Lipke A, Perez R. Taking a moment: Implementation of the pause initiative. Quality Improvement podium presentation at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.
Quality Improvement podium presentation at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.
Background: Following patient expiration during a medical code, the responders return to previous work assignments without opportunity to debrief, honor the patient or reflect on efforts provided. Lack of acknowledgement of human factors has the potential to create distress in providers and lead to increased risk of burnout. Facilitation of a reflective exercise is a best practice recommended for nurses to cope with a patient’s death.
Local Problem: This urban level-1 trauma center lacked a formalized process of debriefing and addressing the distress effecting providers after resuscitation efforts. Prior to February 2021, no formal debriefing consistently occurred after a Medical Code event.
Method: The intervention included a formal debrief for all Medical Codes and facilitation of a Pause in the event of patient expiration. The Pause included reading of the provided scripting paying homage to the patient and the team’s efforts. Buy-in was established with the Medical Executive team and key stakeholders. Education was provided to assist in implementation and sustainment of the process. Departments of focus were emergency, intensive care units, respiratory therapy, spiritual care, and medical/surgical residents. Surveys utilizing validated tools focusing on recent literature, were sent out pre-implementation, 6-month and 12-month post go-live. The 14-question survey focused on paying homage to the patient/team, responder distress/burnout and debriefing processes.
Results/Conclusions: The Pause was performed 44 times of 48 codes with expiration during the 12-month period. An increase in formal debriefing being performed more consistently post implementation was noted. Survey results demonstrated an increase from 9.2% to 32.1% in responders feeling the ability to pay homage to their patient, and organized debriefing allowed team members time to ground themselves after events. Of note, there was a decrease in response rate with each survey.
Implications for practice: The utilization of Pause and formal debriefing can improve culture surrounding Medical Code events as well as improve team member wellbeing.