the case for peer support programs in healthcare · 2014-03-25 · supporting our second victim...
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Supporting Our Second Victim Colleagues:Supporting Our Second Victim Colleagues:the Case for Peer Support Programs in Healthcare
Hanan Edrees, DrPH, MHSAHanan Edrees, DrPH, MHSAAssociate Faculty, Johns Hopkins Bloomberg School of Public Health, USA
Manager, Ministry of National Guard Health Affairs, Kingdom of Saudi Arabia
International Forum on Quality and Safety in HealthcareSingapore, September 2016
Kimberly HiattKimberly Hiatt
N f 24• Nurse for 24 years
• Seattle Children’s HospitalSeattle Children s Hospital
• Medication error (September 20 0)2010): – child 5 mo/patient dies– dispensed 1.4 grams of CaClp ginstead of 140 milligrams
• Dismissed from jobDismissed from job
What about ?What about….?
• What about the doctor who wrote this order?
• What about the pharmacist that approved this order?order?
• What about the process/system that set them up?
Kimberly Hiatt commits suicide after 7 months after th tthe event
http://www.nbcnews.com/id/43529641/ns/health‐health_care/t/nurses‐suicide‐highlights‐twin‐tragedies‐medical‐errors/http://www.dailymail.co.uk/news/article‐2008789/Nurse‐committed‐suicide‐medical‐blunder‐led‐death‐baby‐overdosed.html#ixzz2DSHiYVi3http://seattletimes.nwsource.com/html/localws/2014830569_nurse21m.html
ObjectivesObjectives
1. To describe the ‘second victim’ phenomenon & its impact on patient care
2. To list the objectives & goals of the Johns Hopkins RISE Program
3. To review study results on assessing the need for organizational second victim support programs among acute care hospitals
Objective #1:Objective #1:To describe the second victim phenomenon & its
impact on patient careimpact on patient care
Second VictimsSecond victims:
• Healthcare providers who are involved with a patient-related d di l d l iadverse event or medical error, and as a result, experience
emotional and sometimes physical distress• First victim: patients and families• Term coined by Dr Albert Wu: 2000• Term coined by Dr. Albert Wu: 2000
Second victims often• Feel personally responsible for the outcomeFeel personally responsible for the outcome• Feel as though they have failed the patient• Second guess their clinical skills and knowledge
Signs & symptoms• Similar to Post Traumatic Stress Disorder symptoms• Physical and psychological distress
N ti ti l• Negative emotional responses• Impaired performance
Signs & Symptoms of Second Victims
Short term: Long term:– Short term:• shock• helplessness• worry and depression
– Long term: (Indistinguishable from posttraumatic stress disorder)
• recurrent experience of the worry and depression• guilt and inadequacy• anger• poor concentration and
event• avoidance• emotional numbing
h i i f h lmemory• intrusive thoughts and nightmares
• sleep disturbance
• chronic signs of hyper‐arousal including sleep disturbance, irritability, poor concentration, diminished memory
• sleep disturbance• physical symptoms• social avoidance
• withdrawal and depression• social functioning can be impaired, and personal and professional relationships canprofessional relationships can suffer
Impact of Error on Second Victims and the O i iOrganization
1. Impact on the individualp• Clinical conditions
o Post‐Traumatic Stress Disorder (> 3 months)o Acute Stress Reaction (up to 1 month)o Acute Stress Reaction (up to 1 month)
• Stress Reactions & Distress
1. Impact on the organization and healthcare team
2. Management & treatment of psychological care2. Management & treatment of psychological care• Continuum of Care
Prevalence of Second VictimsStudy 1 Study 2 Study 3
Prevalence 10.4%1 30%2 43.3%3
Population otolaryngologists sample of medical students, physicians, and nurses
physicians, nurses, and pharmacists, and other healthcare professionals
Feelings/symptoms
described an error they were involved in during the past 6
personal problems related to anxiety, depression, and
the error had a moderately severe or severe harmful effect on
months challenges in their ability to provide care during the past 12 months
their personal lives
1 Lander, L. I., Connor, J. A., Shah, R. K., Kentala, E., Healy, G. B., & Roberson, D.W. (2006). “Otolaryngologists’ responses to errors and adverse events.” Laryngoscope,116, 1114–1120.
2 Scott, SD; Hirschinger, LE; Cox, K; et al. (2010). “Caring for Our Own: Deploying A Systemwide Second Victim Rapid Response Team.”
10
2 Scott, SD; Hirschinger, LE; Cox, K; et al. (2010). Caring for Our Own: Deploying A Systemwide Second Victim Rapid Response Team. Joint Commission Journal Quality Patient Safety, 36: 233‐240
3 Wolf, Z. R., Serembus, J. F., Smetzer, J., Cohen, H., & Cohen, M. (2000). Responses and concerns of healthcare providers to medication errors. Clinical Nurse Specialist,14: 278–287.
Limited studies on second victims
• Limited literature– Prevalence of second victims: 10.4% ‐ 43.3% – Studies on concept of second victims:
• Switzerland, Belgium, Sweden, Italy, the United Kingdom, and the United States
– Descriptions of organizational support programs– Little documentation of the steps involved in their d ldevelopment
– Limited resources for evaluating the feasibility and ff ti f theffectiveness of these programs
Wu, A. (2000). British Medical Journal
Examples of support interventions/programs
• Support programs for hospital workforce– Medically Induced Trauma Support Services (MITSS)y pp ( )– University of Missouri: forYOU program– Kaiser Permanente Program– Boston Children’s Hospital: The Office of Clinician Support (OCS)– Brigham and Women’s Hospital: The Center for Professionalism and
Peer Support (CPPS)pp ( )– Johns Hopkins Hospital: Resilience In Stressful Events (RISE)
Program
• Support for other psychological trauma– Psychological First Aid (PFA) & RAPID‐PFA– Critical Incidence Stress Management (CISM)– Support programs for the military
Objective #2:To list the objectives & goals of the Johns Hopkins
RISE Programg
The Johns Hopkins HospitalThe Johns Hopkins Hospital
• 1,075‐licensed bed, urban, academic medical center in the state of Maryland, USA
• Medical errors and adverse patient‐related events are inevitable– reported investigated and debriefed with staffreported, investigated and debriefed with staff
• Several events occurred…
• Hospital leadership created second victim taskforce to establish an organizational support program/service for
d i tisecond victims
Our Current InfrastructureOur Current Infrastructure
• Patient Safety & Quality Departments• Risk Management• Employee Assistance Program• Chaplain Services• Occupational Health• Human Resources
….. no clear pathway to help second victims cope with their emotions
Organizational Assessment
• Organizational survey was administered at 2nd Annual Johns Hopkins Patient Safety Summit in June 2010Johns Hopkins Patient Safety Summit in June 2010
• Results (n 140)• Results (n=140): – Two‐thirds reported experiencing emotional distress following an unanticipated adverse eventfollowing an unanticipated adverse event
– More than half had reached out for support from a peer or colleaguepeer or colleague
– The need for a peer support program to benefit second victims in the Hospitalsecond victims in the Hospital
Edrees HH, Paine LA, Feroli ER, Wu AW. (2011). Health care workers as second victims of medical errors. Pol Arch Med Wewn, 121(4): 101‐8.
RISE Team: Resiliency In Stressful Events
Mission:“To provide timely support to employees who encounter
stressful patient‐related events”
Objectives:
stressful, patient related events
Objectives:
1. Increase awareness of the “second victim” phenomenon2. Provide multi‐disciplinary, one‐to‐one or group, peer support in a non‐judgmental
environment3. Equip managers & employees with healthy coping strategies to promote well‐being4. Reassure & guide employees to continue thriving in their role
Developing the RISE programDeveloping the RISE program
Phase 1: Developing the RISE Team
Phase 2: Recruiting and training Peer Responders
Phase 3: Launching RISE pilot in Department of Pediatrics
Phase 4: Launching RISE hospital‐wide
Phase 1: D l i h RISE TDeveloping the RISE Team
• The RISE Leadership team• The RISE team:The RISE team:
– trained Hopkins employees, Peer Responders, who volunteer to support second victims through avolunteer to support second victims through a dedicated pager 24 hours a day, 7 days a week
• A project charter to include RISE scope ofA project charter to include RISE scope of services
What does RISE do?
• Supportive and attentive• Supportive and attentive conversation
• Facilitate resources within the hospital that might be helpfulhospital that might be helpful
• Provide 24/7 available support• Provide 24/7 available support
• One to one or group support• One to one or group support
What does RISE NOT do?
• We are not counselors or psychiatristsp y
• We do not investigate or report back to• We do not investigate or report back to supervisors
• We do not problem solve
• We do not fix employment problemsWe do not fix employment problems
Phase 2:Recruiting and Training of Peer RespondersRecruiting and Training of Peer Responders
• 40 individuals were invited to participate40 individuals were invited to participate
• RISE Leadership team met with peer responders to discuss:1. Roles and responsibilities: attend training, respond to RISE
calls, and participate in monthly Peer Responder meetings
2. On‐Call Schedule
3. RISE binder: policies and procedures, evaluation tools, and additional resources.
Contacting RISEgEvent happens
Second victim pages RISE RISE page p g
Referrals: self, manager, legal/risk management, peer
p greceived by Peer Responder
Peer Responder meets withmeets with second victim
Peer Responder activates debriefing with RISE team to discuss de‐identified interaction with second victim‐ learning opportunity for RISE team‐ support for the Peer Responder
Training Peer Responders
1. Psychological First Aid (PFA)d t d ib l i t ti t dd ti l di t• used to describe early interventions to address emotional distress
• goals of PFA are similar to that of physical first aid– stabilize, mitigate psychological distress, facilitate recovery, and promote access to
additional resourceadditional resource
2. Peer Responder meetings• Educational sessions: lecture presentations, Role‐play, Video excerpts,
Handouts, Narratives
3. Debriefings
Continuum of Care
Psych Crisis Counseling PsychotropicPsychFirst Aid**
Crisis Intervention
Counseling Psychotropic Meds & Psychotherapy
Basic Life Support
Advanced Life Support
Medicine & Surgery
Physical First Aid
Support Support Surgery
** stabilize psychological and behavioral functioning, mitigate psychological distress and dysfunction, facilitate recovery and return to adaptive psychological and behavioral functioning, and promote access to additional resources
Phase 3: L hi RISE il t i th D t t f P di t iLaunching RISE pilot in the Department of Pediatrics
• Launch of Awareness Campaign• significance of stress after unanticipated events, g p ,the second victim problem, peer support, resilience, and stress management
• 3 one‐hour sessions held during all three shifts
Pager: 410‐283‐3953
Phase 4: Launching RISE hospital‐wide
• Kick‐off was held at the 4th Annual Johns Hopkins Patient Safety Summit in 2012
• Additional Peer Responders were recruited
• Assessment of Peer Responder perceptions– Peer Responders desired additional training to increase competence and
fid l l i di t d i ticonfidence levels in responding to second victims
***Available online: October 2016
Objective #3:To review study results on assessing the need forTo review study results on assessing the need for organizational second victim support programs
among acute care hospitalsamong acute care hospitals
Study Overview
• Objective:f ’– To assess patient safety leaders’ perspectives on the
concept of second victims and support programs
• Methods: – In‐depth, semi‐structured interviews– 43 patient safety representatives from 38 acute hospitals in Maryland
– Descriptive statistics were generated for hospital andDescriptive statistics were generated for hospital and participant characteristics
R R t 83%• Response Rate: 83%
Manuscript accepted in Journal of Patient Safety (2016)
PART I:Does One Size Fit All?
Assessing Need for Organizational Second Victim Support Programs
• Objectives:Objectives: – To assess the extent of the second victim problem, – To determine the availability of emotional support services, and
T th d f i ti l t– To assess the need for organizational support programs.
• Results: – All participants reported that they and their executives were aware of the
second victim problem. – All participants believed that hospitals should offer organizational support
programs. – There continues to be a stigma associated with speaking up and accessing
support if it were offered.
Edrees H & Wu A. (2016). Journal of Patient Safety. [manuscript accepted]
Part II:Do Hospitals Support Second Victims?
Collective Insights from Patient Safety LeadersCollective Insights from Patient Safety Leaders
• Objectives:– To describe the extent to which organizational support for second victims isTo describe the extent to which organizational support for second victims is
perceived as desirable by the hospitals, and– To identify existing support programs
• Results:– All of the hospitals offered Employee Assistance Programs to their
l b h i h iemployees, but there were gaps in the services– Moreover, there are no valid measures in place to assess the effectiveness
of these services. – Participants identified a need for peer support, both for the second victim
and for individuals who provide that support. – Approximately 6 Maryland hospitals offer a second victim support program,
with differences in structure, accessibility, and outcomes.
Edrees H, Morlock L, & Wu A. [manuscript in draft]
Significance of the Study
• Addresses the need to develop second victim tsupport programs
• Builds on an ongoing collaboration with JHH and other organizations in the development of a second victim peer support training program
• Supports public health practice, policy, & research implications for organizations interested in developing peer support structures
• Promotes a healthier workforce
Research Implications & Future Work1. Quantifying the prevalence of second victims
2 Validate interview questionnaire and data collection tools2. Validate interview questionnaire and data collection tools
3. Target audiences in different settings: • Collect data on second victims• Collect data on second victims• Focus on senior executives • Implications in other settings such as: ambulatory care or long‐term care facilities, and local health departments or physicians’ officesand local health departments, or physicians offices
4. Implications for developing an ideal support program
5. Address influencing factors in willingness to develop a program: organizational resources, priorities, culture, transparency, and funding
1. Ability to align current patient safety infrastructure with a second victim program, such as incident reporting system
How can your organization participateHow can your organization participate
• Acknowledge the problem of the second victim
• When errors happen, encourage staff to be involved in system changes that will mitigate future errorssystem changes that will mitigate future errors
• Hold debriefings and offer formal organizational g gsupport and coping strategies for individuals
• Develop multidisciplinary second victim support• Develop multidisciplinary second victim support programs that align with existing organizational infrastructure
C i d ll b i h i i i h h– Communicate and collaborate with institutions that have existing or emerging programs
Developmental Stages
2010 Self Care Care for Caregivers2010 Self Care Care for Caregivers
2004 Reporting Learn from Mistakes
2001 Disclosure Being Open
2000 S f t D N H2000 Safety Do No Harm
Acknowledgementsg
• Johns Hopkins RISE Programp g– Dr. Albert Wu– Lori PaineCh l C– Cheryl Connors
– Matt Norvell– Dr. Henry Taylory y– Dr. George Everly– Johns Hopkins RISE Peer Responders J h H ki S d Vi ti Ad i B d– Johns Hopkins Second Victim Advisory Board
• Maryland Patient Safety CenterMaryland Patient Safety Center
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