Arnold Provider as 2nd Victim WOEMA Webinar 2016 0427€¦ · 3.The “do’s and don’ts of a disclosure session 4.Providers as “second victims”, ... Assist the organization

Coping with Medical Errors: Mistakes Happen / CAPT Lisa Arnold, MSN, BSN, PNP

April 27, 2016 / WOEMA 2016 Webinar Series

HEALTHCARE RESOLUTIONS MANAGING THE UNEXPECTED

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PLEASE STAND BY – WEBINAR WILL BEGIN AT 12:00 PM PST

FOR AUDIO: CALL 866-740-1260

ACCESS CODE: 764-4915#

Conflict of Interest Disclosure I, CAPT Lisa Arnold, hereby declare that the content for this activity, including any presentation of therapeutic options, is well balanced, unbiased, and to the extent possible, evidence-based. My partner/spouse and I have no financial relationships with commercial entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients relevant to the content I am planning, developing, presenting, or evaluating.



HEALTHCARE RESOLUTIONS PROGRAM MANAGING THE UNEXPECTED

Objectives: You will have an understanding of:

1.HCR Program History/Overview/Goals/High Reliability

2.Disclosure requirements 3.The “do’s and don’ts of a disclosure session 4.Providers as “second victims”, review of the literature and way forward

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HIGH RELIABILITY A High Reliability Organization is a transparent

organization that is not defined by adverse medical events but rather learns from them, thereby cultivating trust, demonstrating integrity and placing value on our staff and those we are privileged to serve – our patients.

Medical errors/adverse events do not define or disable an organization.

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HIGH RELIABILITY Transparency is required to earn the trust

of staff and patients as well as to learn from events.

Transparency drives change. Lack of transparency complicates care

delivery. HRO strives for zero instances of

preventable harm.

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TRUTHS

“Patients will often forgive honest mistakes when they’re disclosed promptly, fully and compassionately”

“They become enraged when they think they’re being stone walled.

Even with serious errors, when a lawsuit may be inevitable, disclosure and apology is still the best course of action. It can mitigate the patients anger. It demonstrates that you had the patient’s best interests at

heart.

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TRUTHS

An appropriate apology doesn’t mean admitting liability. Providers are second victims. Providers often begin healing after an adverse event and

learning from it via disclosure. Patients want 3 things What to know what happened A sincere apology What steps will be taken to ensure this does not happen

in the future

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BASIS OF PROGRAM

When there are… UNEXPECTED OUTCOMES

ADVERSE OUTCOMES MEDICAL ERRORS

We Will… DISCLOSE THE FACTS…

Even if the patient is not harmed…….

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PROGRAM OVERVIEW

Non-legal venue to attempt to resolve healthcare issues following unexpected outcomes of care or quality care concerns.

Early intervention process at time of service delivery; prior to

claims being filed. Separate from Staff Judge Advocate, Customer Service/

Patient Relations, Risk Management and Patient Safety

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PROGRAM HIGHLIGHTS

Promotes organizational transparency and integrity. Coaching prior and after disclosure sessions. Follow-up within twenty-four hours of session. Address remaining issues. Maintain open communication between the patient/family and the

organization. Convene future meetings to discuss episodes of care resulting in

unanticipated/adverse outcomes. Assist the organization in “doing the right thing.” Preserve trust in healthcare and the therapeutic relationship.

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REFERRAL CRITERIA EARLY REFERRAL AND “HEADS-UP” ARE KEY Complications/Errors/Not going well in

general

Disclosure issues

Unanticipated outcomes of care

Sentinel events/wrong site, wrong patient procedures

Delayed diagnosis

Medical/medication errors

Elevation of care caused by hospital/nosocomial infections

Expected or unexpected deaths

Patient dissatisfaction with treatment outcomes or perceived quality of care

Poor patient-provider interaction/communication

Appropriate patient disengagement without abandoning patient care

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HIGHER GUIDANCE

The Joint Commission Standard RI 01.02.01 Patient Centered Communication DoD 6025.13-R Military Health System (MHS) Clinical Quality Assurance Program

BUMED Instruction 6010.28 “Healthcare Resolutions Program” BUMED Instruction 6010.13 Quality Assurance Program BUMED Instruction 6010.23 “Participation in the MHS Patient Safety Program”

Professional Societies Code of Ethics State Apology Laws

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DISCLOSURE

Unintentional human error and system failures account for most preventable harm to patients.

Disclosure session—never a 1 time event Tips for sessions -Before -During -After

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The only risk greater than disclosure … is the risk to know

something and not disclose it.

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AMA OPINION ON CODE OF ETHICS

“It is a fundamental ethical requirement that a physician should at all times deal honestly and openly with patients. Patients have a right…to be free of any mistaken beliefs concerning their conditions. Situations occasionally occur in which a patient suffers significant medical complications that may have resulted from the physician’s mistake or judgment. In these situations, the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred… Concern regarding legal liability which might result following truthful disclosure should not affect the physician’s honesty with a patient.”

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DISCLOSURE RESPONSIBILITY The Joint Commission Standard RI 01.02.01 specifies that disclosure is responsibility

of licensed independent practitioner or his/her designee.

Should include provider involved in the unexpected outcome, one who accepts responsibility and can answer clinical questions.

“The hospital provides the patient or surrogate decision-maker with the information about the outcomes of care, treatment, and services that the patient needs in order to participate in current and future health care decisions.”

“The hospital informs the patient or surrogate decision-maker about unanticipated outcomes of care, treatment, and services that relate to sentinel events considered reviewable by The Joint Commission.”

“The licensed independent practitioner responsible for managing the patient’s care, treatment, and services, or his or her designee, informs the patient about unanticipated outcomes of care, treatment, and services related to sentinel events when the patient is not already aware of the occurrence or when further discussion is needed.”

Keep number of participants to a minimum

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THE JOINT COMMISSION PATIENT-CENTERED COMMUNICATION STANDARD

Chapter: Provision of Care, Treatment, and Services

Standard: PC 02.01.21: The hospital effectively communicates with patients when providing care, treatment and services.

Rationale for PC 02.01.21:

This standard emphasizes the importance of effective communication between patients and their providers of care, treatment or services. Effective patient-provider communication is necessary for patient safety. Research shows that patients with communication problems are at an increased risk of experiencing preventable adverse events, and that patients with limited English proficiency are more likely to experience adverse events than English speaking patients.

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APOLOGY

Patients and physicians are human and need to understand each other better…Physicians fear honest disclosure will be used against them and patients suffer from the lack of understanding of what happened and why, as well as how their doctor feels about the mistake. Most patients want to understand these things and to gain some assurance that steps have been taken to avoid future mistakes of the same type.

- The Physician Executive Journal

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CHALLENGES TO SUCCESSFUL DISCLOSURE

Temptation to defend yourself KEY ERROR HEALTHCARE PROFESSIONALS MAKE IN A

DIFFICULT CONVERSATION IS CONSIDERING IT TO BE A FACTUAL CONVERSATION, FOCUSING ONLY UPON INFORMATION-SHARING

REALITY IS THAT DISCLOSURE IS A COMPLEX INTERPERSONAL DISCUSSION, WITH CONSIDERABLE EMPHASIS UPON FEELINGS. PROVIDERS CAN ASSUME NOTHING ABOUT HOW THE NEWS WILL BE RECEIVED.

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CHALLENGES TO SUCCESSFUL DISCLOSURE Being prepared to listen and learn to tolerate silence. Knowing how to be comfortable with not knowing all the

facts. Knowing how to deliver timely and accurate information. Knowing how to deliver bad news with clarity. Too much medical jargon. Knowing how to address rumors, misperceptions and

unrealistic expectations, internet feedback.

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COMMON QUESTIONS Can I be sued? What happens to me if I am sued? Is disclosure ok with attorneys? What about National Practitioner Data

Bank? Who can I turn to for support?

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WHO CAN I TRUST????



PROVIDERS AND HOSPITAL STAFF- THE SECOND VICTIMS

Four Training Objectives :

•  Define and explain the "second victim" concept

•  Discuss best practices and evidence-based options for early intervention and

provider/staff wellness following an event

•  Discuss the different levels (individual and organizational) of second victim support for providers

•  Provide an overview of successful second victim support systems

BASED ON THE ARTICLE:

Supporting involved health care professionals (second victims) following an

adverse health event: A literature review

Citation:

Says D, Scott S, Wu A, et al. Supporting involved health care professionals (second victims) following an adverse health event: a literature review. Int J Nurs Stud 2013;50:678–87.



BACKGROUND – FROM ABSTRACT Background: One out of seven patients is involved in an adverse event. The first priority

after such an event is the patient and their family (first victim). However the involved

health care professionals can also become victims in the sense that they are traumatized

after the event (second victim). They can experience significant personal and professional

distress. Second victims use different coping strategies in the aftermath of an adverse

event, which can have a significant impact on clinicians, colleagues, and subsequently the

patients. It is estimated that nearly half of health care providers experience the impact as a

second victim at least once in their career. Because of this broad impact, it is important to

offer support.

One out of seven patients

health care professionals can become victims

half of health care providers

RESULTS OF THE STUDY Results: •  21 research articles and 10 non-research articles in this literature review. •  Strategies included support organized at the individual, organizational, national or

international level. •  A common intervention was to support the health care provider immediately. •  Strategies on the organizational level can be separated into programs specifically

aimed at second victims and more comprehensive programs that include support for all individuals involved in the adverse event.

•  Support should be given to the patient, their family, the health care providers, and the organization.

individual, organizational support support the health care provider immediately

support for all individuals involved in the adverse event



CONCLUSIONS- FROM ABSTRACT

Conclusions:

•  Second victim support is needed to care for health care workers and to improve quality of care.

•  Support can be provided at both the individual and organizational level.

•  Programs need to include support provided immediately post adverse event as well as on a middle long and long term basis.

WHAT WAS KNOWN BEFORE THIS REVIEW:

1.  When an adverse event occurs, health care providers can be traumatized by this event.

2. In the aftermath of an adverse event, symptoms of second victims are mainly post-traumatic stress and burnout.

3. These symptoms may lead to problems of work-life balance and increase the likelihood of additional incidents, therefore support is needed.



WHAT THIS REVIEW ADDS:

1. Support to second victims after adverse events must be

organized on the individual and organizational level.

2. Support needs to be provided immediately after the

adverse event but also at middle long and long term intervals.

3. An overview of second victim support systems is described which may inspire health care organizations in their search for optimal support systems.

PROFESSIONAL AND PERSONAL SUFFERING

The majority of the perioperative

registered nurses in the study of Chard (2010)

reported that they were angry with themselves after

committing an error and showed some level of emotional

distress.

Because of the extreme distress and shattered

confidence in the aftermath of an adverse event, some of

them felt unfit to be a nurse any longer (Arndt, 1994).

Chard, R., 2010. How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors. AORN Journal 91 (1), 132–145. Arndt, M., 1994. Medication errors. Research in practice: how drug mistakes affect self-esteem. Nursing Times 90 (15), 27–30.



WHEN AN ERROR OCCURS…

Ideally, when an error or adverse event comes to light, the case is reviewed, leading to changes in system processes and practices. Second victims may be able to contribute to the design of constructive change which not only address vulnerabilities within the health care system but also help the health care providers to heal. Second victims need help in coping as adaptively as possible.

Chard, R., 2010. How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors. AORN Journal 91 (1), 132–145. Smith, M.L., Forster, H.P., 2000. Morally managing medical mistakes. Cambridge Quarterly of Healthcare Ethics 9 (1), 38–53. Wu, A.W., Folkman, S., McPhee, S.J., Lo, B., 1991. Do house officers learn from their mistakes? The Journal of the American Medical Association 265 (16), 2089–2094.

INITIAL STEPS TO HEALING:

Second victims should be encouraged to accept responsibility for an unexpected outcome and to assist in bringing about constructive changes in practice. HOWEVER; It should be recognized that this approach is associated with heightened emotional distress, and support is crucial. (Chard, 2010; Smith and Forster, 2000; Wu et al., 1991).

Chard, R., 2010. How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors. AORN Journal 91 (1), 132–145. Smith, M.L., Forster, H.P., 2000. Morally managing medical mistakes. Cambridge Quarterly of Healthcare Ethics 9 (1), 38–53. Wu, A.W., Folkman, S., McPhee, S.J., Lo, B., 1991. Do house officers learn from their mistakes? The Journal of the American Medical Association 265 (16), 2089–2094.



A VERY BAD SECOND VICTIM OUTCOME

Kimberly Hiatt, a longtime critical care nurse at Seattle Children's Hospital, committed suicide in April, 2011; seven months after accidentally overdosing a fragile baby with calcium chloride.

EMOTIONAL SUPPORT

Emotional support should be provided, including the

sharing of lessons from previous adverse events, because

not getting support makes the situation even worse (Arndt, 1994).

Understanding what other second victims have experienced

can help the suffering provider to cope with the feelings of

guilt, shame, fear and loss of confidence (Schelbred and Nord, 2007).

Schelbred, A.B., Nord, R., 2007. Nurses’ experiences of drug administration errors. Journal of Advanced Nursing 60 (3), 317–324. Arndt, M., 1994. Medication errors. Research in practice: how drug mistakes affect self-esteem. Nursing Times 90 (15), 27–30



WITHOUT SUPPORT…

Hiatt, who had worked as a nurse for more than two decades without making a

medical error, was fired from her job by Seattle Children’s Hospital, her license

suspended.

Many physicians and other health professionals hold themselves to a standard of

perfection, and when things go wrong, they feel alone.

Physician health experts estimate that 250 doctors commit suicide annually -- a rate

about double that of the general population.

THE CURRENT REALITY OF SECOND VICTIMS:

Many health care providers:

•  struggle to find support after a medical error

•  Do not know where to find assistance or guidance

•  Did not receive the adequate support for coping with the stress that is associated with an adverse event

(Gallagher et al., 2003; Scott et al., 2008; Waterman et al., 2007).

Gallagher, T.H., Waterman, A.D., Ebers, A.G., Fraser, V.J., Levinson, W., 2003. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. The Journal of the American Medical Association 289(8), 1001–1007. Scott, S.D., Hirschinger, L.E., Cox, K.R., 2008. Sharing the load. Rescuing the healer after trauma. Registered Nurse Journal 71 (12), 38–43. Waterman, A.D., Garbutt, J., Hazel, E., Dunagan, W.C., Levinson, W., Fraser, V.J., Gallagher, T.H., 2007. The emotional impact of medical errors on practicing physicians in the United States and Canada. The Joint Commission Journal on Quality and Patient Safety 33 (8), 467–476. [email protected]



INSTITUTION/ORGANIZATION ROLE

Health care institutions often fail to take responsibility for the provision

of support and provision of the necessary elements of a

support system (Conway et al., 2010; Gallagher et al., 2003;

Schwappach and Boluarte, 2008).

In some cases, second victims are

only able to find solace outside of their institutions,

during national or international conferences

(Engel et al., 2006; Gallagher et al., 2003; van Pelt, 2008).

Conway, J., Federico, F., Stewart, K., Campbell, M., 2010. Respectful Management of Serious Clinical Adverse Events. IHI Innovation Series White Paper. Institute for Healthcare Improvement, Cambridge, MA.. Gallagher, T.H., Waterman, A.D., Ebers, A.G., Fraser, V.J., Levinson, W., 2003. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. The Journal of the American Medical Association 289 (8), 1001–1007. Engel, K.G., Rosenthal, M., Sutcliffe, K.M., 2006. Residents’ responses to medical error: coping, learning, and change. Academic Medicine 81 (1), 86–93. van Pelt, F., 2008. Peer support: healthcare professionals supporting each other after adverse medical events. Quality & Safety in Health Care 17(4), 249–252 Schwappach, D.L., Boluarte, T.A., 2008. The emotional impact of medical error involvement on physicians: a call for leadership and organisational accountability. Swiss Medical Weekly 139 (1–2), 9–15..

RESEARCH QUESTIONS OF THIS REVIEW:

Research question 1:

What kind of support can be

provided on the individual level?

Research question 2:

WHICH support can be rendered at

the organizational level?



QUESTION 1: WHAT KIND OF SUPPORT CAN BE PROVIDED ON THE INDIVIDUAL LEVEL?

Individual support for second victims can be rendered

by a variety of individuals, such as managers, supervisors, counselors, therapists and

colleagues.

The highest level of collegial support is found by

discussion of the adverse event to understand what went

wrong

Clinicians who accept criticism and discuss the

adverse event with colleagues perceive more

support from those colleagues

INDIVIDUAL LEVEL SUPPORT, CONTINUED

Clinicians who discuss the clinical error with

colleagues do this usually for professional and personal

reasons including the need for emotional support

Open discussion and disclosure of the mistake

could have a positive impact on their stress and reduce the

likelihood of future mistakes and should be organized and

facilitated

Disclosure also has the potential to lead to better patient

outcomes, better patient–professional relationship and

improved health care delivery



WHAT IS THE CURRENT PERCEPTION OF THE INDIVIDUAL SUPPORT CLIMATE (1/2)?

Discussing a clinical error with a colleague is still not

common practice in today’s health

care systems

30% of faculty physicians and nearly

50% of trainees were not comfortable discussing their

error in 2010 Study

WHAT IS THE CURRENT PERCEPTION OF THE INDIVIDUAL SUPPORT CLIMATE (2/2)?

Physicians found it hard to talk with colleagues about

errors because they were afraid of potential damage to their professional reputation and

image

Some physicians feel that colleagues minimize the

mistake or avoid their emotional concerns



IMPORTANT OBSERVATIONS

Physicians studied by Gallagher et al. (2003) reported that none of the

participants studied saw a counselor or a psychologist about the

error.

Providers found that the most difficult challenge was to

forgive themselves for the error.

Gallagher, T.H., Waterman, A.D., Ebers, A.G., Fraser, V.J., Levinson, W., 2003. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. The Journal of the American Medical Association 289 (8), 1001–1007.

TAKE HOME MESSAGES:

Supervisors can support second victims by emphasizing

continued trust in them. This can be done by reassuring the

second victim that their professional abilities are still important to

the organization and to their professional teams (Engel et al.,

2006; Newman, 1996; Schwappach and Boluarte, 2008).

Scott et al. (2008) suggest that immediate support should

be provided to the clinician following the adverse event

and that the time between the adverse event and support is

crucial.

Scott, S.D., Hirschinger, L.E., Cox, K.R., 2008. Sharing the load. Rescuing the healer after trauma. Registered Nurse Journal 71 (12), 38–43. Engel, K.G., Rosenthal, M., Sutcliffe, K.M., 2006. Residents’ responses to medical error: coping, learning, and change. Academic Medicine 81 (1), 86–93. Newman, M.C., 1996. The emotional impact of mistakes on family physicians. Archives of Family Medicine 5 (2), 71–75. Schwappach, D.L., Boluarte, T.A., 2008. The emotional impact of medical error involvement on physicians: a call for leadership and organisational accountability. Swiss Medical Weekly 139 (1–2), 9–15.



TAKE HOME MESSAGES:

A trusting relationship between the involved

health care provider and the individual that is providing

support is important (Schelbred and Nord, 2007; Scott

et al., 2009).

Family members, friends and colleagues seem

to provide more support than managers and physicians

(Wolf et al., 2000).

Schelbred, A.B., Nord, R., 2007. Nurses’ experiences of drug administration errors. Journal of Advanced Nursing 60 (3), 317–324. Scott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M., Brandt, J., Hall, L.W.,2009. The natural history of recovery for the healthcare provider “second victim’’ after adverse patient events. Quality & Safety in Health Care 18 (5), 325–330. 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 (6), 278–287

TAKE HOME MESSAGES: Most nurses feel they need to be

supported by discussing their errors with

colleagues and nurses in the ward (Meurier et al., 1997).

Support can be given by asking about the emotional impact

of the adverse event and how the colleague is coping

(Meurier et al., 1997; Wu, 2000).

Cycle of recovery (or not)

Duck and hide; survive; thrive (Scott et. Al 2017)

Wu, A.W., 2000. Medical error: the second victim. The doctor who makes the mistake needs help too. British Medical Journal 320 (7237), 726–727. Meurier, C.E., Vincent, C.A., Parmar, D.G., 1997. Learning for errors in nursing practice. Journal of Advanced Nursing 26 (1), 111–119.



TAKE HOME MESSAGES Scott et al. (2008) described key phrases that managers

can use to stimulate a critical conversation with second

victims and suggested some key actions for interacting

with the second victim.

KEY PHRASES:

‘‘This had to have been difficult. Are you okay?’’

‘‘I believe in you.”

‘‘I cannot imagine what that must have been like for you. “

“Can we talk about it?”

‘‘You are a good nurse working in a very complex environment.’’

Scott, S.D., Hirschinger, L.E., Cox, K.R., 2008. Sharing the load. Rescuing the healer after trauma. Registered Nurse Journal 71 (12), 38–43.

TAKE HOME MESSAGES Key actions for interacting with the second victim include being

there and present for the clinician, practicing active listening

skills and allowing the second victim to share the personal

impact of his or her story. It is important to avoid

condemnation without knowing the story (Scott et al.,

2008).

Be there - Be positive - Active listening-

Good support from colleagues and a good relationship

with the patient in the aftermath of an error can have a

positive effect on the second victim (Sirriyeh et al., 2010).

Scott, S.D., Hirschinger, L.E., Cox, K.R., 2008. Sharing the load. Rescuing the healer after trauma. Registered Nurse Journal 71 (12), 38–43. Sirriyeh, R., Lawton, R., Gardner, P., Armitage, G., 2010. Coping with medical error: a systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals’ psychological well-being. Quality & Safety in Health Care 19, e43.



WHAT IS ACTIVE LISTENING?

Maintain eye contact Make few distracting movements

Lean forward, face speaker Have an open posture

Allow few interruptions

Signal interest with encouragers and facial expressions

Reflect what has been said by paraphrasing. "What I'm hearing is," and "Sounds like

you are saying,"

Ask questions to clarify certain points. “Do you mean…?"

Summarize the speaker's comments periodically.

QUESTION 2: WHICH SUPPORT CAN BE RENDERED AT THE ORGANIZATIONAL LEVEL?



QUESTION 2: WHICH SUPPORT CAN BE RENDERED AT THE ORGANIZATIONAL LEVEL?

A support program that is part of a comprehensive plan for

taking actions to correct system and actions to

support the second victims on organizational

level

A culture that supports mutual criticism and

constructive feedback at the workplace reduces the

impact of the adverse event

configure support to maximize timeliness and

availability, and guarantee the confidentiality of

discussions with facilitated access to a higher level of

professional support if needed

ORGANIZATIONAL LEVEL SUPPORT, CONTINUED (1/2)

credible peer support 24 /7 and interactions

should be available immediately after an incident as a

form of emotional first aid, ideally before the clinician

leaves the clinical environment.

department supervisors should be trained to identify

the need for support and to refer providers accordingly



ORGANIZATIONAL LEVEL SUPPORT, CONTINUED (2/2)

Rights for second victims (Denham, 2007)

Providers should have an opportunity to contribute to

enhancing systems of care

Health care providers in a harmful event are encouraged to actively

participate in the communication process and disclosure as a part

of their healing and learning processes

Denham, C.R., 2007. TRUST: the 5 rights of the second victim. Journal of Patient Safety 3 (2), 107–119.

WHAT IS THE EFFICACY OF THE ORGANIZATIONAL SUPPORTS (1/2)?

60% of second victim providers found organizational

support from individual unit leaders and colleagues/peers

sufficient

30 % of participants in Scott’s study needed peer support which was organized by a

specially trained peer support ‘emotional first aid’

rapid response team.

Scott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M., Hahn-Cover, K., Epperly, K.M., Phillips, E.C., Hall, L.W., 2010. Caring for our own: deploying a systemwide second victim rapid response team. The Joint Commission Journal on Quality and Patient Safety 36 (5), 233–240.



WHAT IS THE EFFICACY OF THE ORGANIZATIONAL SUPPORTS (2/2)?

10 % of providers needed expedited referral to

professional counseling services following the

unanticipated clinical event


WHAT IS EMOTIONAL FIRST AID?

•  Getting support from family, friends, colleagues

•  Seeking professional support, such as psychological, spiritual

•  Engaging in self-care, such as exercise, nutrition, mindfulness, relaxation, nature

•  Obtaining professional/skill development as needed



PERSONAL EMOTIONAL FIRST AID

1.  Recognize when you’re in emotional pain.

2.   Be gentle and compassionate with yourself.

3.   Distract yourself from rumination.

4.   Redefine your view of failure.

5.   Find meaning in loss.

Winch, G. (2014). Emotional First Aid: Healing Rejection, Guilt, Failure and Other Everyday Hurts. New York: Plume – Penguin Group.

MORE TAKE HOME MESSAGES : Denham (2007) proposes

five rights for second victims:

Treatment,

Respect,

Understanding and compassion,

Supportive care and

Transparency

Along with the opportunity to contribute to enhancing

systems of care.

Denham, C.R., 2007. TRUST: the 5 rights of the second victim. Journal of Patient Safety 3 (2), 107–119.



SUMMARY OF KEY CONSIDERATIONS

Time between adverse event and support is crucial with 24/7 availability

Structured sessions need to be provided

Highly respected clinicians should be encouraged to discuss their errors and feelings

KEY CONSIDERATIONS, CONTINUED

Programs which focus to prevent, identify and treat burnout are helpful

Promote empathy within the team

Physicians in senior positions should be encouraged to discuss their errors and feelings



SUMMARY OF KEY STRATEGIES

Talk and listen to second victims

Organize and facilitate open discussion of the error

Share experiences with peers

KEY STRATEGIES, CONTINUED

Organize special conferences on the issue of second victims to increase awareness

Provide a professional and confidential forum to discuss errors

Inquire about colleague coping

Expressive writing



MAXIMIZING THE EFFICACY OF ORGANIZATIONAL SUPPORTS:


Recall:

60% of second victim providers found organizational support from

individual unit leaders and colleagues/peers sufficient

30 % of participants in Scott’s study needed peer support

which was organized by a specially trained peer

support ‘emotional first aid’ rapid response team.

CONSIDER IMPLEMENTATION OF AN INSTITUTIONAL RESPONSE PLAN The Institute for Healthcare Improvement (IHI), recently published a white paper on respectful management of a serious clinical adverse event (Conway et al., 2010). The IHI Clinical Crisis Management Plan has an ultimate strategy of avoiding harm after the crisis of an adverse clinical event. The Institute for Healthcare Improvement (IHI), an independent not-for-profit

organization based in Cambridge, Massachusetts, is a leading innovator, convener, partner,

and driver of results in health and health care improvement worldwide. At our core, we

believe everyone should get the best care and health possible. This passionate belief fuels

our mission to improve health and health care.

From: http://www.ihi.org/about/Pages/default.aspx

Conway, J., Federico, F., Stewart, K., Campbell, M., 2010. Respectful Management of Serious Clinical Adverse Events. IHI Innovation Series White Paper. Institute for Healthcare Improvement, Cambridge, MA.



INSTITUTIONAL RESPONSE PLAN, CONTINUED

This institutional response plan includes the following elements:

1.  organizational culture of safety

2.   internal notification

3.   a Crisis Management Team

The Clinical Crisis Management Plan takes into account

three victims with corresponding priorities.

Patient and Family, Providers and Staff, Organization

INSTITUTIONAL RESPONSE PLAN, CONTINUED

Priority 1 is the patient and family

Priority 2 is the involved staff

Priority 3 is the organization.

Priority 3, the organization, includes elements

concerning the event, internal and external

communication, external notifications and possibly unannounced

visits by regulatory bodies.



INTERNAL NOTIFICATION OF ERRORS

Internal notification protocols and policies vary by organization

Ensure that organizational policies are in place for internal notification of unexpected

outcomes, near-miss scenarios, and general or specific care concerns

Transparency and neutrality are pillars of the organizational policy

Facilitate staff and provider training in compassionate disclosure (separate training

by healthcare resolutions team)

SUMMARY

Second victims need assistance fast, empathetically, and with provision for open and

reciprocal conversations with peers in structured and collegial settings

Second victims need programs that identify and treat burnout, and need

encouragement from highly respected senior providers and staff

Second victims need coping skills, empathy, conversations regarding burnout, and to

be reminded that they are valuable to the organization



Lisa Arnold Special Assistant for Healthcare

Resolutions Navy Medicine West

619-532-6405 Blackberry 619-726-4352 [email protected]

Thank you for participating in today’s webinar. At the conclusion of this call you will receive an

email with a link to a post-webinar questionnaire.

You will need to complete this questionnaire in order to receive CME for this webinar.

This webinar presentation can be downloaded at www.woema.org

Documents

Arnold Provider as 2nd Victim WOEMA Webinar 2016 0427€¦ · 3.The “do’s and don’ts of a disclosure session 4.Providers as “second victims”, ... Assist the organization