Code debriefings

Specialties Critical

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

My hospital has lots of new nurses right now, especially on nights. We have had quite a few codes, and not all of them have had positive outcomes. Does anyone have a code follow-up or debriefing team that reaches out to team members when a code isn't successful? I know that I have had a hard time myself after a couple poor outcomes and it's been hard to get past. I think for newer nurses than me, it could be a really bad thing for starting out their career. Any thoughts or suggestions?

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Rather (or perhaps in addition to) forming a team to reach out to staff after an unsuccessful code after the fact, consider immediately debriefing after all codes. Discuss what went well and what didn't in a matter-of-fact and non-judgmental manner, pointing out what things team members did well, what could have been done better, and reviewing any possibilities that could have been overlooked.

Debriefing immediately after codes has a few big advantages. For one, the events of the code are still fresh and well-remembered, leading to better and more accurate feedback. For another, making debriefing a habitual occurrence after every code ensures that the process doesn't get abandoned, and also that a debriefing doesn't appear to be a disciplinary matter that only gets implemented if someone messes up. Finally, debriefing immediately encourages staff not to stew silently on bad outcomes for days or weeks before anyone gives them an opportunity to talk about it, which might help relieve some of the trauma staff can feel after an unsuccessful code.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I love that idea, I just don't know how that works from a staffing standpoint. Generally when a code is completed, either the patient has transferred to critical care and the responding critical care staff members leave with them, or the unit that called the code is left with the tasks of postmortem care. I'm not sure people would be willing/able to stay at the time to debrief. I will definitely look into it more.

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18 minutes ago, JBMmom said:

I love that idea, I just don't know how that works from a staffing standpoint. Generally when a code is completed, either the patient has transferred to critical care and the responding critical care staff members leave with them, or the unit that called the code is left with the tasks of postmortem care. I'm not sure people would be willing/able to stay at the time to debrief. I will definitely look into it more.

Sorry, I had imagined you worked in a critical care unit already.

I am often on the code response team at my hospital, and you're right that the responding staff typically would leave with any successful resuscitation effort as they're transferred to an ICU. However, a routine debriefing should typically last no more than 5 to 10 minutes, and should be possible immediately after any unsuccessful resuscitation attempt. Ten minutes is a worthwhile investment, especially considering that most unsuccessful codes last at least 20 minutes - post-mortem care can wait. You just have to convince the responding team that a debriefing is a part of the process, just like making sure the code documentation sheet is filled out and signed appropriately.

Having a hospital administrative coordinator or senior floor staff lead routine debriefings after successful codes might also be possible. Or, especially if your hospital has a dedicated code/rapid response team that doesn't have patient assignments of their own, arranging for a brief followup meeting an hour or so after the code might also be possible.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I am in the CCU, I'm often the responding staff member from my unit. I'm definitely going to bring this up to my unit manager to see whether something could be implemented. Everyone seems in such a rush to run away, but as you said, 5-10 minutes could really be a worthwhile investment, especially for newer staff. I wish we were staffed enough to have a response team without patient assignments, but I think we're too small for that.

Thanks for the input!

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I like the idea of this and know how it works.

Just the same, someone used to reach out to newer nurses after these experiences, which was a worthwhile endeavor and I sincerely don't think the new iteration of "debriefing" accomplishes the same.

The scenarios that end up burned into people's memories are not helped by a quick run through consisting of clinical critiques and compliments.

These are life-changing experiences; especially if they are extraordinarily bad/different in some way or if they come at a particular time in someone's life/career. I'm not convinced there's really any way to prevent people from dwelling, per se; sometimes processing (positive or at least normal) is mistaken for dwelling/stewing (negative/detrimental).

I really think a manager or educator should reach out or that there should just be sort of an open-door for these things, in addition to the more clinically-oriented debriefing. Often now people participate in the debriefing and if the say they'd like to talk more, they are referred to EAP/CID team, which I think is a step beyond what most people are looking for. It seems too far-removed and formal.

So my summary/suggestion would be something that is a happy medium between the quick debriefing and EAP/CID team.

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