<p>Second victims in health care: current perspectives</p>

Abstract

Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected patient outcomes. These unexpected complications and unintentional errors will always be a part of the medical system due to the universal nature of human fallibility and technology. While not all errors are life-threatening, they can significantly compromise a patient’s quality of life. However, the victims of medical error reach far beyond the patient. The second victim (SV), which defined for the first time by Albert Wu in his description of the impact of errors on HCPs by both personally and professionally, is a medical emergency equivalent to post-traumatic stress disorder. When the errors occur, it causes a domino effect including the four groups: the patient and family (first victim), the HCP [SV], the hospital reputation (third victim), and patients who are harmed subsequently (fourth victims). The rights of our patients to safe, reliable, and patient-centered care are critical and most important as a primary and utmost aim of medicine. However, we also have to take care of our own (SVs), especially when we have good people who mean to do well and then find themselves in an emotionally complex situation. There is a need to articulate to the public, politicians, and media how system failure leads to medical error even in hand of well-educated and competent HCPs are given an increasing clinical workload. Furthermore, despite several leading institutions in western countries have developed formal support programs that allow HCPs to cope with their emotional distress by obtaining timely support in an emphatic, confidential, non-judgmental environment, we need to raise awareness of this phenomenon and appropriate institutional responses both to harmed patients and their families and HCPs.

A cross‐sectional survey on nurses’ second victim experience and quality of support resources in Singapore

“…We suggest a parallel mobilization of a peer rapid response team in addition to a root cause investigation when delving into an adverse event. Such temporal association is crucial as second victims have higher likelihood to embroil in another adverse event in the initial 4-24 hours (Ozeke, Ozeke, Coskun, & Budakoglu, 2019 (Scott et al, 2010) and the Resilience in Stressful Events (RISE) programme (Edrees et al, 2016). However, there is none in the local context to the best of our knowledge.…”

“…We suggest a parallel mobilization of a peer rapid response team in addition to a root cause investigation when delving into an adverse event. Such temporal association is crucial as second victims have higher likelihood to embroil in another adverse event in the initial 4–24 hours (Ozeke, Ozeke, Coskun, & Budakoglu, ). Furthermore, round‐the‐clock confidential professional counselling support should be made accessible for instances when the emotional turmoil of a second victim proves too much for the peer rapid response team to handle.…”

Stress and Fear

“…Negative ruminations and perseveration are common after these events, and providers are now recognized to be at risk for becoming “second victims” as they struggle with subsequent feelings of anxiety, fear, guilt, or anger, leading to social withdrawal, troubling memories, depression, and insomnia. 54 The basis for negative auto-suggestion that accelerates and prolongs stress in these circumstances is uncertain. However, it is conceivable that the hostility of the historical medical training environment 55 , 56 , 57 perpetuates a negative self-assessment which is exacerbated in times of stress.…”

Criminalisation of human error in health care: How and why legal accountability can crowd out professional accountability and undermine patient safety

“…Furthermore, in circumstances in which quality information is critical for improving safety and learning from mistakes, professionals are less likely to provide that information if information provided will be used against them in legal action. On the other hand, when a sense of safety from prosecution exists, defensive routines among the professionals are less likely to take over and a climate of trust is more likely to be achieved enabling organisational learning (Dekker 2012;Greiling 2014;Ozeke et al 2019). That said, one must wonder how and why can legal accountability crowd out professional accountability?…”