Www.aana.com Wellness in the Face of Critical Adverse Event Stress February 6, 2015 Lynn Reede,...
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www.aana.com Wellness in the Face of Critical Adverse Event Stress February 6, 2015 Lynn Reede, CRNA, DNP, MBA AANA Senior Director, Professional Practice USC Graduate Program in Nurse Anesthesia
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Transcript of Www.aana.com Wellness in the Face of Critical Adverse Event Stress February 6, 2015 Lynn Reede,...
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Wellness in the Face of Critical Adverse Event Stress
February 6, 2015
Lynn Reede, CRNA, DNP, MBA
AANA Senior Director, Professional Practice
USC Graduate Program in Nurse Anesthesia
www.aana.com
Explore
• Discuss the impact and how to mitigate vertical and lateral violence.
• Discuss the importance of the disclosure process and resources.
• Describe the process for care of yourself and peers for emotional recovery following a critical adverse event.
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Wellness
The AANA has defined wellness as a balanced state of mental, spiritual, and physical well-being
The foundation of practice is being well
Facility Culture of Safety
www.aana.com
A Culture of Respect, Communication & Disclosure
Leadership
Just Culture
Training
Disclosure Process
Family and Staff Support
Learning and ImprovementIHI Assessment Tool http://www.ihi.org/resources/Pages/Tools/DisclosureToolkitandDisclosureCultureAssessmentTool.aspx
www.aana.com
Workplace Lateral Violence
Behaviors that undermine a culture of safety
Often seen from positions of power Intimidating & disruptive Overt and passive activities
http://www.workplacebullying.org/individuals/problem/early-signs/
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Feel like throwing up Obsessing about work at home Feel too ashamed to tell "mental health breaks" to escape Days off are exhausted and lifeless Favorite activities are no longer enjoyable Believe that you provoked the workplace
cruelty
Symptoms of Lateral Violence
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Workplace Lateral Violence Cost
Medical errors, increased cost of care
Patient satisfaction Fear of reporting Leaving the job
TJC, Sentinel Event Alert, Issue 40, July 9, 2008
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Crucial Conversation…Staying above the “line”
ISSUE or BEHAVIOR
PERSONAL
FACTIONS
UNDERMINE
DO NOT CROSS THIS LINE!!!
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How Full is Your Bucket? Full “bucket” Empty “bucket”
Feel upbeat and happy
Praise generates good feelings
Focus on what is right
Positive emotions can increase your life span, provide a buffer against illness, and reduce stress and depression.
Feel negative and sad
Negative actions are contagious
Focus on what is wrong
Negative emotions can cause health problems
Rath, T., Clifton, D. (2004) How full is your bucket? Gallup Press
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Perspective
The only person you can change is you.
The only story you can reframe is your own.
Adverse Event
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Adverse Event
An injury to a patient caused by their medical care rather than their underlying disease
Does not imply "error," "negligence," or poor quality care. It simply indicates that an undesirable clinical outcome resulted from some aspect of diagnosis or therapy, not an underlying disease process.
Adverse Events – Guidelines for Disclosure to PatientsWashington University School of Medicine in St. Louishttps://fpp.wusm.wustl.edu/patientservices/Pages/Adverse_Event_Patient_Disclosure.aspx
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Sentinel Event Review Look at process not people – confidential review
Framework for Conducting a Root Cause Analysis
http://www.jointcommission.org/sentinel_event.aspx
Action Plan is developed from Root Cause Analysis
The Joint Commission
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Adverse Event - Now What!?!
• Take care of the patient • Take care of family
(disclosure)• Chain of command• Risk management• How are you and your team?
Disclosure
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Patient Disclosure
Providing information to patients and/or their families about unexpected harm that occurs as a result of their medical care, not directly because of a patient's illness or underlying disease.
Adverse Events – Guidelines for Disclosure to PatientsWashington University School of Medicine in St. Louis
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Why Disclose
• Establishes a bond, relationship• Decrease payouts, law in 21 states• Decreases stress, time spent for
discovery, deposition, and court for everyone
• Everyone’s contribution can improve care
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Patient disclosure isn’t: Claiming liability by saying, “I caused this
problem . . .” Criticism of care or response of other
providers Making excuses, being misleading,
defensive or mysterious Altering the medical record, or placing
personal notes or comments in the record Adverse Events – Guidelines for Disclosure to PatientsWashington University School of Medicine in St. Louis
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Acknowledge that an adverse event or medical error has occurred.
Describe the nature of the event in a factual and compassionate manner
What happened and what are the potential consequences to the patient
How and why it happened, to the best of your knowledge (do not speculate or hypothesize if the exact cause of the adverse event is unknown)
Guidelines for Communication
Adverse Events – Guidelines for Disclosure to PatientsWashington University School of Medicine in St. Louishttps://fpp.wusm.wustl.edu/patientservices/Pages/Adverse_Event_Patient_Disclosure.aspx
The Second Victim
The Second Victim
BMJ Vol 320 18 March 2000
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Pulley,S. Critical Incident Stress Management. March 21, 2005.www.emedicine.com
People are disturbed not by things, but by the views they take of them.
Greek philosopher Epictetus
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How You Feel
• Work first - “Need to do the next case: we have an OR to run”
• Patients need support, not the provider• Uncertainty = Weakness• Seeking help = Weakness• Discussing true feelings about the case =
increased risk associated with litigation• Did you…I would have never done that
2013
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Second Victim Stages1. Chaos & Accident Response
2. Intrusive Reflections
3. Restoring Personal Integrity
4. Enduring the Inquisition
5. Obtaining Emotional First Aid
6. Moving On
1. Dropping Out
2. Surviving
3. Thriving
Stage 1-3 may occur simultaneously
Triggering symptoms may occur anytime in stages 2-6
University of Missouri Health System 2009
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Peer Support TeamINTRODUCTION: Thank you for meeting with me today. I would like to hear how you are feeling. I know that you have discussed what happened with others. My focus is on you.
EXPLORATION: You have really been through something tough, how are you feeling?
NORMALIZING: You are an excellent CRNA, you have taken care of my family. You would not let another CRNA beat themselves up. Could you let yourself off the hook?
FOLLOW-UP: May I check in with you tomorrow? Here’s my number, text or call anytime.
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Something said only one time can make the difference in one person’s lifetime…
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Pulley, S. Critical Incident Stress Management. March 21, 2005. www. e-medicine.com
“Memorable” Events
Early Responses
Alternate between denial & intrusive thoughts
This process allows for eventual integration of the trauma
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Disasters & Their Aftermath
Where to turn
Venue to openly share feelings
May turn inward looking for solutions
Dealing with these complex and strong emotions may lead to dysfunctional behavior
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The Path Ahead
http://www.rahafharfoush.com/blog/wp-content/uploads/2008/03/fork-int-the-road.jpg
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Ways to Cope• Remind yourself that it is OK that you are
experiencing expected reactions to a stressful event
• Keep your life as routine as possible• Physical exercise, relaxation• Avoid alcohol and drug use• Give yourself permission to react. Don’t try to hide
your feelings• Eat regularly, minimize use of sugar and caffeine• Do something nice for yourself
University of Missouri Health System
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Booth, J.V., et al. Substance Abuse Among Physicians: A Survey of Academic Anesthesiology Programs. Anesth Analg 2002; 95: 1024-30
Staggering Statistics
Anesthesia providers are at greater risk for suicide and drug abuse.
Nurse Anesthetists ~ 15% are drug addicted
Anesthesiologists ~3-4% of all physicians
Yet, comprise 20-30% of drug addicted physicians
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Signs of PTSD?Feeling upset by things that remind you of what happened
Having nightmares, vivid memories, or flashbacks of the event that make you feel like it’s happening all over again
Feeling emotionally cut off from others
Feeling numb or losing interest in things you used to care about
Becoming depressedMake the Connection, US Department of Veterans Affairshttp://maketheconnection.net/conditions/ptsd?gclid=CMaAx_W_4L8CFahj7AodLX0Arg#1
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Identification and Treatment
It’s never too late to get professional treatment or support
Receiving counseling or treatment as soon as possible can keep your symptoms from getting worse
You can also consider connecting with:• Your family doctor• A mental health professional, such as a therapist• A spiritual or religious advisor
Make the Connection, US Department of Veterans Affairs
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Peer SupportINTRODUCTION: How you are feeling? I know that you have discussed what happened with others. I only want to talk about you.
EXPLORATION: You have really been through something tough, how are you feeling?
NORMALIZING: You are an excellent CRNA, you have taken care of my family. You would not let another CRNA beat themselves up. Could you forgive yourself?
FOLLOW-UP: When can we talk again tomorrow? Here’s my number, text or call anytime.
Resources
www.aana.com
www.AANA.com/AdverseEvents
www.aana.com
www.AANA.com/AdverseEvents
www.aana.com
Supporting Patients, Families and Care Providerswww.mitss.org
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Anesthesia Patient Safety Foundation
(APSF)Administrative Guidelines for Response to an Adverse Anesthesia Event
Minimize patient injury & identify the cause of an adverse event
Enhanced vigilance & sympathetic support for co-worker
www.apsf.org/resource_center/clinical_safety/adverse_event.mspx
http://www.apsf.org/resources_safety_protocol.php
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Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2009.
Respectful Management of Serious Clinical Adverse Events
www.ihi.org
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How are you?
We care for others needs and help others
succeed
It is “OK” to not be “OK”
Let yourself off the hook
Be the one to reach out to your student/colleague
& ask: “Are you OK?”
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AANA Resourceswww.AANA.com/adverseevents
Lynn Reede
Julie Rice
Maria (Magro) van Pelt
