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Monday 23 October 2017
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Thriving or surviving

LEADER

Peer support for ‘second victims’ who suffer emotionally when patients in their care are harmed should be available alongside risk management and error-reporting schemes; it makes no sense to neglect the needs of health care staff

 

Christine Clark PhD FRPharmS FCPP(Hon)
Editor, HPE


‘It takes a rare type of courage to stand in front of an audience and describe how you accidentally dispensed an item that led to the death of an infant, but that is what Natasha Nicol did last December at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting (see page 18). She vividly described the shock, bewilderment, self-doubt and despair that she felt when she saw her own initials on the label of the dispensed item that had caused the harm. The tide of emotion in the room was palpable and I suspect that many people were reliving their own memories of being involved in medication errors in which patients were harmed. However, this was no ordinary session about systems failures and error reduction measures. This was a session devoted to the phenomenon of ‘second victims’ – those who suffer emotionally when the care that they provide leads to patient harm.


Although it has long been recognised that caring, responsible people make mistakes, this has not always been acknowledged in practice and, often, they have received little or no support. A few high-profile cases show that individuals have been dismissed from their jobs, served prison sentences and even taken their own lives as a result of being involved in medication errors. Many more have been left to cope on their own – there is a popular view that people who deal with sickness, injury and death in their daily work can take accidental harm to a patient in their stride. But research suggests that significant numbers of health care staff are severely traumatised by such events.


Dr Nicol’s own case – working in a frenetically busy, understaffed, poorly-equipped hospital pharmacy – recalled a situation that will be familiar to many readers.  Speakers went on to describe how the topic has been researched and how measures have been developed to tackle the problems. Refreshingly, this does not involve armies of external counsellors and a load of psychobabble, but other health care professionals trained as ‘peer supporters’.  Health care staff, like war correspondents, seek support from their own kind when they have experienced catastrophic events. First level responders provide a safe space for second victims to vent their feelings. Often this is the very thing that people are fearful of doing in case they lose their jobs or because they have been told to speak to no-one until there is a formal inquiry.


There are lessons for all healthcare organisations here. Looking after second victims is an important element of staff welfare. Health care staff are often put in difficult, pressured situations, as much medication error research shows, and when a patient is harmed it is natural to look for someone to blame. But health care professionals are expensive to train and the majority are caring, responsible individuals. It makes no sense to abandon them.


Many hospitals and healthcare systems have well-developed risk management and adverse event reporting systems. Arguably, second victim schemes should stand alongside these.  About 20 years ago, the Guild of Healthcare Pharmacists in the UK started to look into the second victim phenomenon. Maybe now is a good time to revive the interest and build on the initiatives described at ASHP. Research shows that second victims become thrivers, survivors or drop-outs. A caring health service would seek to maximise the thrivers who often become powerful advocates for
patient safety.

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