1. MCIC Perioperative Initiative February 14, 2006 Operating Room Briefings

2. Briefing Defined A briefing is a discussion between two or more people, often a team, using succinct information pertinent to an upcoming event or procedure.

3. What a Briefing 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.

4. Briefings Enhance Situational Awareness Our ability to have the same understanding of what is occurring during the procedure, and to focus on: Preparation/ planning and vigilance Workload distribution Distraction Avoidance

5. Effective Briefings Sets the tone for the day…… organized and efficient versus chaotic 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 Predicts what will happen later Plans for the unexpected-Contingency Plan ( include equipment, medications, consults)

6. Communication Techniques Use names, make introductions. Make eye contact with all members of the team. Clear and concise language Active listening. Positive nonverbal-approachable, open.

7. When to Conduct Briefings Prior to any procedure. Beginning of the Day- Morning Briefing (separate tool) Situational – change in patient status results in deviation from the plan of care Reporting-off- breaks, shift change

8. Consider Briefings –Fatigue or Staffing Challenges –New or change in Team Members –Experienced and Novices working side-by-side –Cultural differences

9. The OR Briefing 1.Introduction of First names and Roles 2.TIME OUT- Review Critical Information Do we have the correct patient? Is the correct side or site marked? Has procedure been agreed upon? Have antibiotics been given?

10. Surface and Mitigate Hazards Nursing - Discuss all relevant issues : Are all the necessary instruments available? Will any specific equipment be considered/needed? Plans for break ( New nurse should introduce themselves upon switching)

11. Surface and Mitigate Hazards Surgery- Discuss plan for the surgical procedure: Describe critical steps Provide the team with pertinent information, including problems that may be encountered. Ask team: If something were to go wrong with this procedure, how could we prevent harm? Ask Team: Does everyone know how to use the equipment?

12. Surface and Mitigate Hazards Anesthesiology - Discuss all relevant issues : Patient comorbid disease that will increase risk. Aspects of surgery that increase that risk. Availability of Blood Products? Interventions to prevent complications such as myocardial infarction or surgical site infection.

13. END of Briefing Surgeon states: If anyone has a concern during the case, please let me know.

14. Briefing-Simplicity in Signing-out: The Tool: Why is this patient here? What are the key issues with this patient? What am I most worried about?

15. Tools for Team Use AM OR Suite Briefing –Structured tool to assist anesthesia coordinator and charge nurse to anticipate problems, increase efficiency and improve patient flow Debriefing Tool –Facilitates learning from factors that positively or negatively impacted complications or adverse events in a specific case Shadowing Tool –Provides structured approach to identify communication and collaboration patterns to be improved