Post on 20-Sep-2020
SECOND VICTIM Internationaal & nationaal prof. dr. Kris Vanhaecht dr. Luk Bruyneel Leuvens Instituut voor GezondheidszorgBeleid (LIGB-KULeuven) Dienst kwaliteit, UZ Leuven
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Makary et al, BMJ, 2016
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Prof. Albert Wu Johns Hopkins
BMJ, 2000
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First Victim
Second
Victim
Third
Victim
Impact based on level of
harm ???
Impact based on (Social) Media ?
Impact based on ?? ??
Medical Error Adverse Events Patient Safety Incident (PSI)
“Second victimness”
A B C D E F G H I Categories of harm
S
E
C
O
N
D
V
I
C
T
I
M
N
E
S
S
Twin
Tragedy
Airembolism
Aërosol
?
Woundcare
SodiumCl /
PotassiumCl
Ultrasound
Canule
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No perception of PSI
Adverse reaction
Perc
eive
d r
esp
on
sib
ility
by
oth
ers
Perceived responsibility by self
No
Ye
s
No Yes
DANGER ZONE!!
SV
SV
SV
What is a second victim?
Second Victim definition: A “second victim” is a healthcare professional perceived responsible by oneself or others for an unanticipated patient safety incident. Although the stress-response and coping strategy in the aftermath of this event can vary, the healthcare professional is to some extent affected by this event.
Source: Van Gerven, E., Sermeus, W., Euwema, M., Vanhaecht, K. (2016). PhD dissertation KULeuven.
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Relation error involvement & QoC/PS
Error involvement
Quality of Care Patient Safety
Guilt
Responses to distress: Burnout, depression, diminishing empathy
Frustration
Fear
Source: Swappach & Boluarte, 2009
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What do we already know? Is there some evidence?
50% of all healthcare workers
experience some degree of
second victimness during their career
Prevalence data from Belgian study
Source: Van Gerven, Vander Elst, Vandenbroeck, Dierickx, Euwema, Sermeus, De Witte, Godderis, Vanhaecht, Medical Care, 2016
Study among 5788 Belgian physicians and nurses
1 in 10 involved in PSI within the last 6 months
Dutch study on impact of PSI in 10 hospitals (Leernetwerk Peer Support VvAA)
“Vanhaecht, K., Coeckelberghs, E., Seys, D., Schouten, L., Zeeman, G. (2016). Resultaten Enquête Leernetwerk Peer Support in de zorg: Impact op zorgverleners na betrokkenheid bij een patiëntveiligheidsincident. Onderzoek Leuvens Instituut voor Gezondheidszorgbeleid (LIGB), KULeuven , in opdracht van Leernetwerk Peer Support in de Zorg.”
Vragenlijst bestaat uit 4 delen
Deel 1: DEMOGRAFIE 2387 medewerkers
Feedback op groepsniveau* en per ziekenhuis
Deel 2: PREVALENTIE Betrokkenheid van 2387
medewerkers bij een PVI tijdens hun volledige carrière en voorbije 6
maanden Feedback op groepsniveau en per
ziekenhuis
Deel 3: SYMPTOMEN 1657 medewerkers beschrijven
symptomen na meest memorabele PVI
Feedback op groepsniveau
Deel 4: ONDERSTEUNING 1572 medewerkers beschrijven ondersteuningsmechanismen
Feedback op groepsniveau en per ziekenhuis
* Groepsniveau = de 10 deelnemende ziekenhuizen
“Vanhaecht, K., Coeckelberghs, E., Seys, D., Schouten, L., Zeeman, G. (2016). Resultaten Enquête Leernetwerk Peer Support in de zorg: Impact op zorgverleners na betrokkenheid bij een patiëntveiligheidsincident. Onderzoek Leuvens Instituut voor Gezondheidszorgbeleid (LIGB), KULeuven , in opdracht van Leernetwerk Peer Support in de Zorg.”
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Verdeling soorten PVI zoals beschreven in de casussen (n=1528)
Type Incident Aantal (n=1528)
Medicatiefout 444
Diagnostisch 244
Procedures (allerlei) 243
Valaccident 120
Chirurgisch 101
Onduidelijk 79
Omission 78
Bevalling 75
wrong pat - side – site 73
Agressie 26
Materiaal 24
Suicide 21
“Vanhaecht, K., Coeckelberghs, E., Seys, D., Schouten, L., Zeeman, G. (2016). Resultaten Enquête Leernetwerk Peer Support in de zorg: Impact op zorgverleners na betrokkenheid bij een patiëntveiligheidsincident. Onderzoek Leuvens Instituut voor Gezondheidszorgbeleid (LIGB), KULeuven , in opdracht van Leernetwerk Peer Support in de Zorg.”
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Full Career Within last 6 months
Never been involved in a PSI 368 (15.4%) 1294 (54.2%)
No Harm 566 (23.7%) 586 (24.5%)
Temporary Harm 597 (25.0%) 307 (12.9%)
Permanent Harm 289 (12.1%) 90 (3.8%)
Death 567 (23.8%) 110 (4.6%)
Dutch Study on most severe PSI (n=2387) Full career & within last 6 months
“Vanhaecht, K., Coeckelberghs, E., Seys, D., Schouten, L., Zeeman, G. (2016). Resultaten Enquête Leernetwerk Peer Support in de zorg: Impact op zorgverleners na betrokkenheid bij een patiëntveiligheidsincident. Onderzoek Leuvens Instituut voor Gezondheidszorgbeleid (LIGB), KULeuven , in opdracht van Leernetwerk Peer Support in de Zorg.”
PERSONAL IMPACT PROFESSIONAL IMPACT
Act differently within the team
Insecure feeling in presence of the team members
Act differently in presence of patients and their family
Uncertainty which elevates the chance in making other
mistakes Burnout
>10% thinks about leaving/changing their job
…
Post traumatic stress General stress symptoms
Anger Insomnia
Nervousness Depression
Effect on family life Suicide
…
Women have higher impact than men
Source: Seys et al, 2012, Seys et al 2013, Van Gerven et al, 2016
Symptoms of Second Victimness
Prevalence of symptoms after PSI (n=1641) Dutch Study 2016
“Vanhaecht, K., Coeckelberghs, E., Seys, D., Schouten, L., Zeeman, G. (2016). Resultaten Enquête Leernetwerk Peer Support in de zorg: Impact op zorgverleners na betrokkenheid bij een patiëntveiligheidsincident. Onderzoek Leuvens Instituut voor Gezondheidszorgbeleid (LIGB), KULeuven , in opdracht van Leernetwerk Peer Support in de Zorg.”
Hyper vigilant Shame
Doubting knowledge & skills Stress
Fear Flashbacks
Feeling of not able to provide quality Unhappy & depressed
Uncomfortable within team Insomnia
Fear for claim Attention disorder
Feeling of being lonely Avoiding risks
Burnout Intention to leave discipline or ward
Intention to leave job Wanting to work in other organization
Fear of loosing job
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Impact of PSI on Burnout
• BURNOUT study 5788 Belgian Medical Doctors & Nurses out of 37 hospitals 9,1% had been involved in patient safety incident in previous 6 months
Twofold risk of burnout for physicians and nurses
involved in a patient safety incident
Source: Van Gerven, Vander Elst, Vandenbroeck, Dierickx, Euwema, Sermeus, De Witte, Godderis, Vanhaecht, Medical Care, 2016
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Impact of Adverse Event
on other outcomes
Source: Van Gerven, Vander Elst, Vandenbroeck, Dierickx, Euwema, Sermeus, De Witte, Godderis, Vanhaecht, Medical Care, 2016
Significant higher medication use Significant twofold risk of burnout
Significant WHI Significant Turnover Intentions
BUT ALSO POSITIVE EFFECT AFTER BEING TRAUMATIZED
“From that moment onwards I always agreed to fill in the surgical safety checklist” Chief of Surgery, 2013
“I now always calculate the dose twice” Oncology nurse, 2014
“I am now much more careful while doing the exercises with my hip arthroplasty patients” Junior physiotherapist, 2015
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• Goal: to examine individual, situational and organisational aspects that influence psychological impact and recovery
• Design: Cross sectional retrospective analysis of physicians, nurses and midwives
• Setting & participants: 913 clinicians
out of 33 hospitals who were all involved
in a patient safety incident
• Main outcome: Impact of Event Scale
(measure of psychological impact at
time of incident and at time of
the survey)
Psychological impact & Recovery
Source: Van Gerven, E., Bruyneel, L., Panella, M., Euwema, M., Sermeus, W., Vanhaecht, K. BMJ Open, 2016
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Psychological impact & Recovery
Harm to patient ↑ IES ↑ • patient died: nurse>phys • Severe harm > patient died
Time of incident ↑ IES ↓
Sense of responsability ↑ IES ↑
Female IES ↑
Optimism ↑ IES ↓
Active coping ↑ IES ↑
Self efficacy ↑ IES over time ↓
Source: Van Gerven, E., Bruyneel, L., Panella, M., Euwema, M., Sermeus, W., Vanhaecht, K. BMJ Open, 2016
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Psychological impact & Recovery
Source: Van Gerven, E., Bruyneel, L., Panella, M., Euwema, M., Sermeus, W., Vanhaecht, K. BMJ Open, 2016
Culture of support ↑ IES ↓
Blame culture ↑ IES ↑
Information what happened ↑ IES ↓ Information what to do ↑ IES ↓ Extra guidance ↑ IES ↓
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First Victim
Second
Victim
Third
Victim
Impact based on level of
harm ???
Impact based on (Social) Media ?
Impact based on ?? ??
#SECONDVICTIM
• Reactions of managers after PIS are emotional and professional • “As this could happen in my organization, I failed” • “It makes me nervous” • “It gave me lots of additional stress” • “I feel guilty” • “I was angry, because how could this happen in MY hospital?”
IMPACT depends on lots of factors like:
Level of harm to the first victim
Was there contact with victim or family
How many healthcare workers were involved
What is the impact on the second victim
It depends on the personality of the CEO-CMO
Was there contact with the press / media
• Support for third victim: (nearly) NONE
Source: LIGB KULeuven, 2012,unpublished
Interviews with CEO - CMO
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Impact on policy level
Study in 1313 Italian Physicians to understand why they practice
Defensive Medicine
Most prominent predictor for DM = Being a second victim
Source: Panella, M., Rinaldi, C., Leigheb, F., Donnarumma, C., Kul, S., Vanhaecht, K., Di Stanislao, F., 2016
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Support Systems
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No real evidence about support ...
Expressive Writing
Route Cause Analysis
Yoga Mindfulness
Eye Movement Desensitization & Reprocessing
Time-out with a friend
Seys, D., Scott, S., Wu, A., Van Gerven, E., Vleugels, A., Euwema, M., Panella, M., Conway, J., Sermeus, W., Vanhaecht, K. (2013). Supporting involved health care professionals (second victims) following an adverse health event: a literature review. International Journal of Nursing Studies, 50 (5), 678-687.
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“Vanhaecht, K., Coeckelberghs, E., Seys, D., Schouten, L., Zeeman, G. (2016). Resultaten Enquête Leernetwerk Peer Support in de zorg: Impact op zorgverleners na betrokkenheid bij een patiëntveiligheidsincident. Onderzoek Leuvens Instituut voor Gezondheidszorgbeleid (LIGB), KULeuven , in opdracht van Leernetwerk Peer Support in de Zorg.”
Need for support (Dutch study, n=1564)
PSI without harm Temporary harm Permanent harm Fatal harm
Info on content
Info on what’s next
Acknowledging the error
Understanding innocence
Need additional support
Time-out
Who to talk to? (1518 Dutch colleagues)
“Vanhaecht, K., Coeckelberghs, E., Seys, D., Schouten, L., Zeeman, G. (2016). Resultaten Enquête Leernetwerk Peer Support in de zorg: Impact op zorgverleners na betrokkenheid bij een patiëntveiligheidsincident. Onderzoek Leuvens Instituut voor Gezondheidszorgbeleid (LIGB), KULeuven , in opdracht van Leernetwerk Peer Support in de Zorg.”
Own colleagues on ward Other involved teammembers
Partner Colleagues who have PSI experience
Direct managers Involved patient or family
Friends outside of professional work Other managers
Neutral person Psychologist or professionally trained peer
Member of the HRM department General practitioner Insurance physician
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Level 3 - Professional support
Emotional support from psychiatrist/psychologist
Cognitive support to go back to work
Level 2 - Formal support
Emotional support from peer support team
Cognitive support: extra guidance at the work place
Level 1 – Informal/formal support
Emotional/practical support from colleagues and home front
Cognitive support: RCA, information on next steps, open disclosure
Van Gerven, E., Sermeus, W., Euwema, M., Vanhaecht, K. (2016). PhD dissertation KULeuven.
Bring Peer Support in daily practice: organisational
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• Drieluik first second third circulair
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Twitter: #secondvictim / @krisvanhaecht E-mail: kris.vanhaecht@kuleuven.be Web: www.secondvictim.be Or read one of our papers below