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INTRODUCTION

“We are all invited to work together for peace. We shall join hands and minds to work for peace through active nonviolence.

We shall help one another, encourage one another and learn from one another how to bring peace to our children and to all.”

–Mairead Corrigan Maguire

OBJECTIVES

  • Cover debriefing after an aggressive episode

  • Find out how to report and document a de-escalation encounter

After any de-escalation event, when things have calmed down, it’s important to conduct a debrief with both the patient and other staff, and to report and document the incident. This helps reduce the chances of it being repeated.

DEBRIEFING WITH THE PATIENT AND STAFF

Debriefing is defined as an official questioning session after an event—an interview in which the patient, nurse, and any other staff present for the de-escalation event are asked about and asked to report on the incident. The process of the debriefing is documented and becomes part of the electronic health record.

Debriefing is not a choice. Debriefing is a Joint Commission (JC) mandated process for all mental health facilities (2019). The JC requires every facility to have written policies and procedures for debriefing. In best practice applications, mental health facilities debrief after every behavioral emergency code (silent or called). Debriefs are also completed after every assault. Finally, debriefs are required after every use of four-point behavioral restraints (on all four extremities)—whether in a mental health facility or a medical facility (including the emergency department). Debriefings must occur within a specific timeframe. The JC allows 24 hours to complete a debriefing. The JC reviews debriefing documentation during annual surveys for accuracy and completion.

A debriefing session is a powerful opportunity for everyone involved in a crisis—including the patient—to examine and share feelings and perceptions about the incident. Patients and staff alike are encouraged to speak about what occurred and to talk about how they feel about what happened. Reviewing the traumatic experience in this way allows those involved to process it and helps to mitigate any damage that might result from the event (Kaplan, Iancu, & Bodner, 2001). Debriefings also offer an opportunity to review clinical data, revise the patient’s treatment plan, and identify opportunities for performance improvement.

NOTE

The inclusion of the patient’s perspective in any debriefing is critical.

Debriefing is a teaching moment. It demonstrates how to work with individuals who are engaging in inappropriate behaviors to help them identify what those behaviors are and to problem-solve and identify how to do something better and differently. The goal of any debriefing is to prevent problems rather than place blame. The debriefing should focus on addressing what can be learned from the incident and how staff and patients can use that knowledge to prevent it from happening again. It provides an opportunity to review techniques used ...

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