Appropriate circumstances for staff debrief:

• In any circumstance that staff members collectively feel they would benefit from debrief
• Death of neonate in NNU
• Death of neonate in labour ward/ theatre/ postnatal ward/ birth centre
• Successful resuscitation following collapse of baby on NNU/ out with NNU (see above)
• Following difficult decision making for neonate (transfer/ reorientation of care/ complex diagnosis)
• Following verbal or physical abuse of staff on NNU/ out with NNU (see above)
• Parents should expect that after a serious episode in their child’s care, that a debrief will be conducted to support the staff who are providing ongoing care to their child and during which the clinical team will learn from reflection on their performance.

Where debrief happens:

• In a supportive learning environment suitable to staff involved

When should debrief occur:

• Wherever possible immediately following episode and ideally before the end of same working shift
• If this is not possible, a relevant date should be set which should be within 3 days and no more than 1 week post event

Who should be present at debrief:

• All staff involved who wish to attend

Debrief should be led by:

• Senior staff involved in baby’s care/ responsible for staff involved in incident (Responsibility of shift registrar to contact relevant consultants involved who should then decide who is most appropriate to lead discussion)
• Senior staff should be knowledgeable about best practice in leading a debrief including tone setting, goal setting, facilitation of discussion, and guidance of the team in the process of reflection and learning.

What should debrief include:

• Brief outline of incident (summary of baby’s care/ summary of event if non-clinical)
• Opportunity to voice thoughts and views on how incident has made people feel, including any concerns about emotional effects felt as a result of incident
• Any immediate safety issues which require addressing
• Key team working processes that were exhibited during the team performance should be described, including planning, situation assessment, supporting behaviour, communication and leadership/initiative
• A focus on key performance issues, including challenges and examples of excellence
• Feedback should be supported with objective indicators of performance and both individual and team-orientated feedback should be given
• The focus should primarily be about how well the team was working together rather than necessarily how well the team achieved its overall objective.
• Chance for those individuals who feel they would benefit from further discussion to be directed to a named person – likely their line manager- who would facilitate further action
• Documentation that a debrief has occurred (but not the content) should be noted in Badger under the medical notes for the neonate involved

Important factors to consider during debrief:

• Team members should feel at ease during the debrief and have equal voice
• Involvement should be encouraged but must remain optional
• Topics discussed should avoid implying any element of blame or individual error
• All members of the team should be knowledgeable about factors affecting team performance for optimal analysis of team behaviour.
• Focus should not be on a detailed clinical review of the case (this is one of the purposes of the monthly mortality review meetings)
• Wherever possible confidentiality of staff involved should be maintained

Reference

Salas et al. Debriefing Medical Teams: 12 Evidence-based practice and tips. Jt Commission Journal on Quality and Patient Safety. 2008;34(9): 518-526