NTWC(C) 13

Appendix 2

Full Debrief

Name of chair
Date of incident
Date today
People present for debrief
If anyone is unable to attend the debrief in person (patient, staff, observers, agency, bank and response staff) please ensure they have provided an account
Supportive documents

Has a treatment environment been created where conflict is minimised?

This relates to the knowledge and skills of the staff present, the treatment environment, the availability of prevention tools, risk assessments and safety planning, comfort and sensory rooms etc.

Was the environment calm and welcoming
Was there anyone present who had a strong relationship with the patient
Did the patient witness a S/R or other upsetting event?
What were the trigger(s)?
Do we have a good enough understanding / formulation of the person’s triggers?
Did something in the environment create a traumatic re-enactment?
Did the change in behaviour occur during the shift or before?
Did the individual want something before the event?

Could the trigger for conflict have been avoided?

Was a safety plan done?
Did the individual receive a phone call or visit (or lack of) that might have caused escalation?
Was the individual worried about something?
Did the individual have to wait an unreasonable amount of time for something they wanted?
Did the individual indicate they needed help, attention or assistance beforehand?
Was the individual ignored, treated rudely, shamed, humiliated or consequence for some behaviour?
Is the individual taking medication – at therapeutic level – side effects?
Were there signs and symptoms of mental illness?

Did staff notice and respond to events in a timely manner?

Behavioural changes should be seen as attempts at communication that require an immediate and respectful response.

Who responded and when?
Was there any warning that the individual was upset?
What were the first signs and who noted them?
If signs were missed, why was this?
Should the individual’s observations have been higher?

Did staff choose an effective intervention?

This section addresses the knowledge and competencies staff in relation to identifying an appropriate and least restrictive approach to escalating behaviour and then implementing the approach directly and immediately. This ability requires training, modelling and practice. The culture at Alnwood needs to empower staff to be creative and to, at times, break unit rules to avoid the need for S/R when it is safe to do so… the notion that ‘rule breaking will lead to chaos’ is generally not the reality.

What intervention was tried first and by whom?
Why was the technique chosen?
Did anything get in the way of the intervention?
Was the intervention delayed for any reason?
How did the person respond to it?
What was the individual’s emotional state at the time?
What was the staff’s emotional state at the time?
What else could have been tried but was not?
Why not?
If the intervention was unsuccessful was another chosen (repeat questions above for new intervention)

Did staff carry out S/R only in response to immediate danger?

The purpose of this section is to ascertain whether S/R was implemented prematurely, i.e. when the individual still had control and could be engaged. This section may also identify where individuals are restrained or secluded every time they hit someone or throw something in an unthinking / routine way. Care must be taken to assure staff that they are free to respond if they feel they are in danger and that unnecessary restrictive responses will be addressed through training and supervision first.

What was the exact behaviour that warranted S/R?
Did it meet the threshold of imminent danger (what would have happened if S/R was not used)?
Who made the decision and why?

Was S/R applied safely?

How was S/R applied and did it follow policy and safety precautions?
Were enough staff available to assist?
Did a professional nurse provide oversight of the event?

Was the individual released ASAP?

Individuals who are in seclusion or restraint should not have to ‘jump through hoops’ to prove they can be released. Once they have regained control S/R should cease. NB individuals who have histories of intentional violence do need to be carefully assessed.

When was the individual released?
Who made the decision and what was it based on?
Was the policy followed?
Could the individual have been released earlier?
Was the release too soon and why?
What were the documented release criteria; were they appropriate?

Did post-event activities occur?

Were peer support workers or advocates involved in the debriefing process? (if not, why not?)

Did learning occur and was it integrated into the treatment plan and practice?

Debriefing can be measured by the learning that occurs and the changes, revisions, additions and deletions that can be tracked in operational procedures and individual care plans.

What was learnt about the S/R event in the debriefing process?
Did this inform policy, practice, procedures, rules, the treatment plan, staff training and education?
Did staff require training / education or counselling?

Action plan

What / Who / When / System check (COGG, CTM…)

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NTW(C)13Positive and Safe Management of Post incident Support and DebriefV01-Jan18

Appendix 2 – Full Debrief