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

2. 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.

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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)

9. 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

10. 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

11. 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

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

13. 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.

14. 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”

15. 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

16. 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

17. 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

18. Questions
THANK YOU !!!