Workplace Bullying/Critical Adverse Events

Transcription

1 Workplace Bullying/Critical Adverse Events October 25, 2014 Lynn Reede, CRNA, DNP, MBA AANA Senior Director, Professional Practice

2 Explore Discuss the impact and how to mitigate vertical and lateral violence occurrence. Discuss the importance of the disclosure process and resources available for the patient, caregiver and healthcare professionals following a critical adverse event.

3 Wellness The AANA has defined wellness as a balanced state of mental, spiritual, and physical well-being The foundation of practice is being well

4 Facility Culture of Safety

5 A Culture of Respect, Communication & Disclosure Leadership Just Culture Training Disclosure Process Family and Staff Support Learning and Improvement IHI Assessment Tool isclosuretoolkitanddisclosurecultureasses smenttool.aspx

6 Facility Assessment Tool Internal Culture of Safety Malpractice Carrier Policies, Guidelines, Procedures, Practices Training Disclosure Process The Disclosure Ongoing Support Resolution Leaning & Improvement Assessment Tool A Culture of Respect, Communication, and Disclosure Institute of Healthcare Policy

7 Workplace Lateral Violence Behaviors that undermine a culture of safety Often seen from positions of power Intimidating & disruptive Overt and passive activities

8 Symptoms of Lateral Violence 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

9 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

10 Crucial Conversation Staying above the line ISSUE or BEHAVIOR DO NOT CROSS THIS LINE!!! PERSONAL FACTIONS UNDERMINE

11 How Full is Your Bucket? Full 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. Empty bucket 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

12 Perspective The only person you can change is you. The only story you can reframe is your own.

13 Adverse Event

14 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 Patients Washington University School of Medicine in St. Louis

15 Sentinel Event Review Look at process not people confidential review Framework for Conducting a Root Cause Analysis Action Plan is developed from Root Cause Analysis The Joint Commission

16 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?

17 Disclosure Patient Family Professional Facility

18 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 Patients Washington University School of Medicine in St. Louis

19 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

20 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 Patients Washington University School of Medicine in St. Louis

21 Guidelines for Communication 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) Adverse Events Guidelines for Disclosure to Patients Washington University School of Medicine in St. Louis

22 The Second Victim

23 The Second Victim BMJ Vol March 2000

24 People are disturbed not by things, but by the views they take of them. Greek philosopher Epictetus Pulley,S. Critical Incident Stress Management. March 21,

25 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

26 Second Victim Stages 1. 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

27 Peer Support Team INTRODUCTION: 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.

28 Something said only one time can make the difference in one person s lifetime

29 Memorable Events Early Responses Alternate between denial & intrusive thoughts This process allows for eventual integration of the trauma Pulley, S. Critical Incident Stress Management. March 21, www. e-medicine.com

30 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

31 The Path Ahead

32 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

33 Staggering Statistics Anesthesia providers are at greater risk for suicide and abuse. drug Nurse Anesthetists ~ 15% are drug addicted Anesthesiologists ~3-4% of all physicians Yet, comprise 20-30% of drug addicted physicians Booth, J.V., et al. Substance Abuse Among Physicians: A Survey of Academic Anesthesiology Programs. Anesth Analg 2002; 95:

34 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 depressed Make the Connection, US Department of Veterans Affairs

35 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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37 Peer Support INTRODUCTION: 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.

38 Resources

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41 Supporting Patients, Families and Care Providers

42 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

43 Respectful Management of Serious Clinical Adverse Events 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;

44 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?

45 AANA Resources Lynn Reede Julie Rice Maria (Magro) van Pelt