When caring hurts; helping helpers heal

When caring hurts;

helping helpers heal

Dr. Katrina Hurley Dr. Bruce MacLeod Dr. Verna Yiu Dr. Albert Wu

Do you have a formal program available to

support healthcare providers involved in a

Patient Safety Incident?

Dr. Katrina Hurley, MD, FRCPC, MHI, Emergency

Physician, IWK Health Centre

“As a physician and parent I have made lots

of mistakes! Although I would not consider

myself an ‘expert’ in mistakes, I have

ruminated about it enough to provide

perspective on the impact to health care

practitioners.”

Do you partner with healthcare providers, in

your organization, who are willing to share

their stories of being involved in a Patient

Safety Incident?

Second Victim / Caring for Our Own

6

The Experience

Psycho-social Physical

• Concentration difficulties

• Loss of confidence

• Frustration, anger, depression

• Excessive excitability

• Disabling anxiety

• Second-guessing career

• Headaches

• Sleep disturbance

• Extreme fatigue/exhaustion

• Hypertension

• Nausea, vomiting, diarrhea

• Personality change

7

Psychology

and Spiritual

Care

Health

Promotion

Workplace

Health and

Safety

Quality and

Patient Safety

Learning

Emergency

Disaster

Management

Palliative and

End of Life

Care

Human

Resources

Physicians Patient Safety

Employee and

Family

Assistance

Initiative Background

• Multidisciplinary team assembled

8

• Desired end state;

– To develop, resource and promote a culture

that fosters psychological well-being.

Principles and Supports Framework

9

Principles & Supports Framework

Psychologically healthy Culture

Inclusiveness

Access

Established model for providing Services

Awareness and Organizational

Communication

Educational Efforts

Promotion and

Prevention

10

Can you help your providers and help us?

Michael.Sidra@albertahealthservices.ca

11

Thank You!

Do you think the AHS Principles are

comprehensive enough to provide support

for a psychologically healthy culture?

Dr. Verna Yiu

Vice President, Quality and Chief Medical Officer

Alberta Health Services

When Caring Hurts

Helping Helpers Heal

Albert Wu, MD, MPH

Professor of Health Policy &

Management and Medicine

Financial Disclosures/Unapproved Use

• I have financial relationships with a commercial entity that is

relevant to the content of this presentation

– Maryland Patient Safety Center (grant funding)

– Josie King Foundation (grant funding)

• I will not reference unlabeled or unapproved uses of drugs or

other products.

Case Study

16

BMJ 2000

Second Victim

• A health care provider involved in an unanticipated adverse patient event and/or medical error who is traumatized by the event

Short Term Symptom (Days – Weeks)

• Numbness, Confusion

• Detachment / Depersonalization

• Grief, depression, anxiety

• Withdrawal, agitation, sleep disturbance

• Re-experiencing of the event

• Physical symptoms

• Shame / guilt / self doubt

• Impairment in functioning

Post Traumatic Stress Disorder (PTSD)

• Re-experiencing the original trauma through flashbacks, nightmares

• Avoidance of stimuli associated with the trauma

• Increased arousal: difficulty falling or staying asleep, anger, hypervigilance

• Symptoms lasting > one month

• “Josie died of dehydration and misused narcotics”

Josie died of sepsis and resulting dehydration

From Closing Ranks to…

…Under the Bus

• Good disclosure but poor follow through

• At expense of the feelings of health care workers?

Doing better but feeling worse

Prevalence

• Estimates 10-43% – Otolaryngologists – 10% (Lander 2006)

– Health professionals - 30% (Scott 2009)

– Medication errors – 43% (Wolf 2000)

– Health professionals – 50% (Edrees 2011)

Joint Commission: Re-envisioning the Sentinel Event

29

Cheryl Connors, RN

Matt Norvell, MDiv

Hanan Edrees, DrPh

Lori Paine, RN

Henry Taylor, MD

George Everly, PhD

R.I.S.E. Resilience In Stressful Events

Pager: 410-283-3953

“Provide timely support to employees who encounter stressful, patient-related events”

The RISE Team - Mission

“To provide timely peer support to

any employee who encounters a stressful,

patient-related event”

Psychological First Aid

• Compassionate, supportive practical assistance to individuals recently exposed to serious stressors

• Involves non-intrusive, practical care and support – Assessing needs and concerns

– Listening, but not pressuring people to talk

– Comforting people and helping them to feel calm

– Helping people Link to information, services and social supports

Continuum of Care

• VOLUNTARY

• Peers: Managers, nurse leaders, pastoral care, social

workers, physicians, surgeons, respiratory therapists,

pharmacy etc…

• Seek recruitment via organizational leaders

Pager: 410-283-3953

RISE Team Membership

RAPID Psychological First Aid

(Johns Hopkins Center for Public Health Preparedness)

Reflective Listening

Assessment of Needs

Prioritization

Intervention

Disposition

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RISE Program: Continuum of Support

Treatment

Psychotherapy, Psychotropic meds

On-going Counseling

Psychological 1st AID

Colleagues, Trained Peers

38

RISE Services

• Non-judgmental, safe, peer-to-peer support for employees

who have experienced a stressful patient related event

• No investigation

• No report back to a supervisor

• 24/7

• One to one or group support

Pager: 410-283-3953

Presented by Maryland Patient Safety Center in collaboration

with The Johns Hopkins Hospital RISE Program

RISE Implementation Roadmap: begin

ABOUT THE RISE TOOLKIT

©2014 The Johns Hopkins University, The Johns Hopkins Hospital, and The Johns Hopkins Health System

All rights reserved.

Caring for the Caregiver: Peer Responder Training

RISE Toolkit Overview The “Peer Support for Caregivers in Distress: Implementing RISE” toolkit was designed to help health care organizations integrate peer support into their own unique environments. This toolkit is based on the RISE (Resilience In Stressful Events) program that was developed and implemented successfully at The Johns Hopkins Hospital. The RISE program offers free, confidential, and timely peer support to any employee who may have encountered a stressful, patient-related event. Prior to receiving the RISE toolkit, you may have reviewed the RISE Toolkit Preview. The preview offered a free introduction and was designed to provide an overview of the process for implementing a RISE program.

The RISE toolkit will guide you through all of the steps necessary to ensure a successful development and launch. There are five modules in the toolkit that walk you through essential phases of implementation: • Module 1: Define the Problem, page 7 • Module 2: Design the Plan, page 27 • Module 3: Develop Your RISE Peer Responder Team, page 58 • Module 4: Rollout RISE, page 83 • Module 5: Sustain Peer Responders and Measure Success, page 106 This toolkit includes content, tools, resources, and information about follow-up support that can be customized to meet your specific

organizational needs.

Summary

• Second Victim: health care worker who suffers emotional

trauma from a patient adverse event

• When patients are seriously harmed by health care, there are

always “Second Victims”

• Extent of problem is large

• Individuals and organizations can increase awareness,

increase resilience and provide psychological first aid

44

Questions?

45

www.josieking.org

47

References

Wu, AW. Medical Error: The Second Victim. The Doctor Who Makes the

Mistake Needs Help Too. BMJ 2000 320:726-727.

Pratt S, Kenney L, Scott SD, Wu AW. How to develop a second victim suppor

program: a toolkit for health care organizations. Jt Comm J Qual Patient

Saf.2012 May;38(5):235-40,

Wu AW, Steckelberg RC. Medical error, incident investigation and the second

victim: doing better but feeling worse? BMJ Qual Saf. 2012 Apr;21(4):267-70

Scott SD, Hirschinger LE, Cox KR, McCoig M, Hahn-Cover K, Epperly KM,

Phillips EC, Hall LW. Caring for our own: deploying a systemwide second

victim rapid response team. Jt Comm J Qual Patient Saf. 2010

May;36(5):233-40.

Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. The natural

history of recovery for the healthcare provider "second victim" after adverse

patient events. Qual Saf Health Care. 2009 Oct;18(5):325-30.

Seys D, Scott S, Wu A, Van Gerven E, Vleugels A, Euwema M, Panella M,

Conway J, Sermeus W, Vanhaecht K. Supporting involved health care

professionals (second victims) following an adverse health event: a literature

review. Int J Nurs Stud. 2013 May;50(5):678-87.

Contact

Albert Wu, MD, MPH

awu@jhu.edu

@withyoudrwu

Do you think healthcare providers feel safer

discussing their involvement with a patient

safety incident today than when Dr. Wu first

started researching this topic in the 1990s?

51

Registration opens May 6, 2015

Please take a minute to fill-out the

evaluation.

Thank You!