Second victim response: How to be first responders to second victims
4/27/2015 Second victim response: How to be first responders to second victims Overview • Define the term second victim • Understand recovery stages of a second victim • Discuss the Scott Three-Tiered Interventional Model of Second Victim Support Lois Stepney, MSW, LISW-S Critical Incident Coordinator and “Team Coordinator” for the NCH Second Victim Peer Support Program ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. Mindfulness Activity Captain Sully – Flight 1549 • • • • • ………………..…………………………………………………………………………………………………………………………………….. “Miracle on the Hudson” Impact on flight crew Lessons learned Recognize emotional toll Identify second victims ………………..…………………………………………………………………………………………………………………………………….. Stiegler MP. What I learned about adverse events from Captain Sully. JAMA. 2015. If an Error Occurs • Take care of the patient! • Use any available resources to help care for the patient • Are any other patients affected? • Follow policy/procedure for notifying the patient/family/prescriber • Take care of the second victim! ………………..…………………………………………………………………………………………………………………………………….. Definition Second victim – “Those who suffer emotionally when the care they provide leads to patient harm” ………………..…………………………………………………………………………………………………………………………………….. Wu AW. BMJ. 2000. 1 4/27/2015 Definition Can you think of a second victim example? Second victim – “Health care provider involved in an unanticipated adverse patient event, medical error and/or a patient-related injury who becomes victimized in the sense that the provider is traumatized by the event.” ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Joint Commission Journ on Quality and Pt Safety. 2010. Suffering of Second Victims • Second victims suffer “a medical emergency equivalent to post-traumatic stress disorder (PTSD)” Statistics • Suicidal ideation associated with a medical error – 501 (6.3%) of 7,905 surgeons – Twice the rate of general population • Significant impact on personal life • “The instant patient harm occurs, the involved practitioner also becomes a patient of the organization – a patient who will often be neglected.” – 368 (28%) of 1,294 physicians involved in an adverse drug event (ADE) – 17% impacted personal life • Need for emotional support after patient’s death – 100% of 74 pediatricians ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. Shanafelt TD, et al. Arch Surg. 2011. ISMP Medication Safety Alert. July 2011. Ashland OG, Forde R. Qual Saf Health Care. 2005. Khaneja S, Milrod B. Arch Pediatr Adolesc Med. 1998. Second Victim • • • • Nurse suicide due to medication error Mathematical error that led to death of infant 27 years of service as an RN After error occurred – – – – RN was terminated from job Fine had to be paid 4 year probation to administer meds Isolation and lack of support Second Victim • Eric Cropp had 8 years experience with IV admixtures • Overdose of sodium chloride led to death of child • Stood before both the State Board of Pharmacy and the Cuyahoga County district court ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. ISMP Medication Safety Alert. July 2011. ISMP Medication Safety Alert. December 2009. 2 4/27/2015 Second Victim • State Board of Pharmacy – Permanently revoked license Rapid Response System • Cuyahoga County District Court – – – – – 6 months of imprisonment 6 months of home confinement 3 years of probation 400 hours of community service $5,000 fine The Natural History of Recovery for the Healthcare Provider “Second Victim” after Adverse Patient Events Caring for Our Own: Developing a System wide Second Victim Rapid Response Team ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. ISMP Medication Safety Alert. December 2009. How they got there… • • • • University of Missouri Health Care (UMHC) 5,300 faculty, staff, students and volunteers Transformation of safety culture began in 2000 Second victim program initiation 2006 • Aim Second Victim Research • 31 health care providers were interviewed • Goal of interviews - to understand suffering experience & elicit specific healing interventions • 6 distinct recovery stages were determined (initial chaos through moving on) – Understanding second victim experience to define effective support structures in a rapid response system (RRS) ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Qual Saf Health Care. 2009. Second Victim Recovery Trajectory Chaos & Accident Response Intrusive Reflections Restoring Personal Integrity Impact Realization Enduring the Inquisition Obtaining Emotional First Aid Moving On Surviving Defining Support Needs • Remove individual right after event before resuming patient care • Formal support provided by institution (preferably at department unit level) • Support network readily accessible and easy access to trained counselors Dropping out ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Qual Saf Health Care. 2009. 3 4/27/2015 Defining Support Needs ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Joint Commission Journ on Quality and Pt Safety. 2010. Second Victim Interventions The Scott Three-Tiered Interventional Model of Second Victim Support Second Victim Interventions The Scott Three-Tiered Interventional Model of Second Victim Support Established Referral Network with • Employee Assistance Program • Chaplain • Social Work • Clinical Psychologist *Ensure availability and expedite access to prompt professional support/guidance* Tier 3 Expedited Referral Network Tier 2 - Risk Management - Patient Safety Team - Trained Peer Supporters Tier 3 Expedited Referral Network Trained peer supporters and support individuals, such as patient safety team, leads, or risk managers who provide one on one crisis intervention, peer supporter mentoring, team debriefings & support through investigation and potential litigation Department/Unit support from manager, supervisor, or coworker who provides one-on-one reassurance to the second victim. Tier 1 Local (Unit/Department) Support ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Joint Commission Journ on Quality and Pt Safety. 2010. Established Referral Network with • Employee Assistance Program • Chaplain • Social Work • Clinical Psychologist *Ensure availability and expedite access to prompt professional support/guidance* Tier 2 - Risk Management - Patient Safety Team - Trained Peer Supporters Trained peer supporters and support individuals, such as patient safety team, leads, or risk managers who provide one on one crisis intervention, peer supporter mentoring, team debriefings & support through investigation and potential litigation Tier 1 Local (Unit/Department) Support Department/Unit support from manager, supervisor, or coworker who provides one-on-one reassurance to the second victim. ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Joint Commission Journ on Quality and Pt Safety. 2010. Identifying a Second Victim Physical ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Joint Commission Journ on Quality and Pt Safety. 2010. Cognitive Emotional Behavioral Rapid heart rate Confusion Fear Crying Profuse sweating Disorientation Guilt Yelling/Screaming Wide, dilated eyes Poor concentration Shock Silence Tense posture Inattention Panic Withdrawal Quick/shallow breathing Inability to recall event Depression Pacing Nausea Agitation Hollow glare Fatigue Intense anger Agitated movement Anxiousness Retarded movement ………………..…………………………………………………………………………………………………………………………………….. What should I say? • Do say – Are you OK? – What do you need? – How do you feel about what happened? • Do NOT say – Everything will be OK – Don’t worry about it ………………..…………………………………………………………………………………………………………………………………….. 4 4/27/2015 Second Victim Interventions The Scott Three-Tiered Interventional Model of Second Victim Support Tier 3 Expedited Referral Network Second Victim Interventions The Scott Three-Tiered Interventional Model of Second Victim Support Established Referral Network with • Employee Assistance Program • Chaplain • Social Work • Clinical Psychologist *Ensure availability and expedite access to prompt professional support/guidance* Tier 2 - Risk Management - Patient Safety Team - Trained Peer Supporters Tier 3 Expedited Referral Network Trained peer supporters and support individuals, such as patient safety team, leads, or risk managers who provide one on one crisis intervention, peer supporter mentoring, team debriefings & support through investigation and potential litigation Tier 2 - Risk Management - Patient Safety Team - Trained Peer Supporters Department/Unit support from manager, supervisor, or coworker who provides one-on-one reassurance to the second victim. Tier 1 Local (Unit/Department) Support ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Joint Commission Journ on Quality and Pt Safety. 2010. Established Referral Network with • Employee Assistance Program • Chaplain • Social Work • Clinical Psychologist *Ensure availability and expedite access to prompt professional support/guidance* Trained peer supporters and support individuals, such as patient safety team, leads, or risk managers who provide one on one crisis intervention, peer supporter mentoring, team debriefings & support through investigation and potential litigation Department/Unit support from manager, supervisor, or coworker who provides one-on-one reassurance to the second victim. Tier 1 Local (Unit/Department) Support ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Joint Commission Journ on Quality and Pt Safety. 2010. Tier 2 Trained Peer Supporters are taught to: Second Victim Interventions The Scott Three-Tiered Interventional Model of Second Victim Support Tier 3 Expedited Referral Network Established Referral Network with • Employee Assistance Program • Chaplain • Social Work • Clinical Psychologist *Ensure availability and expedite access to prompt professional support/guidance* Tier 2 - Risk Management - Patient Safety Team - Trained Peer Supporters Trained peer supporters and support individuals, such as patient safety team, leads, or risk managers who provide one on one crisis intervention, peer supporter mentoring, team debriefings & support through investigation and potential litigation Department/Unit support from manager, supervisor, or coworker who provides one-on-one reassurance to the second victim. Tier 1 Local (Unit/Department) Support ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. Scott, S. Joint Commission Journ on Quality and Pt Safety. 2010. Second Victim Interventions The Scott Three-Tiered Interventional Model of Second Victim Support Tier 3 Expedited Referral Network Second Victim Conceptual Model Thriving Established Referral Network with • Employee Assistance Program • Chaplain • Social Work • Clinical Psychologist *Ensure availability and expedite access to prompt professional support/guidance* Tier 2 - Risk Management - Patient Safety Team - Trained Peer Supporters Tier 1 Local (Unit/Department) Support Trained peer supporters and support individuals such as patient safety team, leads, or risk managers who provide one on one crisis intervention, peer supporter mentoring, team debriefings & support through investigation and potential litigation Department/Unit support from manager, supervisor, or coworker who provide one-on-one reassurance to the second victim. ………………..…………………………………………………………………………………………………………………………………….. Unanticipated Clinical Event Second Victim Reaction Psychosocial Physical Institutional Response Clinician Support Clinician Recovery Surviving Dropping Out Tier 3 Tier 2 Tier 1 Comprehensive Tiered Support Interventions ………………..…………………………………………………………………………………………………………………………………….. 5 4/27/2015 NCH Pharmacy Statistics • Survey sent to ~180 pharmacy staff • Out of 120 surveys returned Starting a second victim program – 81.9% heard of the term second victim – 30% experienced personal problems within the past 12 months as a result of a clinical patient safety event (anxiety, depression, concerns about ability to perform job) – 13.3% contemplated leaving NCH and/or their profession ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. Pharmacy Survey Results Everything Matters… including YOU! Do you feel the department of pharmacy would benefit from a program to support second victims ? 6.7% Yes No 93.3% • YOU Matter team will provide 24-hr support to second victims, 7 days a week • Second victim – health care team member who is traumatized by an unanticipated patient event or stressful situation • YOU Matter team has been created to: • Increase awareness of the second victim phenomenon • Deliver system-wide guidance & support of second victims • Provide additional resources to effectively support staff ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. YOU Matter Team Operationalize the Program • Consists of – – – – – – Physicians Nurses Pharmacists Social workers Respiratory therapists Other allied health team members • Expected to use three-tiered model to facilitate second victims transition through 6 stages of emotional recovery ………………..…………………………………………………………………………………………………………………………………….. • Key elements of putting second victim program into motion – – – – – Identify core team Build central portal to share all information Schedule meetings regularly Define roles and responsibilities Present idea at various committees, education days, etc. to gain support from leadership – Involve marketing – Conduct training sessions ………………..…………………………………………………………………………………………………………………………………….. 6 4/27/2015 Director of QIS Executive Sponsor Program Director Team Coordinator Outpatient Clinics Spring/Summer 2015 May 2014 June 2014 – January 2015 Inpatient Leads Outpatient Leads Core Team Emergency Department Leads Onsite and offsite NICU go live 2015 *Research project* March 2014 Perioperative Leads November 2013 Pharmacy Lead Neonatology Leads ………………..…………………………………………………………………………………………………………………………………….. Peer Supporters Peer Supporters Peer Supporters Peer Supporters Peer Supporters Peer Supporters Peer Encounter Forms ………………..…………………………………………………………………………………………………………………………………….. Badge Buddies Badge Buddies ………………..…………………………………………………………………………………………………………………………………….. Contacting YOU Matter Team • YOU Matter phone number – ext. 25005 • E-mail support group “Second Victim Peer Support” • Peer e-mail groups ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. 7 4/27/2015 Involve Marketing! ………………..…………………………………………………………………………………………………………………………………….. Digital Quality Boards ………………..…………………………………………………………………………………………………………………………………….. Current Statistics 14 members on CORE steering committee 152 peer encounter forms submitted 245 Trained Peer Supporters 30 leads identified 8 group encounter forms submitted ………………..…………………………………………………………………………………………………………………………………….. Updated April 2015 Percent of Peer Supporters by Discipline Percent of Peer Encounters by Location November 2013 - January 2015 n=200 November 2013 - January 2015 3% 2% 4% 2% 3% 5% 6% RN/LPN 3% 3% MD 4% 1% 10% Social Work 5% 6% 3% ED PCA Pharmacy Other Other PICU Pharmacist APN/NP 6% RT CTICU 12% OR/Surgery Homecare Medical Resident 55% 6% Behavioral Health Constant Attendant 64% Unit Coordinator 7% Administrative Support Pharmacy technician ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. 8 4/27/2015 Number of Second Victims by Discipline Types of Peer Encounters November 2013 - January 2015 Number of encounters 35 34 30 25 20 15 10 5 Patient death 24 19 Medication error 14 Alleged abuse 8 4 3 3 2 2 0 Cardiac Arrest Second victim response Multiple traumas Discipline ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. Survey Results from ED Future Directions 96% familiar with the term second victim 17% had spoken to a peer supporter 100% felt benefited from talking with a peer supporter • Conduct two peer supporter trainings per month • Implement second victim program hospital-wide by December 2015 • Determine effectiveness of second victim program 67% of staff are willing to utilize the program if needed ………………..…………………………………………………………………………………………………………………………………….. ………………..…………………………………………………………………………………………………………………………………….. In Conclusion • Healthcare providers face harsh realities • Large portion of healthcare providers suffer in silence References • • • • • • Healthcare institutions must provide support not only for patients, but for their employees as well • • • ………………..…………………………………………………………………………………………………………………………………….. Wu AW. Medical error: The second victim. The doctor who makes the mistake needs help too. BMJ. 2000;320(7237):726-727. Scott SD, et al. Caring for our own: Deploying a systemwide second victim rapid response team. Jt Comm J Qual Patient Saf. 2010;36(5):233-240 Scott SD, et al. The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Qual Saf Health Care. 2009;(18):325-330. Shanafelt TD, et al. Special report: Suicidal ideation among American surgeons. Arch Surg. 2011;146(1): p.54-62. Ashland OG, Forde R. Impact of feeling responsible for adverse events on doctors’ personal and professional lives: The importance of being open to criticism from colleagues. Qual Saf Health Care. 2005;14(1):13-17. Khaneja S, Milrod B. Educational needs among pediatricians regarding caring for terminally ill children. Arch Pediatr Adolesc Med. 1998;152(9):909-914. Denham C. TRUST: the 5 rights of the second victim. J Patient Saf. 2007;3(2):107119. Stiegler MP. What I learned about adverse events from Captain Sully. JAMA. 2015;313(4):361-362. ………………..…………………………………………………………………………………………………………………………………….. 9 4/27/2015 Second victim response: How to be first responders to second victims Jenna Merandi, PharmD, MS Jenna.Merandi@nationwidechildrens.org Medication Safety Coordinator ………………..…………………………………………………………………………………………………………………………………….. 10
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