Second victim response: How to be first responders to second victims

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Diane Copeland
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1 Second victim response: How to be first responders to second victims Jenna Merandi, PharmD, MS Charline Catt, RN, MS

2 Overview Define the term second victim Understand recovery stages of a second victim Discuss the Scott Three-Tiered Interventional Model of Second Victim Support Discuss structure of Nationwide Children s Hospital (NCH) second victim program

3 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

4 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!

5 Definition Second victim Those who suffer emotionally when the care they provide leads to patient harm Wu AW. BMJ

6 Definition 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

7 Suffering of Second Victims Second victims suffer a medical emergency equivalent to post-traumatic stress disorder (PTSD) The instant patient harm occurs, the involved practitioner also becomes a patient of the organization a patient who will often be neglected. ISMP Medication Safety Alert. July 2011.

8 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 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 Ashland OG, Forde R. Qual Saf Health Care Khaneja S, Milrod B. Arch Pediatr Adolesc Med

9 Second Victim Kim Hiatt, involved in fatal medication error. Committed suicide months later. Eric Cropp, involved in fatal medication error who served jail time and had license revoked. ISMP Medication Safety Alert. July 2011.

10 Second Victim Recovery Trajectory Chaos & Accident Response Intrusive Reflections Restoring Personal Integrity Enduring the Inquisition Obtaining Emotional First Aid Moving On Surviving Impact Realization Dropping out Scott, S. Qual Saf Health Care

11 Scott, S. Joint Commission Journ on Quality and Pt Safety

12 Second Victim Interventions The Scott Three-Tiered Interventional Model of Second Victim Support Tier 3 Expedited Referral Network Tier 2 - Risk Management - Patient Safety Team - Trained Peer Supporters Tier 1 Local (Unit/Department) Support 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. Scott, S. Joint Commission Journ on Quality and Pt Safety

13 Starting a second victim program

14 NCH Pharmacy Statistics Survey sent to ~180 pharmacy staff Out of 120 surveys returned 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

15 Pharmacy Survey Results Do you feel the department of pharmacy would benefit from a program to support second victims? 6.7% Yes No 93.3%

16 Everything Matters including YOU! 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

17 YOU Matter Team 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

18 Operationalize the Program 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

19 Managing a second victim program

Director of QIS Executive Sponsor Program

2015 Team Coordinator Onsite and offsite

2014 January 2015 May 2014 Core Team March

Outpatient Leads Emergency Department Leads

21 Director of QIS Executive Sponsor Program Director Outpatient Clinics Spring/Summer 2015 Team Coordinator Onsite and offsite NICU go live 2015 *Research project* June 2014 January 2015 May 2014 Core Team March 2014 November 2013 Inpatient Leads Outpatient Leads Emergency Department Leads Perioperative Leads Pharmacy Lead Neonatology Leads Peer Supporters Peer Supporters Peer Supporters Peer Supporters Peer Supporters Peer Supporters

23 Identifying Peer Supporters

24 Peer and Group Encounter Forms

25 Peer Encounter Forms

26 Badge Buddies

27 Badge Buddies

28 Contacting YOU Matter Team YOU Matter phone number ext support group Second Victim Peer Support Peer groups

29 Involve Marketing!

30 Digital Quality Boards

31 Current Statistics 11 members on steering committee 113 peer encounter forms submitted 200 Trained Peer Supporters 30 leads identified 8 group encounter forms submitted Updated February 2015

Percent of Peer Supporters by Discipline November 2013 - January 2015 n=200 6% 4% 5% 2% 5% 3% 2% 3% 3% 3% RN/LPN MD Social Work PCA Other

32 Percent of Peer Supporters by Discipline November January 2015 n=200 6% 4% 5% 2% 5% 3% 2% 3% 3% 3% RN/LPN MD Social Work PCA Other Pharmacist 6% APN/NP RT Medical Resident 6% 7% 55% Behavioral Health Constant Attendant Unit Coordinator Administrative Support Pharmacy technician

Percent of Peer Encounters by Location November 2013 - January 2015

33 Percent of Peer Encounters by Location November January % 3% 4% 1% 12% 10% ED Pharmacy Other PICU CTICU OR/Surgery Homecare 64%

34 Number of encounters Number of Second Victims by Discipline November January Discipline

35 Types of Peer Encounters Medication error Patient death Alleged abuse Cardiac Arrest Second victim response Multiple traumas

36 Survey Results from ED 96% familiar with the term second victim 17% had spoken to a peer supporter 100% felt benefited from talking with a peer supporter 67% of staff are willing to utilize the program if needed

37 Future Directions Conduct two peer supporter trainings per month Implement second victim program hospital-wide by December 2015 Determine effectiveness of second victim program

38 In Conclusion Healthcare providers face harsh realities Large portion of healthcare providers suffer in silence Healthcare institutions must provide support not only for patients, but for their employees as well

39 References Wu AW. Medical error: The second victim. The doctor who makes the mistake needs help too. BMJ. 2000;320(7237): 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): 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): Shanafelt TD, et al. Special report: Suicidal ideation among American surgeons. Arch Surg. 2011;146(1): p 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): Khaneja S, Milrod B. Educational needs among pediatricians regarding caring for terminally ill children. Arch Pediatr Adolesc Med. 1998;152(9): Denham C. TRUST: the 5 rights of the second victim. J Patient Saf. 2007;3(2): Stiegler MP. What I learned about adverse events from Captain Sully. JAMA. 2015;313(4):

40 Second victim response: How to be first responders to second victims Jenna Merandi, PharmD, MS Charline Catt, RN, MS

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