Second Victim-Peer Support Team Phyllis O’Neill BSN, RN Geri Sanfillippo BSN, RN

Disclosure Phyllis O’Neill BSN, RN and Geri Sanfillippo BSN RN, have no financial interest/arrangement with any organization(s) that could be perceived as a real or apparent conflict of interest with the subject matter of the presentation.

Learning Objectives • Identify the “second victim” potential in adverse events • Describe the solution and process developed to resolve the problem of “second victims” • Outline a plan for developing a support structure for providers who are “second victims” that will lead to accountability throughout the organization and community

Capital Health Leadership identified a gap in the services provided for staff A needs assessment of nursing was performed via Survey Monkey New venture for Capital Health and a committee was formed to design and implement a program specifically for peer support

Nurse's suicide highlights twin tragedies of medical errors Kimberly Hiatt killed herself after overdosing a baby, revealing the anguish of caregivers who make mistakes

Define the Mission of a Team To provide peer support to staff involved in stressful clinical events such as traumatic clinical events, failure of rescue efforts following prolonged intervention, adverse patient outcome related to a medical error, the death of a child, and any other event that is unusually emotionally challenging and stressful in our healthcare environment.

Second Victim Definition A second victim is a health care provider involved in an unanticipated adverse patient event, medical error and/or patient related injury who becomes victimized in the sense that the provider is traumatized by the event Second Victims often: Feel personally responsible for the outcome Feel as though they have failed the patient Second guess their clinical skills and knowledge The first victim is the patient

TRUST - Five Rights of the Second Victim Treatment that is just – deserve the presumption that their intentions were good Respect – should not be shamed for human fallibility Understanding and compassion- compassionate help to grieve and heal Supportive Care- entitled to psychological and supportive services Transparency and opportunity to contribute- the right to participate in the learning gathered from the error (ISMP Medication Safety Alert, 2011)

Signs and Symptoms of a Second Victim Short term: shock helplessness worry and depression guilt and inadequacy anger poor concentration and memory intrusive thoughts and nightmares sleep disturbance physical symptoms social avoidance

Signs and Symptoms ( Cont’d) Long term: (Indistinguishable from posttraumatic stress disorder) recurrent experience of the event avoidance emotional numbing chronic signs of hyper-arousal including sleep disturbance, irritability, poor concentration, diminished memory withdrawal and depression social functioning can be impaired, and personal and professional relationships can suffer

Significance of a Second Victim Phenomenon Policy Implications IOM Report To Err Is Human -Joint Commission Sentinel Events Policy includes the term “second victims” recommends that health care institutions identify the need of second victims by offering a support structure for staff who encounter a serious medical event Non-Profit Organizations Medically Induced Trauma Support Services (MITSS) - “To Support Healing and Restore Hope” to patients, families, and clinicians who have been affected by an adverse medical event Healthcare organizations with active programs University of Missouri and Johns Hopkins

Current Situation No formal support structure Providers do not seek emotional support Existing Resources: Informal support structures Organizational resources

If current situation remains the same: Providers will not be able to provide the best quality care Providers will continue to develop short and long term symptoms Other factors on the unit will be affected, such as teamwork, patient safety, job satisfaction, working conditions, quality, etc.

Shared Vision and Basic Message An effective and regularly accessed emotional support structure at the Hospital Support one's emotional feelings/trauma following an unanticipated stressful, patient-related adverse event Basic Message: “If you do not recognize and address your inability to emotionally cope following an adverse event, you will not be able to provide quality care for your patients”

Initial Leg Work Complete a literature search related to second victim- Peer Support Group Introduced initiative to Organization Leadership Recruited Volunteers Scheduled initial meeting Survey of RN Staff

TeamSTEPPS Approach Phase I — Assessment – completed with the survey monkey on the hospital intranet Phase II — Planning, Training, & Implementation – to accomplish this phase it is important to obtain funding for education and materials, the education itself and the development of an intranet site for staff. Phase III — Sustainment - through the use of a dedicated team with knowledge and experience staff , the support initiatives must be widely communicated so everyone is aware of the available resources and how to access these resources

Future for Capital Health Brochure to staff with peer support process and contact information Addition of other services in the hospital Continual evaluation and improvements based on feedback Work in progress- interested in participating with program contact poneill@capitalhealth.org gsanfillippo@capitalhealth.org

Questions THANK YOU !!!