keywords: postpartum hemorrhage, postpartum hemorrhage risk factors, postpartum hemorrhage debriefing, postpartum hemorrhage management, treatment

Improving medication practices for persons with intellectual and developmental disability: Educating direct support staff using simulation, debriefing, and reflection

Direct support professionals (DSP) are increasingly active in medication administration for people with intellectual and developmental disabilities (IDD), thus supplementing nursing and family caretakers. Providing workplace training of DSPs is often the duty of nursing personnel. This article presents empirical data and design suggestions for including simulations, debriefing, and written reflective practice during in-service training for DSPs in order to improve DSPs’ skills and confidence related to medication administration. Quantitative study results demonstrate that DSPs acknowledge that their skill-level and confidence rose significantly after hands-on simulations. The skill- level effect was statistically significant for general medication management -4.5 (p <0.001) and gastrointestinal medication management -4.4 (p < 0.001). Qualitative findings show a deep desire by DSPs to not just be “pill poppers” but to understand the medical processes, causalities, and consequences of their medication administration. On the basis of our results, the authors make recommendations regarding how to combine DSP workplace simulations and debriefing with written reflective practice in DSP continuing education

Tracking and debriefing birth data at scale: A mobile phone application to improve obstetric and neonatal care in Bihar, India.

AimThis analysis assessed changes over time in skill and knowledge related to the use of evidence-based practices associated with quality of maternal and neonatal care during a nurse midwife mentoring intervention at primary health clinics (PHCs) in Bihar, India.DesignNurse midwife mentors (NMMs) entered live birth observation data into a mobile App from 320 PHCs.MethodsThe NMMs completed prompted questions in the App after every live birth witnessed. The App consisted of questions around three main themes, "What went well?", "What needed improvement?" and "What can be done differently next time?".ResultsObservational data from 5,799 births was recorded by 120 NMMs in 320 PHCs. Knowledge and skill during normal spontaneous vaginal deliveries and complicated deliveries with either a postpartum haemorrhage or non-vigorous infant all showed statistically significant improvement (p &lt; .001) over time using a Chi-squared test for trend with a mean increase of 41% across all indicators

Pocket Book for Simulation Debriefing in Healthcare

© 2018 Springer International Publishing AG. This is a post-peer-review, pre-copyedit sample portion of 'Pocket Book for Simulation Debriefing in Healthcare'. The final authenticated version is available online at: http://dx.doi.org/10.1007/978-3-319-59882-6This book is a concise manual on debriefing techniques in a clinical educational context. It presents the most popular debriefing techniques and, hence, can be used as a reference manual by educators to help them achieve their intended debriefing objectives. The overarching objective of debriefing is to promote reflection and improve patient safety awareness at an individual and a team level. This book provides clear explanations of what constitutes a valuable and effective debriefing, and presents the various approaches that can be used and how debriefing differs from feedback. It includes key recommendations on aspects that directly or indirectly impact debriefing with different populations of learners such as students or qualified healthcare professionals of various levels of seniority. This book can also be used as a survival guide for both simulation educators and clinicians during debriefings. It includes several useful sections explaining the different phases of a debriefing session, which help learners develop and consolidate their knowledge, and identify potential knowledge or performance gaps and near misses. The underlying philosophy of this book is to also promote profound respect for the trainee by using a non-offensive debriefing approach. Debriefing facilitators will appreciate the several key sentences that will help them lead and engage their learners in the various phases of expressing their emotions and analyzing their experience and actions

Acting out our dam future: science-based role-play simulations as mechanisms for learning and natural resource planning

Science often does not make its way into decisions, leading to a problematic gap between scientific and societal progress. To tackle this issue, our research tests a novel science-based negotiation simulation that integrates a role-play simulation (RPS) with a system dynamics model (SDM). In RPSs, stakeholders engage in a mock decision-making process (reflecting real-life institutional arrangements and scientific knowledge) for a set period. System dynamics models (SDMs) are visual tools used to simulate the interactions and feedback within a complex system. We test the integration of the two approaches with stakeholders in New England via a series of two consecutive workshops across two states. The workshops engage stakeholders from diverse groups to foster dialogue, learning, and creativity. Participants discuss a hypothetical (yet realistic) decision scenario to consider scientific information and explore dam management options that meet one another\u27s interests. In the first workshop, participants contributed to the design of the fictionalized dam decision scenario and the SDM. In the second workshop, participants assumed another representative\u27s role and discussed dam management options for the fictionalized scenario. This presentation will briefly report on the practical design of this science-based role-play, and particularly emphasize preliminary results of workshop outcomes, which were evaluated using debriefing sessions, surveys, concept mapping exercises, and interviews. Results will determine the extent to which this new knowledge production process leads to learning, use of science, and more collaborative decision-making about dams in New England and beyond

Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.

INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). METHODS: We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining \u3e100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. RESULTS: The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. CONCLUSION: This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use