Helping Staff Deal with a Sentinel Event

I'd like some advice from those of you on the front lines of healthcare. I've been wondering what an organization should do for healthcare professionals who are involved in an unexpected adverse event that leads to death or permanent harm for a patient? 

Sentinel Events happen.  We do our best to prevent them, and when they do occur we work hard to identify the root causes in order to prevent them from happening again.

We address the needs of patients and families to the best of our ability.  But what do we do for the doctors, nurses, techs, etc. who may also be deeply affected? 

The Joint Commission issued a statement in 2003 regarding ways to help staff deal with the psychological aftermath of a sentinel event:

Post traumatic stress disorder (PTSD) is a well-documented psychiatric illness that can happen as a result of a shocking or highly stressful situation.

Despite the awareness of PTSD, many health care organizations are slow to recognize its effects in the aftermath of a sentinel event. Like those who experience other traumatic events, health care providers involved in a sentinel event typically experience high levels of stress, guilt, and shame, and in many cases they are ill equipped to deal with their feelings. While organizations recognize and address the tragedy from the perspective of the patient and family, oftentimes the health care provider’s needs are overlooked.

Organizations may choose not to have a formalized response to this issue but instead have options available for the provider. This allows for a more individualized approach to the problem.

Your ultimate goal should be to help the provider put the event in perspective and move on with his or her life.

Read the full Joint Commission Article:  http://www.jcrinc.com/5453/

This Joint Commission article suggests offering options.  Do you agree?  Or should there be a designated course for everyone identified as a "key" participant?  Does establishing an across-the-board policy minimize any possible stigma about talking with a mental health provider or an employee assistance counselor?  Or is something other than formal counseling a better option?

We need more physicians and nurses, not fewer.  We can't afford to lose caring, dedicated professionals because we didn't step up to help when it was needed.

Leave a comment.  Advice on this important matter is appreciated.

Comments

[Dr. Deb]

Actually, way before PTSD sets in, Acute Stress Disorder is operating. It begins within seconds of the onset of a trauma or sentinel event. This is the most *crucial* time for intervention. Many of the links listed do not address Acute Stress, which is a mistake. PTSD begins two weeks after an event, and research shows that getting to those in need during the Acute State fare better overall.

For more information, this is a great book:

http://www.amazon.com/Acute-Stress-Disorder-Assessment-Treatment/dp/1557986126/ref=sr_1_2/103-0641477-2266235?ie=UTF8&s=books&qid=1175982229&sr=1-2

As for implementing one approach, I'm never a one size fits all. I think the best approach for dealing with a sentinel event is to tailor it as best as one can to the needs of the organization, etc.

[The Cheerful Oncologist]

Having been involved in 'sentinel events' before I can tell you that from my perspective the only true intervention that can help a health care professional maintain his or her ability to practice with dedication, compassion and excellence is this:

Let them talk about it...and talk, and talk, and let it all out, day after day, week after week. Do not even try to give advice or God forbid pass judgement on them. Just listen. I guarantee this will lead to healing and prevent the loss of a good doctor, nurse or other health care professional.

[Kim]

Wow - I know we track "sentinel events" but I have never been at a facility that has any sort of debriefing team. Oh, there is the employee "help" plan where if you need counseling you can get it anonymously (ha!), but there is no actual team. I've had sentinel events happen in some hospitals I've worked in and had the staff fired (travel nurses).

[N=1]

Been through that at several places. What worked best overall (and everyone's mileage varies): Mandatory face to face touching base with a debriefing team member. Affected staff decide whether they want to meet in a group, but group sessions are offered by respected counselors around the clock over the week immediately following the event. Then talk, talk, talk some more, and allowances for increased absenteeism, potlucks, opportunities to decompress, as much staffing overage as possible, etc. Frequent walk rounds by immediate manager to "shoot the breeze", take staff pulse, be available. Ditto with staff chaplains, social workers, employee health staff.

[TC]

I'm actually trained in critical incident stress debriefing and at the last hospital I worked at, we had a team. It was very helpful to the staff when something happened, but the team was underutilized. Whether this was because people were afraid to use it or they just didn't know about it, I don't know. We actually were called to go to another hospital when one of their nurses came in as a trauma. They were so glad for the help that it inspired them to start their own team. I think we need to get past incrimination when something bad happens and work towards learning how not to make it happen again. So often the things that lead to sentinel events are caused by an institutional weakness and are not just the fault of one or two individuals.