The aftermath of adverse events in Spanish primary care and hospital health professionals

BMC Health Services Research

Pilar Astier²  Roberto Nuño-Solinís^1,11  Julián Vitaller⁷  José Ángel Maderuelo-Fernández⁹  Elena Zavala⁴  Fuencisla Iglesias^1,10  Guadalupe Olivera⁶  Pastora Pérez-Pérez⁸  Carmen Silvestre³  Lena Ferrús¹  Susana Lorenzo⁵  Irene Carrillo⁷  José Joaquín Mira⁷ 

[1]Consorci Sanitari Integral, L’Hospitalet de Llobregat, Barcelona, Spain

[2]Medicina de Familia y Comunitaria, Centro de Salud Caspe, Sector Alcañiz, Aragon Health Service (SALUD), Zaragoza, Spain

[3]Atención Primaria Comarca Donostia, Donostia, Spain

[4]Hospital Universitario Donostia, Donostia, Spain

[5]Hospital Universitario Fundación Alcorcón, Madrid, Spain

[6]Servicio Madrileño de Salud, Madrid, Spain

[7]Universidad Miguel Hernández, Elche, Spain

[8]Observatorio para la Calidad del Sistema Sanitario en Andalucía, Sevilla, Spain

[9]Gerencia de Atención Primaria de Salamanca, Castilla y León Health Service (SACYL), Salamanca, Spain

[10]Castilla La Mancha Health Service (SESCAM), Toledo, Spain

[11]Basque Institute for Healthcare Innovation (O + Berri), Bilbao, Spain

关键词: Hospital;    Primary care;    Healthcare providers;    Catastrophic loss;    Medical errors;    Adverse events;    Patient safety;   

Others  :  1164291
DOI  :  10.1186/s12913-015-0790-7

 received in 2014-09-26, accepted in 2015-03-16,  发布年份 2015

【 摘 要 】

Background

Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims.

Methods

A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals.

Results

A total of 430 health professionals (39.6%) had informed a patient of an error. Reporting to patients was carried out by those with the strongest safety culture (Odds Ratio –OR- 1.1, 95% Confidence Interval –CI- 1.0-1.2), nurses (OR 1.9, 95% CI 1.5-2.3), those under 50 years of age (OR 0.7, 95% CI 0.6-0.9) and primary care staff (OR 0.6, 95% CI 0.5-0.9). A total of 381 (62.5%, 95% CI 59-66%) and 346 (72.5%, IC95% 69-77%) primary care and hospital health professionals, respectively, reported having gone through the second-victim experience, either directly or through a colleague, in the previous 5 years. The emotional responses were: feelings of guilt (521, 58.8%), anxiety (426, 49.6%), re-living the event (360, 42.2%), tiredness (341, 39.4%), insomnia (317, 38.0%) and persistent feelings of insecurity (284, 32.8%). In doctors, the most common responses were: feelings of guilt (OR 0.7 IC95% 0.6-0.8), re-living the event (OR 0.7, IC95% o.6-0.8), and anxiety (OR 0.8, IC95% 0.6-0.9), while nurses showed greater solidarity in terms of supporting the second victim, in both PC (p = 0.019) and hospital (p = 0.019) settings.

Conclusions

Adverse events cause guilt, anxiety, and loss of confidence in health professionals. Most are involved in such events as second victims at least once in their careers. They rarely receive any training or education on coping strategies for this phenomenon.

【 授权许可】

   
2015 Mira et al.; licensee BioMed Central.

【 参考文献 】

• [1]Wu AW: Medical error: the second victim. BMJ 2000, 320:726-7.
• [2]Scott S, Hirschinger L, Cox K, McCoig M, Hahn-Cover K, Epperly K, et al.: Caring for our own: deploying a systemwide second victim rapid response team. J Comm J Qual Patient Saf 2010, 36:233-40.
• [3]Hilfiker D: Facing our mistakes. N Engl J Med 1984, 310:118-22.
• [4]van Pelt F: Peer support: healthcare professionals supporting each other after adverse medical events. Qual Saf Health Care 2008, 17:249-52.
• [5]Christensen JF, Levinson W, Dunn PM: The heart of darkness: the impact of perceived mistakes on physicians. J Gen Intern Med 1992, 7:424-31.
• [6]Newman MC: The emotional impact of mistakes on family physicians. Arch Fam Med 1996, 5:71-5.
• [7]Schwappach D, Boluarte TA: The emotional impact of medical error involvement on physicians: a call for leadership and organisational accountability. Swiss Med Weekly. 2008, 138:9-15.
• [8]White AA, Waterman A, McCotter P, Boyle D, Gallagher TH: Supporting health care workers after medical error: considerations for healthcare leaders. J Clin Outcomes Manag 2008, 15:240-7.
• [9]Sirriyeh R, Lawton R, Gardner P, Armitage G: Coping with medical error: a systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals’ psychological well-being. Qual Saf Health Care 2010, 18:746-52.
• [10]Brandom B, Callahan P, Micalizzi DN: What happens when things go wrong? Pediatr Anesth 2011, 21:730-6.
• [11]Seys D, Scott S, Wu A, Van Gerven E, Vleugels A, Euwema M, et al.: Supporting involved health care professionals (second victims) following an adverse health event: a literature review. Int J Nurs Stud 2013, 50:678-87.
• [12]Abd Elwahab S, Doherty E: What about doctors? The impact of medical errors. Surgeon 2014, 12:297-300.
• [13]Waterman AD, Garbutt J, Hazel E, Dunagan WC, Levinson W, Fraser V, et al.: The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient Saf 2007, 33:467-76.
• [14]Aasland OG, Forde R: Impact of feeling responsible for adverse events on doctors’ personal and professional lives: the importance of being open to criticism from colleagues. Qual Saf Health Care 2005, 14:13-7.
• [15]Aranaz JM, Mira JJ, Guilabert M, Herrero JF: Vitaller J y grupo de trabajo segundas víctimas: Repercusión de los eventos adversos en los profesionales sanitarios. Estudio sobre las segundas víctimas. Trauma Fund MAPFRE 2013, 24:54-60.
• [16]Aranaz-Andrés JM, Limón R, Mira JJ, Aibar C, Gea MT, Agra Y, et al.: What makes hospitalized patients more vulnerable and increases their risk of experiencing an adverse event? Int J Qual Health Care 2011, 23:705-11.
• [17]Aranaz J, Aibar C, Limon R, Mira JJ, Vitaller J, Agra Y, et al.: A study of the prevalence of adverse events in primary healthcare in Spain. Europ J Publ Health 2012, 22:921-5.
• [18]Spanish National Statistics Institute. Producto Interior bruto (PIB). Available in: http://www.ine.es/prensa/pib_prensa.htm. Accessed 07/02/2014.
• [19]Spanish Ministry of Health, Social Services and Equality. Primary Care Information System (SIAP) Available in: http://www.msssi.gob.es/estadEstudios/estadisticas/estadisticas/estMinisterio/siap.htm. Accessed: 09/30/2014
• [20]Spanish Ministry of Health, Social Services and Equality. Specialised Care Information System (SIAE) Available in: http://www.msssi.gob.es/estadEstudios/estadisticas/estHospiInternado/inforAnual/homeESCRI.htm. Accessed: 09/30/2014
• [21]World Health Organization: The conceptual framework for the international classification for patient safety, version 1.1. WHO, Geneva; 2009.
• [22]Field TS, Mazor KM, Briesacher B, Debellis KR, Gurwitz JH: Adverse drug events resulting from patient errors in older adults. J Am Geriatr Soc 2007, 55:271-6.
• [23]Ministerio de Sanidad, Servicios Sociales e Igualdad. Cuestionario sobre seguridad de los pacientes. Versión española del Hospital Survey on Patient Safety. Madrid. 2005 Available in: http://www.msc.es/organizacion/sns/planCalidadSNS/docs/CuestionarioSeguridadPacientes1.pdf. Accessed: 01/07/2015. Accessed: 01/07/2014.
• [24]Torijano-Casalengua ML, Olivera-Cañadas G, Astier MP, Maderuelo-Fernández JA, Silvestre-Busto C: Validación de un cuestionario para evaluar la cultura de seguridad del paciente de los profesionales de atención primaria en España. Aten Primaria 2013, 45:21-37.
• [25]Colla JB, Bracken AC, Kinney LM, Weeks WB: Measuring patient safety climate: a review of surveys. QualSaf Health Care 2005, 14:364-6.
• [26]Conway JB, Weingart S: Leadership: assuring respect and compassion to clinicians involved in medical error. Swiss Med Wkly 2009, 139:3.
• [27]Hotvedt R, Førde O: Doctors are to blame for perceived medical adverse events. A cross sectional population study. The Tromsø study. BMC Health Serv Res 2013, 13:46. BioMed Central Full Text
• [28]Skivenes M, Trygstad S: When whistle blowing works: the Norwegian case. Hum Relat 2010, 63:1071-97.
• [29]O’Beirne M, Sterling P, Palacios-Derflingher L, Hohman S, Zwicker K: Emotional impact of patient safety incidents on family physicians and their office staff. J Am Board Fam Med 2012, 25:177e83.
• [30]Arndt M: Nurses’ medication errors. J Adv Nurs 1994, 19:519e26.
• [31]Meurier CE, Vincent CA, Parmar DG: Nurses’ responses to severity dependent errors: a study of the causal attributions made by nurses following an error. J Adv Nurs 1998, 27:349e54.
• [32]Schelbred AB, Nord R: Nurses’ experiences of drug administration errors. J Adv Nurs 2007, 60:317e24.
• [33]Ullström S, Andreen Sachs M, Hansson J, Ovretveit J, Brommels M: Suffering in silence: a qualitative study of second victims of adverse events. BMJ Qual Saf. 2014, 23:325-31.
• [34]Van Gerven E, Seys D, Panella M, Sermeus W, Euwema M, Federico F, et al.: Involvement of healthcare professionals in an adverse event: the role of management in supporting their workforce. Polish Arch Intern Med 2014, 14:035. AOP
• [35]Goldberg RM, Kuhn G, Andrew LB, Thomas HA: Coping with medical mistakes and errors in judgment. Ann Emerg Med 2002, 39:287-92.
• [36]de Wit ME, Marks CM, Natterman JP, Wu A: Supporting second victims of patient safety events: shouldn’t these communications be covered by legal privilege? J Law, Med Ethics 2013, 41:852-8.
• [37]Burlison JD, Scott S, Browne E, Thompson S, Hoffman J. The Second Victim Experience and Support Tool: Validation of an Organizational Resource for Assessing Second Victim Effects and the Quality of Support Resources. J Patient Saf. 2014; Aug 26. Epub ahead of print.
• [38]Scott S, Hirschinger L, Cox K, McCoig M, Brandt J, Hall L: The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Qual Saf Health Care 2009, 18:325-30.
• [39]Mira JJ, Lorenzo S, Carrillo I, et al. Degree of implementation and perceived usefulness of interventions that health organisations could put into practice to reduce the impact of adverse events in second and third victims in hospitals and primary care centres in Spain.