© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Conducting a Morning Briefing Armstrong Institute for Patient Safety and Quality Presented by: David A. Thompson DNSc, MS, RN

Focus is Preparation/planning and vigilance Workload distribution Distraction avoidance Situation Awareness

Members of the team have and understanding of “what’s going on” and “what is likely to happen next” Teams are alert to developing situations, sensitive to cues ( red flags, caution) and aware of their implications. Situation Awareness An Overview

Know the game plan – through briefings and team management (e.g., workload & workflow management, task coordination) Anticipate next steps and possible events Follow known policies and procedure Cross-check and verify Provide ongoing updates – call-outs, cross-talk, and briefings Improving Situation Awareness

Briefing Defined What a Briefing immediately does? 1.Map out the plan of care. 2.Identify Roles and Responsibilities for each team member. 3.Heightens awareness of the situation. 4.Allows the team to plan for the unexpected. 5.Team members needs, and expectations are met. A briefing is a discussion between two or more people, often a team, using succinct information pertinent to an event.

Sets the tone for the day…… chaotic versus organized and efficient Encourages participation by all team members Owned by all team members Organized in thought regarding the procedure Establishes competence- who has what skills who performs what who knows what Predicts what will happen later Plans for the unexpected ( include equipment, medications, consults) Effective Briefings

When to Conduct Briefings  Beginning of the Day- Morning Briefing  Prior to any procedure in any setting.  Situational – change in patient status results in deviation from plan of care  Reporting-off- breaks, shift change

Morning Briefing Process Three simple questions 1.What happened overnight that I need to know about? 2.Where should I begin rounds? 3.Do you anticipate any potential defects in the day?

What happened overnight that I need to know about? You should be thinking about…Was there adequate coverage? Were there any equipment issues? Were cases posted to the ICU? Unexpected changes in patient acuity? Were there any adverse events?

Where Should Rounds Begin? 1.Is there a patient who requires my immediate attention secondary to acuity? 2.Which patients do you believe will be transferring out of the unit today? 3.Who has discharge orders written?

As you continue planning rounds…plan 4. How many admissions are planned today? 5. What time is the first admission? 6. How many open beds do we have? 7. Are there any patient having problems on an inpatient unit?

Do you anticipate any potential defects in the day? Patient scheduling Equipment availability/ problems Outside Patient testing/Road trips Physician or nurse staffing Provider skill mix

When you identify defects/ problems Want to assign a person to the issue- have them follow up. Identify actions taken to meet any patient or unit needs Report back to the staff what those actions were or will be. If ongoing- continue to report it during morning briefing until it is resolved.

© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Questions? THANK YOU