The Opiod Crisis: The Osteopath as Second Victim Octob tober r - - PowerPoint PPT Presentation

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The Opiod Crisis: The Osteopath as Second Victim Octob tober r - - PowerPoint PPT Presentation

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The Opiod Crisis: The Osteopath as Second Victim Octob tober r 24, 2019 Albert t W. Wu, MD, MPH Johns Hopkins Bloomberg School of Public Health AOAAM Annual Meeting Disclosures None 2 Objectives 1. Explain who are the second

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The Opiod Crisis: The Osteopath as Second Victim

Octob tober r 24, 2019 Albert t W. Wu, MD, MPH Johns Hopkins Bloomberg School of Public Health AOAAM Annual Meeting

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Disclosures

  • None

2

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Objectives

1. Explain who are the “second victims” of patient adverse events 2. Explain the value of peer support to health care workers and health care organizations 3. Describe the RISE (Resilience in Stressful Events) peer support program

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Conflicts of Interest

  • None to report
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Case

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Staff members are supported by my institution after an adverse event

  • 1. Rarely
  • 2. Occasionally
  • 3. Sometimes
  • 4. Most of the time
  • 5. All of the time
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Second Victim

A health care provider involved in an unanticipated adverse patient event and/or medical error who is traumatized by the event

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Natural History of the Second Victim

(1) Clinician response to initial incident

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Short and Longer Term Symptoms

  • Numbness, confusion
  • Detachment, depersonalization
  • Grief, depression, withdrawl
  • Anxiety, agitation
  • Sleep disturbance
  • Flashbacks, re-experiencing the event
  • Physical symptoms
  • Shame, guilt, self doubt
  • Impaired functioning
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The Resilient Zone Model

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Post Traumatic Stress Disorder (PTSD)

  • Re-experiencing the original trauma through

flashbacks, nightmares

  • Avoidance of stimuli associated with the trauma
  • Increased arousal: difficulty falling or staying asleep,

anger, hypervigilance

  • Symptoms lasting > one month
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Peer Response

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BMJ 2000

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Natural History of the Second Victim

(1) Initial response to incident (2) Peer response

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What Would You Like S omeone to S ay to You?

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Things People S ay

Well, I wouldn’t have done that Didn’t you realize what would happen? What were you thinking? Why didn’t you do x? Nothing (Things behind your back)

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Natural History of the S econd Victim

(1) Initial response to incident (2) Peer response (3) Investigation

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Natural History of the S econd Victim

(1)Initial response to incident (2) Peer response (3) Investigation (4) Malpractice suit

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Multiple S econd Victim Traumas

8

(1) Adverse Event (2) Peer Response (3) Investigation (4) Litigation

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Kimberly Hiatt

Nurse Seattle, 2010 Medication error 5 yr old patient dies Dismissed from job Commits suicide

http://www.vox.com/2016/3/15/11157552/medical-errors-stories-mistakes

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Burnout

When passionate, committed people become deeply disillusioned with a job from which they have previously derived much of their identity and meaning. It comes at the things that inspire passion and enthusiasm are stripped away and tedious or unpleasant things crowd in.

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Emotional exhaustion loss

  • f enthusiasm for work

Depersonalization feeling cynicism, treating people as objects Low sense of personal accomplishment feeling ineffective at work Eroded professionalism Compromised quality of care Increased risk for medical errors Early retirement Addiction & suicidal ideation

This is burnout Burnout may contribute to

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Burnout by Specialty

Shanafelt Arch Intern Med 2012:172:1377

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Staff members perceive asking for help as being “weak”

  • 1. Agree strongly
  • 2. Agree somewhat
  • 3. Unsure
  • 4. Disagree somewhat
  • 5. Disagree strongly
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75% wanted prompt debriefing for individual or group/team)

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RISE

“Safe” and Confidential – no report back, notification, investigation 24/7 on call support (online or page) Call back within 30 minutes One to one or group support by peers Psychological First Aid

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R.I.S.E. Resilience In Stressful Events

Pager: 410-283-3953

“Provide timely support to employees who encounter stressful, patient-related events”

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Psychological First Aid (PFA) Guide for Field Workers

WHO publication: www.who.int Collaborative effort: – World Health Organization – War Trauma Foundation – World Vision International Endorsed by 24 UN/NGO international agencies Available in several languages

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Continuum of Care

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The RISE team

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Add Modern Healthcare

  • http://www.modernhealthcare.com/article/20180131/NEWS/

180139979

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Cost Benefit Analysis of RISE

  • RISE costs money up-front to implement
  • Cost of Nurse
  • Time off = $211 per day
  • Quitting = $100,000
  • The cost-benefit of RISE within 1-year, i.e. a positive “net

monetary benefit (NMB)” of $22,576 per call

  • Additional savings from improved safety+quality

Moran, Wu, Connors, Chappidii, Sreedhara, Selter,

  • Padula. J Patient Safety in press
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Presented by Maryland Patient Safety Center in collaboration with The Johns Hopkins Hospital RISE Program

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A Fourth Aim of Health Care?

  • Enhance patient experience of

care

  • Improve the health of

populations

  • Reducing the per capita cost of

health care

  • Maintain well being of the

health care team

  • Bodenheimer, Ann Fam

Med 2014

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Health care depends on healthy doctors and nurses Care of the patient requires care of the provider

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Journal of Patient Safety and Risk Management

Please submit your papers!

Peer-reviewed journal print+online that provides international forum for new knowledge+ideas in patient safety, risk management and medico-legal. Prioritizes evidence-based research, reviews, commentary, cases on patient safety issues with implications for patient care, clinical and professional practice, health care governance and policy

https://mc.manuscriptcentral.com/jpsrm Albert W. Wu, MD, MPH, Editor-in-Chief Awu@jhu.edu @withyouDrWu

http://journals.sagepub.com/home/cri

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Education and Training

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https://www.jhsph.edu/academics/online-learning-and-courses/online- programs/online-programs-for-applied-learning/master-of-applied-science-patient- safety-and-healthcare-quality/index.html

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www.josieking.org

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awu@jhu.edu @withyouDrWu

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Some Resources

 Wu, AW. Medical Error: The Second Victim. The Doctor Who Makes the Mistake

Needs Help Too. BMJ 2000 320:726-727

 Wu AW, Steckelberg RC. Medical error, incident investigation and the second

victim: doing better but feeling worse? BMJ Qual Saf. 2012 Apr;21(4):267-70

 Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. The natural history

  • f recovery for the healthcare provider "second victim" after adverse patient
  • events. Qual Saf Health Care. 2009 Oct;18(5):325-30

 de Wit ME, Marks CM, Natterman JP, Wu AW. Supporting second victims of

patient safety events: shouldn't these communications be covered by legal privilege? J Law Med Ethics. 2013 Winter;41(4):852-8

 Edrees H, Connors C, Paine L, Norvell M, Taylor H, Wu AW. Implementing the RISE

second victim support programme at the Johns Hopkins Hospital: a case study. BMJ Open. 2016 Sep 30;6(9):e011708

 Moran D, Wu AW, Connors C, Chappidi MR, Sreedhara SK, Selter JH, Padula WV.

Cost-Benefit Analysis of a Support Program for Nursing Staff. J Patient Saf. 2017 Apr 27