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When caring hurts; helping helpers heal
The document discusses the concept of 'second victims,' referring to healthcare providers who experience emotional trauma as a result of adverse patient events. It highlights the prevalence of psychological distress among these providers and emphasizes the need for support programs that promote psychological well-being and resilience in healthcare settings. The RISE (Resilience in Stressful Events) program is presented as a model for delivering peer support to affected healthcare workers, aimed at mitigating the impact of such traumatic experiences.
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When caring hurts; helping helpers heal
- 1. When caring hurts; helpinghelpers heal Dr. Katrina Hurley Dr. Bruce MacLeod Dr. Verna Yiu Dr. Albert Wu
- 2. Do youhave 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 youpartner 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 Qualityand 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 endstate; – 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 modelfor providing Services Awareness and Organizational Communication Educational Efforts Promotion and Prevention
- 10. 10 Can you helpyour providers and help us? Michael.Sidra@albertahealthservices.ca
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- 12. Do youthink the AHS Principles are comprehensive enough to provide support for a psychologically healthy culture?
- 13. Dr. Verna Yiu VicePresident, Quality and Chief Medical Officer Alberta Health Services
- 14. When Caring Hurts HelpingHelpers 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.
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- 18. Second Victim • Ahealth 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 StressDisorder (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 diedof dehydration and misused narcotics”
- 22. Josie died ofsepsis and resulting dehydration
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- 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-envisioningthe Sentinel Event
- 29. 29 Cheryl Connors, RN MattNorvell, 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
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- 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 FirstAid (Johns Hopkins Center for Public Health Preparedness) Reflective Listening Assessment of Needs Prioritization Intervention Disposition
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- 37. RISE Program: Continuumof Support Treatment Psychotherapy, Psychotropic meds On-going Counseling Psychological 1st AID Colleagues, TrainedPeers
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- 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 MarylandPatient SafetyCenter in collaboration with The JohnsHopkins Hospital RISE Program
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- 43. ABOUT THE RISETOOLKIT ©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
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- 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 youthink 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
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- 53. Please takea minute to fill-out the evaluation. Thank You!