Susan D. Scott

Health Care Professionals as Second Victims after Adverse Events A Systematic Review

Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers.

Supporting involved health care professionals (second victims) following an adverse health event: A literature review

BACKGROUND One out of seven patients is involved in an adverse event. The first priority after such an event is the patient and their family (first victim). However the involved health care professionals can also become victims in the sense that they are traumatized after the event (second victim). They can experience significant personal and professional distress. Second victims use different coping strategies in the aftermath of an adverse event, which can have a significant impact on clinicians, colleagues, and subsequent the patients. It is estimated that nearly half of health care providers experience the impact as a second victim at least once in their career. Because of this broad impact it is important to offer support. OBJECTIVE The focus of this review is to identify supportive interventional strategies for second victims. STUDY DESIGN An extensive search was conducted in the electronic databases Medline, Embase and Cinahl. We searched from the start data of each database until September 2010. RESULTS A total of 21 research articles and 10 non-research articles were identified in this literature review. There are numerous supportive actions for second victims described in the literature. Strategies included support organized at the individual, organizational, national or international level. A common intervention identified support for the health care provider to be rendered immediately. Strategies on organizational level can be separated into programs specifically aimed at second victims and more comprehensive programs that include support for all individuals involved in the adverse event including the patient, their family, the health care providers, and the organization. CONCLUSION Second victim support is needed to care for health care workers and to improve quality of care. Support can be provided at the individual and organizational level. Programs need to include support provided immediately post adverse event as well as on middle long and long term basis.

Effectiveness of patient safety training in equipping medical students to recognise safety hazards and propose robust interventions

Objectives In an effort to improve patient safety attitudes and skills among third-year medical students, two patient safety training sessions were added to their curriculum, complementing a previously implemented second-year curriculum on quality improvement, patient safety and teamwork. Methods Safety attitudes and skills were assessed before and after students completed the medicine clerkship training and were compared with historical controls. Students identified and reported on observed safety events, with their reports matched to event type and harm score with contemporaneous safety reports from University of Missouris Patient Safety Network (PSN). Comparisons were assessed by five internal safety experts using criteria for report submission “worthiness”, blame tone, target of blame and presence/strength of proposed solutions. Results Students completing the third-year safety booster conferences expressed statistically higher comfort levels with identifying the cause of an error than did the student control group (p<0.05). Medical students proposed safety interventions that were more robust than those suggested by event reporters regarding similar events within our health system (p<0.0001). The worthiness and blame tone of medical student reports were not statistically different than event reports in PSN. Conclusions Completion of two 1-h patient safety booster conferences in the third year of medical school led to increased student comfort in safety event analysis. Students documented stronger resolution robustness scores, suggesting similar training should be offered to PSN reporters. Medical students represent an underutilised resource for identifying and proposing solutions for patient safety issues.

The Second Victim of Adverse Health Care Events

Nurses and other professionals drawn to health care by their desire to help others may be traumatized because they are involved in situations that bring harm rather than healing to patients. Health systems should develop early warning systems to alert unit or team leaders when health workers are at risk of harm from adverse events. This article focuses on health professionals who become second victims of adverse events that occur to patients.

The Second Victim

Gary Donnell MD, is a second-year resident in Medicine caring for Mr. Pauley, a 64-year-old with a history of diabetes and chronic renal insufficiency. Mr. Pauley’s nurse is Katie, a new graduate. Mr. Pauley was admitted for sudden-onset left side-weakness. A CT scan of his brain on admission showed no evidence of hemorrhage/mass. Katie paged Dr. Donnell 4 h later, when she found the patient to have a distinct change in his speech patterns from her initial admission assessment. Busy with several ER patients, Dr. Donnell did not evaluate Mr. Pauley, but ordered a STAT repeat head CT scan based on Katie’s findings. Radiology assured Dr. Donnell that Mr. Pauley’s CT would be completed within the hour. Dr. Donnell instructed Katie to perform hourly neurologic exams, and to page him with any changes.

The Effects of the Second Victim Phenomenon on Work-related Outcomes: Connecting Self-reported Caregiver Distress to Turnover Intentions and Absenteeism

OBJECTIVES Second victim experiences can affect the well-being of healthcare providers and compromise patient safety. The purpose of this study was to assess the relationships between self-reported second victim-related distress to turnover intention and absenteeism. Organizational support was examined concurrently because it was hypothesized to explain the potential relationships between distress and work-related outcomes. METHODS A cross-sectional, self-report survey (the Second Victim Experience and Support Tool) of nurses directly involved in patient care (N = 155) was analyzed by using hierarchical linear regression. The tool assesses organizational support, distress due to patient safety event involvement, and work-related outcomes. RESULTS Second victim distress was significantly associated with turnover intentions (P < 0.001) and absenteeism (P < 0.001), while controlling for the effects of demographic variables. Organizational support fully mediated the distress-turnover intentions (P < 0.05) and distress-absenteeism (P < 0.05) relationships, which indicates that perceptions of organizational support may explain turnover intentions and absenteeism related to the second victim experience. CONCLUSIONS Involvement in patient safety events and the important role of organizational support in limiting caregiver event-related trauma have been acknowledged. This study is one of the first to connect second victim distress to work-related outcomes. This study reinforces the efforts health care organizations are making to develop resources to support their staff after patient safety events occur. This study broadens the understanding of the negative effects of a second victim experience and the need to support caregivers as they recover from adverse event involvement.

Care at the point of impact: Insights into the second-victim experience.

As risk managers, there is an understanding of the tremendous pressures of working in todays health care setting. When medical errors or unanticipated complications occur, these stressors skyrocket. The purpose of this article is to provide insights from the collective 9 years of MUHC research exploring the second-victim phenomenon and insights into the healing process for second victims of unanticipated health care events-our health care providers.