Welcome Debriefing – Level 1 Main title slide page To help reduce use of physical interventions

Situation Staff working within the NHS are often exposed to challenging operational situations. Some staff have reactions to Serious Incidents which potentially might impact on their well being, their health and team functioning. 2016-2017 Statistics for the Trust as per CFT Annual Security Report 330 direct physical assaults on staff 412 incidents in which verbal aggression was used.

Background NICE guidance recognises that when incidents occur, the staff member may experience a reaction with a range of symptoms from anxiety, lethargy, sleeplessness, increased consumption of alcohol and being unable to concentrate. The distress experienced can significantly impact on their ability to work effectively and often results in staff sickness and team productivity being reduced. Over time, if left untreated this may result in the staff member being at risk of developing PTSD. NHS Protect standards -It is important that staff feel safe in their working environment. Violent behaviour not only affects them personally but it also has a negative impact on the delivery of patient care.

Debrief Describe events as factually as possible Evaluate what went well/to change next time Banish emotions/beliefs/assumptions that cloud judgement and development Review and analyse in light of previous experience (pattern recognition) Identify lessons learned Establish follow up actions Feedback on actions

Local Debriefing (Level 1) Local debriefing is usually held on the day or within 5 days of the incident by Managers, and can take the form of face to face, team meetings, individual supervision or telephone calls.

Benefits to patient and staff Patients feel listened to Staff feeling valued Equipping staff regarding how stress and trauma can impact them and how to manage it Allowing reflection Potential reduction in staff absence Staff retention Recognition of uncontrollable factors Supporting the delivery of patient centric care

Assessment Patient Experience Staff Engagement AIM PRIMARY DRIVERS SECONDARY DRIVERS Patient Experience Debrief Questions Staff Engagement Satisfaction of debrief Personal Safety Awareness Training 100% of Harvest Ward staff are offered a level 1 debrief within 5 days of the incident following a physical assault by June 2017 Managers Response on Incident Management System Team Manager Engagement Training – Supervision/Debrief Infrastructure in line with the Health and Wellbeing strategy Recording/Managing OH referrals Process development Just in case Policy reviews (HR, OH, Supervision) Exec involvement Culture and Expectations Sharing lessons learnt

PDSA Testing Ramps for: Staff engagement DATA FEEDBACK TO FRONTLINE STAFF 1F: Collate information review PDSA Cycle 1E: Review questionnaire and re-issue if required- Re-issue and test on two other wards Cycle 1D: Feedback from 1B Cycle 1C: Create a questionnaire using 1B to test Cycle 1B: Identify ward team for the testing of follow up questions Cycle 1A ; Looking at incidents, which will then inform 1B 43

PDSA Testing Ramps for: Process Development DATA FEEDBACK TO FRONTLINE STAFF 1D: Collate information review PDSA 1C: review with another ward and adapt flow chart and test with 5 debrief sessions 1B: Flow chart tested with staff member 1A ; Meeting with ward manager to develop flow chart 43

Measurement Managers reports from incidents Staff sickness and turnover figures Occupational Health referrals Ward questionnaires (Meridian survey for staff) 1.1, team meetings and supervision feedback Personal Safety Training There are range of balance and process measures that impact on this project.

Outcome Measurement There have been 10 debriefs documented for the ward. The language of the debriefs is also used verbally when communicating with patients and staff. 10

0 referrals received to OH for DABS Baseline Measures 0 referrals received to OH for DABS

Measures DABs Incidents – Physical Contact Made (Patient on Patient and Patient on Staff)

Measures Estimated cost of staff sickness on the ward.

Update Positive response to first ward test Debrief questions for the Incident Management system - this has been expanded to include patient experience following a restraint so it is a more holistic tool. A flow chart to support the process of developing a structured approach to undertaking debrief has been completed and is being tested on another ward Manager’s debrief training is being delivered face to face with the team as part of the roll out. Debrief form has been developed and now incorporates a help guide on the first page. Line managers are briefed by Head of Security prior to rolling out debriefing in the area Policies are now reflecting the debrief as good practice

Recommendations and Next Steps Review initial six months of recorded information to establish if any of the aspects identified have been put into practice. Learning from debrief is shared in team briefs as a standard agenda item. One lesson learnt each week will be displayed staff notice board. Transfer checklist used for patients – area for reflection to incorporate learning from any of the debrief incidents. This will done with the patient. 1 month follow up from discharge Recording the debrief session within the incident management system to ensure period of reflection and that the actions are captured. This will be tested. Correlation with Patient Experience Availability of debrief and review tool – controlled until PDSA completed Personal Safety Awareness training to include debrief

Managing expectations PBS Plans Follow - up All about me Safewards Patient experience Debrief effects and influences many other areas in patient care and staff experience…… Debrief MDT Huddles Managing expectations and perceptions

We listen, we support, we learn, we grow Key improvement message learnt We listen, we support, we learn, we grow