Nationwide Children's Hospital, located in Columbus, Ohio is a nationally ranked pediatric care center which spans 68 facilities caring for the sickest children in the state. While they care for children, they also care for their staff.The Agency for Healthcare Research and Quality describes second victims of medical errors: "While the focus of the patient safety field has mostly been on improving systems of care, such systems include real people, and safety events may take an emotional toll. Frequently, clinicians review medical errors and understand what has unfolded, reacting with appropriate sadness and concern. Such errors occasionally result in an intense period of professional and personal anguish, even among the "strongest" caregivers."So, how do we care for the second victims?AN recently interviewed Jenna Merandi, PharmD, MS who is the Medication Safety Coordinator; Director, at Nationwide Children's Hospital. Her educational credentials include: PharmD, West Virginia University School of Pharmacy and an MS in Health-System Pharmacy Administration, The Ohio State University.1. The nursing community has heard of second victims committing suicide. (Kim Hiatt, RN). What happens if an employee is terminated due to an error? Where can they go for support?Generally speaking, we do not terminate an employee for one mistake as everyone is human and we can all make errors. Each situation is evaluated on its own merits to determine the appropriate course of action. For any employee who makes an error, they can reach out to their supervisor, peer supporter (one is available in every department), or Matrix services for support. Very difficult situations are also presented through our Schwartz rounds.2. What measures are in place to ensure that what is discussed in the peer to peer discussions is not discoverable if a lawsuit ensues?We train our peer supporters to focus on providing emotional support to individuals, not discussing the details of an event. No information is recorded or documented that relates to the event itself. The main goal of peer support is to provide one on one assurance to second victims and support them emotionally.3. Can a second victim utilize EAP at the same time as this program?Yes, EAP is actually a part of our program. We utilize the "Scott Three Tiered Interventional Model of Support" which consists of:Tier 1 support - could be provided by a manager, supervisor or colleague to recognize the signs and symptoms of a second victim and provide reassurance to that individual.Tier 2 support - consists of trained peer supporter who has been trained with the basic skills of responding to second victims and who provides one on one interventions and potential team debriefingsTier 3 support - our professional resources which include Employee Assistance Program (EAP), Clinical Psychologist, Social Work and Pastoral CareSecond victims who need additional help beyond that of a peer supporter can utilize our EAP.4. Has there been culture-wide education? By that I mean, when a nurse/provider/someone else makes a mistake, one of the common phrases heard is "well that could never happen to me because I'm too careful." Its the whole system that needs to change.Yes, there has been culture-wide education both related to Zero Hero and our peer support program and as it relates to safety in our organization. The safety culture is incredible at Nationwide Children's as frontline staff feels comfortable reporting adverse events and working to try and prevent harm. We have a "just culture" at our institution which means there is shared accountability and follow up actions match the behaviors regardless of who is involved and what the outcome is.5. Are there any additional measures in place in case of the death of a patient due to an error? Is critical incident stress debriefing used at all?Yes, we have a Critical Incident Stress Management (CISM) team and debriefings could be conducted for larger group intervention (that beyond the role of peer supporter).Second victims are often forgotten in the scheme of an error. Nationwide Children's Hospital is at the forefront of programs designed to decrease the trauma of being a second victim.What is your facility doing to help the second victim? Please share. 1 Down Vote Up Vote × About traumaRUs, MSN, APRN Trauma Columnist 88 Articles 21,257 Posts Share this post Share on other sites