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After an Adverse Event, Staff Needs Support

Tami Swartz, March 28, 2013

Vanhaecht recently spoke with a group of surgeons who thought it was possible that all surgeons might experience being a second victim at some point in their career. The issue, of course, is also generational, as physicians and healthcare providers with decades-long careers vividly remember a culture that swept errors under the rug.

Most AEs are a result of system failures, and most of the time more than one professional is involved in such an event. While healthcare is working toward a team model, there is frequently one person who made the final human contribution to an event, and he or she can become victimized despite several people taking part in the patient's care.

However, Vanhaecht says the research shows that the entire care team can be immediately victimized, ­particularly in settings like the operating room. He ­suggests a rapid response team style for support in such events.

Creating your support design

Immediate support was found necessary by 60% of second victims in one study; follow-up support that involved staff specifically trained in second victim trauma and follow-up was necessary for 30%; and 10% needed support that included outside professional counseling.

Particularly for nursing, immediate support by colleagues is crucial to helping the second victim. Department managers must be aware of the organization system for handling errors, especially regarding second victims.

For physicians, morbidity and mortality meetings are a key step in identifying errors. The literature shows no consensus for how to effectively ­support second victims or how best to design a ­support ­program. Some hospitals have begun to integrate emotional ­support in their root cause analysis, but some experts believe that this should be handled as a ­separate function.

Medical and nursing students can also be second victims, and therefore must be included in organizational planning. The literature review mentions a recommendation that students have frequent meetings to discuss mistakes, even ones with positive outcomes.

Vanhaecht says that it's quite possible for many hospitals to lack protocol for second victims, and notes that many might not have a protocol that meets recommendations provided by the IHI (Respectful Management of Serious Clinical Adverse Events).

This article appears in the February 2013 edition of Patient Safety Monitor.

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