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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
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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
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• Desired end state;
– To develop, resource and promote a culture
that fosters psychological well-being.
Principles and Supports Framework
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Principles & Supports Framework
Psychologically healthy Culture
Inclusiveness
Access
Established model for providing Services
Awareness and Organizational
Communication
Educational Efforts
Promotion and
Prevention
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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
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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
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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
@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!
