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

2. 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.
Statistics for the Trust as per CFT Annual Security Report
330 direct physical assaults on staff
412 incidents in which verbal aggression was used.

3. 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.

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 0 referrals received to OH for DABS
Baseline Measures
0 referrals received to OH for DABS

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

14. Measures
Estimated cost of staff sickness on the ward.

15. 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

16. 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

17. 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

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