Objective Introduce principles and review strategies for supporting healthcare professionals impacted by adverse patient safety events. By the end of the session the participant will be able to: 1.Relate to the impact of a patient safety adverse event on the provider, based on a personal story provided by a healthcare professional. 2.Describe the potential impact of traumatic experiences on the health and well-being of healthcare professionals. 3.Identify key elements of an effective program for supporting caregiver coping with adverse patient safety events. 4.Explain how a just culture promotes peer to peer support of the second victim. WATCH: http://bit.ly/1HxceIf

1. When caring hurts;
helping helpers heal
Dr. Katrina Hurley Dr. Bruce MacLeod Dr. Verna Yiu Dr. Albert Wu

2.  Do you have a formal program available to
support healthcare providers involved in a
Patient Safety Incident?

3. 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.”

4.  Do you partner with healthcare providers, in
your organization, who are willing to share
their stories of being involved in a Patient
Safety Incident?

5. Second Victim / Caring for Our Own

6. 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. 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. 8
• Desired end state;
– To develop, resource and promote a culture
that fosters psychological well-being.
Principles and Supports Framework

9. 9
Principles
& Supports
Framework
Psychologically
healthy Culture
Inclusiveness
Access
Established
model for
providing
Services
Awareness and
Organizational
Communication
Educational
Efforts
Promotion
and
Prevention

10. 10
Can you help your providers and help us?
Michael.Sidra@albertahealthservices.ca

11. 11
Thank You!

12.  Do you think the AHS Principles are
comprehensive enough to provide support
for a psychologically healthy culture?

13. Dr. Verna Yiu
Vice President, Quality and Chief Medical Officer
Alberta Health Services

14. When Caring Hurts
Helping Helpers Heal
Albert Wu, MD, MPH
Professorof Health Policy &
Management and Medicine

15. 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.

16. Case Study
16

17. BMJ 2000

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

19. 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

20. 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
• Symptomslasting > one month

21. • “Josie died of dehydration
and misused narcotics”

22. Josie died of sepsis and resulting dehydration

23. From Closing Ranks to…

24. …Under the Bus
• Good disclosure but poor follow
through
• At expense of the feelings of
health care workers?
Doing better but feeling worse

25. Prevalence
• Estimates 10-43%
– Otolaryngologists – 10% (Lander 2006)
– Health professionals - 30% (Scott 2009)
– Medication errors – 43% (Wolf 2000)
– Health professionals – 50% (Edrees 2011)

27. Joint Commission: Re-envisioning the Sentinel Event

29. 29
Cheryl Connors, RN
Matt Norvell, MDiv
Hanan Edrees, DrPh
Lori Paine, RN
Henry Taylor, MD
George Everly, PhD

30. R.I.S.E.
Resilience In Stressful
Events
Pager: 410-283-3953
“Provide timely support to employees who encounter
stressful, patient-related events”

31. The RISE Team - Mission
“To provide timely peer support to
any employee who encounters a stressful,
patient-related event”

32. 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

33. Continuum of Care

34. • 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

35. RAPID Psychological First Aid
(Johns Hopkins Center for Public Health Preparedness)
Reflective Listening
Assessment of Needs
Prioritization
Intervention
Disposition

36. 36

37. RISE Program: Continuum of Support
Treatment
Psychotherapy, Psychotropic
meds
On-going Counseling
Psychological 1st AID
Colleagues, TrainedPeers

38. 38

39. 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

40. Presented by Maryland Patient SafetyCenter in collaboration
with The JohnsHopkins Hospital RISE Program

41. RISE Implementation Roadmap: begin

43. ABOUT THE RISE TOOLKIT
©2014 The Johns Hopkins University, The Johns Hopkins Hospital, and The Johns Hopkins HealthSystem
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 offereda 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.

44. 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

45. Questions?
45

46. www.josieking.org

47. 47

49. 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.

50. Contact
Albert Wu, MD, MPH
awu@jhu.edu
@withyoudrwu

51.  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

52. Registrationopens May 6, 2015

53.  Please take a minute to fill-out the
evaluation.
Thank You!