1. Communication in the Perioperative Setting
Implementation of a Brief and Debrief
Mary Pat Gilligan MSN CNOR NEA-BC
Mount Saint Joseph University
DNP Scholarly Project
Background
Research
Experimental
Quasi-experimental
Non-experimental
Qualitative
Non-Research
AORN Practice Guidelines
Organizational Experience
Clinical Expertise
Patient preferences
Expert opinion
Internal
Factors
External
Factors
Culture
Perioperative Environment
Communication
Perioperative Team
Hierachies
Teamwork
Patient
Quality Measures
Legislation
Joint Commission
AORN Standards
CMS
Practice
Education Research
Adaption of JHNEBP Model
(Dearholt & Dang, 2012)
"Team discussions are common in the Operating Room here"
4.00 4.00
2.81
3.19
2.97
3.39
3.31
4.69
3.40
4.00
2.75
3.63
0.00
3.60
3.17
2.92
3.03
3.55
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
Pre Implementation Post Implementation
Surgeons (N = 3)
CRNA's (N = 16)
Nurses (N = 36)
Surgical Residents (N = 13)
Surgical Assistants (N = 5)
Scrub Technicians (N = 16)
Anesthesiologists (N = 10)
OR Assistants (N = 12)
Total (N = 111)
*
Methods Results
Conclusion
•Research has demonstrated nurses remain
silent upon witnessing a potentially unsafe
practice or actual event in the operating room
(Cvetic, 2011).
•The purpose of this project was to support
strategies to eliminate the implications of
communication inconsistencies and potential
adverse events in the perioperative setting.
PICO Question
Do members of the surgical team (P),
who participate in a brief /debrief initiative (I),
vs. those who do not (C)
experience less miscommunication and more
team cohesiveness and improved
perioperative care(O) ?
•The implementation of a brief and debrief utilizing a
safety checklist was implemented to enhance and
encourage communication among the perioperative
team to ensure a safe and quality perioperative
encounter.
•An eight question survey tool was first utilized to
measure communication and team work in the operating
room. (Makary et al., 2007).
•This data suggests the significance of teamwork and safety
education for health care team members who are in training
programs, such as surgical residents. Further education among
the disciplines may provide insights in how best to approach
implementation of strategies for team building and patient safety.
Cvetic, E. (2011). Communication in the perioperative setting. AORN, 94(3), 261-270.
doi:10.1016/j.aorn.2011.01.017
Makary, M. A., Mukherjee, A., Sexton, J. B., Syin, D., Goodrich, E., Hartmann, E.,...Pronovost, P. J. (2007).
Operating room briefings and wrong-site surgery. Journal American College of Surgeons, 204(2), 236-243.
doi:10.1016/j.jamcollsurg.2006.10.018
•The implementation of the brief and debrief initiative
appears to have had an overall positive impact upon the
perception of teamwork and communication in the perioperative
setting.
• A 35% improvement in wound classification accuracy was
noted immediately during dissemination of the project. This
metric directly reflects accuracy in communication
among the team and supports quality in perioperative care
practices by ensuring appropriate interventions are implemented
which impact length of stay and post operative outcomes.