When patients are harmed, there is often a second victim – a healthcare provider who is traumatized by the event. Supporting healthcare professionals impacted by adverse patient safety events was the focus of the When caring hurts, helping helpers heal webinar held on April 27, 2015. Almost 1,000 participants registered for the 90-minute presentation hosted by Alberta Health Services and the Canadian Patient Safety Institute.

Dr. Katrina Hurley, an emergency physician at the IWK Health Centre in Halifax, Nova Scotia recanted her experience in losing a two-year old boy and the errors that were made. “As a physician and parent, I have made lots of mistakes,” says Dr. Hurley. “Although I would not consider myself an ‘expert in mistakes’, I have ruminated enough to provide perspective on the impact to health care practitioners. Every mistake you make should help you to make better decisions.”

Dr. Hurley says that often physicians are the last to seek support from their peers.  She looked to a physician colleague and family for support after the death of her patient. Dr. Hurley also reinforced how important it is to stifle gossip after an adverse event occurs, saying that gossip can undermine confidence in your ability to perform your clinical duties. 

Dr. Bruce MacLeod, an active emergency physician and Provincial Medical Advisor to Quality & Patient Safety, Alberta Health Services (AHS) illustrated the how the stress of the environment has an impact on healthcare providers, citing an 80 per cent turnover in nursing after the loss of a young child at an Alberta hospital.  “We often pass judgement when we should be providing support,” says Dr. MacLeod. “We need to provide better care for our own in Alberta Health Services.”

AHS assembled a multi-disciplinary team to develop a Principles and Supports Framework to foster psychological well-being after an adverse event. Dr. MacLeod invited other healthcare organizations to share their challenges and processes so that we can learn from one another and continue the dialogue on helping second victims.

Dr. Verna Yiu, Vice-President, Quality & Chief Medical Officer, AHS acknowledged the guilt, shame and self-doubt felt by healthcare providers following an adverse event. She commended the courage of those individuals who come forth to tell their stories, saying that you can’t change minds until you learn from those who have lived the personal experience.

“We can never lose sight of the impact harm has on the patients and families,” says Dr. Yiu. “One way we can honour our patients is by providing more support to our second victims and promoting a psychologically healthy culture.”

Dr. Albert Wu, a practicing internist, co-directs the RISE (Resilience in Stressful Events) staff support program at John Hopkins Hospital in Baltimore, Maryland. The aim of the RISE team is to provide timely peer support to any employee who encounters a stressful patient-related event. “There are always second victims, not just in errors, but often in near misses as well,” says Dr. Wu. “Anything that shocks or moves you can result in emotional trauma where you are a second victim.”

The RISE team is a voluntary group of individuals that provide non-judgemental, safe, peer-to-peer support to employees who have experienced a stressful patient-related event. They include managers, nurse leaders, pastoral care, social workers, physicians, surgeons, respiratory therapists, pharmacists and others who are available 24/7. Their role is not to investigate, or report back to the individual’s supervisor. 

The RISE team provides RAPID Psychological First Aid. RAPID is the acronym for Reflective Listening, Assessment of Needs, Prioritization, Intervention and Disposition. Dr. Wu explains that psychological first aid provides compassionate, supportive practical assistance to individuals recently exposed to serious stressors.  This non-intrusive practical care and support includes:

• 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 support

The John Hopkins Hospital has developed a program to help other healthcare organizations implement second victim programs. The RISE Implementation guide outlines the steps in developing a RISE program and training modules are available to help first-responders do psychological first aid, providing peer responders with the skills they need to respond effectively.

Learn more about caring for caregivers after traumatic patient-related incidents.  The webinar has been archived and is available at www.saferhealthcarenow.ca