Providing care to the ailing humanity is a complex task and comes with an inherent risk of error. Medical community is well aware of the risk of medical errors, especially after the report of Institute of Medicine that has come out in 2000. The report titled “To err is Human” described that healthcare system has increased number of preventable medical errors resulting in loss of life. This loss of life causes a ripple effect for the people who care for these patients. These errors cause distress and anguish in the hearts and minds of people who were caring of those patients. It results in the phenomenon caused Second Victim Syndrome.
With the occurrence of any error and the resultant death or disability of any patient leads of many victims. The patient involved in this error is the “First Victim” as they are the one who sustained significant injury or harm, which at times can even be death. The people taking care of patient in the hospital, the doctor and nurse becomes the second victim. The third Victim is the institution which provided care for the patient. Any patients harmed subsequently become the fourth victim.
The term Second Victim was coined by Albert Wu to highlight the impact of medical error on to the healthcare professionals. By calling them victim, the intention is not to take the responsibility away from them but to highlight that something needs to be done to avoid future mistakes rather than assigning the blame and leaving second victims deal with the aftermath by themselves(4).
It is seen that half of the healthcare staff involved in medical error experiences its impact at least one time in career time, and almost 43% experience what is called Second Victim phenomenon(5). This number could be Falsely low because of the fear of litigation and absence of well reporting system, as after any serious event most of the proceedings are kept confidential(6). Although any person taking care of the patient can be involved in medical errors but mostly it is reported in surgical issues and also infusion errors(7). In another study 27% of Emergency physicians and about similar percentage of Emergency nurses described being the second victim(8, 9).
The healthcare staff who gets involved in the any medical error manifests the symptoms of getting traumatized. These range from Psychological to cognitive to physical reaction. It could mean the healthcare professional may feel shame and guilt or become anxious or depressed. They would feel like burned out and have compassion dissatisfaction. We may them having elevated heart beat and at times may be having trouble breathing, dry mouth or lower blood pressure. Usually these symptoms can start from the time of the medical error been committed or upto few weeks, and lasts for weeks and upto several years. In this time span the healthcare worker go through predictable course, this can be divided into 6 stages.
- Chaos and accident response.
- Intrusive reflection.
- Restoring personal responsibility.
- Enduring the inquisition.
- Obtaining emotional first aid.
- Moving on.
With moving on, people may survive, but stay damaged. They may also drop out and change the profession even, or they may thrive and learn from this experience. The effects of second victim phenomenon is much higher when there is catastrophic even like death of the patient or permanent damage as opposed to near misses(10).
Another side effect of the second victim phenomenon is that the people who survive or the one who thrived would show signs of restrain or over treatment of the patient. They will start practicing defensive medicine, which would increase the cost of healthcare delivery.
What actually needs to be done for these healthcare providers has extensively been studied. In one such study done at University of Missouri on about 900 people showed that they needed a limited time off from patient care to go through this initial response to the medical error. They also wanted some departmental support and also professional support to bring them back to where they can go back to normal working pattern. In response to the study the University created the three tier system and say that it can positively impact the second victims in their bid to come back to normal pattern of working. The first tier of support was through trained departmental level colleagues, and local leaders. This will result in 60% of physicians meeting their needs. The second tier was through one to one support and monitoring in the high risk clinical units. This tier also provided access to organizational resources and access to managerial leaders about patient safety as well as risk management. The 30% physicians go help in this tier. In the last 10% of the cases the physicians were helped through access to the professional help and counselling.
What is actually needed besides the support of the second victim is the change in the culture of “shaming” and blaming” the victim and provide them with the just culture. Through this the errors will be addressed to avoid the circle of perpetual mistakes. Through fixing the root cause of the event that resulting in all these victims, we can improves the system, avoid errors and have the second victim move on to become a productive member of treatment team once again.
References:
- Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press; 2000. ISBN: 9780309068376.
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