7.5.23 ME M.L. Debrief
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Arizona Western College *
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Course
BIO-299
Subject
Health Science
Date
Jan 9, 2024
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Pages
2
Uploaded by RustyShackleford007
Attachment (B) MEMORANDUM Date: 5 July 2023 @ 1308 From: Sarah Lerczak NOD Subj: Medical Emergency Rapid Response
Behavioral Emergency To: Emergency Services Committee (MS) / Disruptive Behavior Committee (MH) This memorandum serves as a debriefing
summary
of a Medical / Behavioral Emergency Response at the Tomah VAMC. The following is to be completed by the Nurse of the Day (NOD) / Designee present at the scene immediately following the emergency / response. Criteria for completing this form: Medical Emergency
–
Behavioral Emergency - 1.
Patient’s Name: Michael Leisgang (34) 0268 2.
Location of Emergency: 402 PT/OT Registration desk 3.
Date/Time of Emergency: 5 July 2023 @ 1308 4.
Inpatient / Outpatient: Outpatient 5.
Time Debriefing Started: via TEAMs as NOD was assisting Veteran to UC. 6.
What went well during the Emergency situation? Everyone responded quickly. 7. What did not go well? NA 8. How do you all feel it went? Good 9. Were there any concerns that precipitated the event? No 10. Was anyone confused by the events that took place during the emergency? No 11. What improvements would you suggest? No new recommendations noted. 12. Any additional concerns that you would like addressed? No 13. Did anyone do an outstanding job? NA 14. Did you have the necessary tools to complete the event at a full performance level? Yes 15. Did you know who was in charge of the Emergency Situation? Yes 16. Provider in Charge of Emergency: Dr. McConnell 17. Staff involved during the emergency: Please see Rapid Response Memo X
18. Recommendations from you or the response team: No new recommendation noted. 19. Is there anyone that would benefit from further support such as EAP? NA 20. Does anyone have any questions on documenting the event? No ______ Sarah Lerczk BSN, NOD___
Printed Name of staff completing memo Signature/Title of staff completing memo
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