Imershein #5 Tool: Post-Op Debrief Audit Cards

Imershein #5 Tool: Post-Op Debrief Audit Cards

by Sarah Imershein -

#5 Tool – Post-Op Debrief Audit Cards

 

A. Describe one tool that you will employ in your intervention strategy using the following domains....

  1. Tool—type: Debrief Audit Cards
  2. Target Population: Circulating Nurses
  3. Target Behavior: Performing Debrief on all neurosurgical cases
  4. PRECEDE Category: Reinforcing
  5. Platform: Initially paper cards with all neurosurgical case charts until process refined, then once ready for all UCSF services, built as OR template in APeX.  Systems/efficiency concerns documented on same paper audit card initially, with goal of documenting in separate protected electronic system that automatically messages appropriate departments (e.g. rounding mobile software)

 

B. For a multi-tool intervention strategy, use the PER worksheet attached to describe how you will address each of the PRECEDE framework components 

PER Worksheet. 

PER Worksheet. 

 

Target Behavior

Performing the Post-Op debrief on all neurosurgical cases

Target Audience

Attending surgeons

Other Key Individuals

Resident surgeons, attending and resident anesthesiologists, crani and spine pod nurses, pre-op team, nursing QI, nursing pod managers, Chair of Neurosurgery, Chair of Anesthesiology, neurosurgery quality team, healthcare services researcher

PREDISPOSING

ENABLING

REINFORCING

KNOW

BE ABLE TO DO (skills)

REMINDED

Post-operative debriefs prevent rare but serious events

Understand all debrief items (e.g. do all surgeons know what all “wound classifications” are)

Fliers in meeting rooms about policy change

Systems issues in the ORs are not clearly defined

Create culture of team communication

Fliers at OR Front Desk about completing audit cards

Debriefs are rolling out system-wide soon.  Time to refine process and make it work

Create system for tracking efficiency problems; paper first with goal of creating electronic system

Email from Chair to attendings and residents regarding policy change

 

Change pre-op behavior to remember a debrief audit card on all neurosurgical case charts

Compliance data reported to Neurosurgical Chair who will communicate to attendings as needed

 

 

Presentation at institutional meetings, grand rounds, staff meetings

BELIEVE/VALUE

ACCESS TO

POSITIVE REINFORCEMENT

Defining systems problems will lead to actual systems change

Debrief audit cards and box for collection of completed cards

Attending performance will be reported and compared to colleagues

Input of all surgical team members; improved team communication

Time (1-4 minutes) at end of case for all team members to stop and communicate

Compliance with performing debrief compared to case load reported back to surgical teams – set targets

Attending and resident surgeons will be responsible for championing the effort

Time for circulating nurse to complete audit card

Neurosurgical resident QI goal for FY15; compliance tied to incentive

Debriefs will reduce delays

QI staff time to document and triage all identified efficiency problems

 

That nurses will not be the OR police

 

 

All feedback welcomed without retribution

 

 

INTENTION

ACCESS REMOVED

NEGATIVE REINFORCEMENT

To perform the debrief on all neurosurgical cases

 

Attending performance will be reported and compared to colleagues

To document all debriefs on the audit cards

 

OR reports cannot be signed off without confirmed performance of debrief (potential downstream)

To document efficiency problems on all cases

 

SOCIAL SUPPORT

To identify and resolve efficiency problems, and communicate back to surgical teams

 

Advisory committee with key stakeholders

OTHER

 

Space for nurses to voice concerns confidentially

 

 

 

 

 

 

Re: Imershein #5 Tool: Post-Op Debrief Audit Cards

by Christina Mangurian -

Great job, Sarah. If you’re going to have folks like Chairs as "Key other individuals," I’d think about expanding to Hospital Administration since they may be working on projects that have some parallels in other parts of the medical center.

I’m wondering if there is something that could be taken OFF the plate to balance the time to do this (removing an obstacle). You (obviously) know this world better than I do, but perhaps there is some check that RNs usually do that could be done while this is being done.

Also, how are you going to tie compliance w/ incentive? Do you have $ from the Department to do this? How will “attending performance be reported and compared to colleagues”? Weekly, monthly? Would the Chair be ccd? These ccs would definitely be BOTH positively and negatively reinforcing. 

Re: Imershein #5 Tool: Post-Op Debrief Audit Cards

by Ralph Gonzales -

I agree with these points… very practical and logistical. 

Re: Imershein #5 Tool: Post-Op Debrief Audit Cards

by Ralph Gonzales -

Hi Sarah,

For the Tool description, if the target behavior is “perform debrief”, then I think the debrief audit cards would be “enablers” rather than “reinforcers”.  Maybe you can describe more detail as to how this works.  I’m a little bit lost in the platform.

 Excellent job with the PER worksheet!!  Hard to find anything additional to add!!

Re: Imershein #5 Tool: Post-Op Debrief Audit Cards

by Sarah Imershein -

I started with Enabler since it's a part of the process, but what the cards do is feedback data that reinforces compliance. The card itself doesnt contribute to the debrief, except as documentation. I almost put both Enabler and Reinforcer. And the main consideration we are dealing with is that the card is considered a hindrance and "one more thing" for the nurses to do.  Thoughts?