SUPPORT FOR SECOND VICTIMS

To acknowledge that the patient is the primary victim in any medical error, unanticipated adverse patient event, or patient-related injury; further,

To acknowledge that involvement by healthcare personnel in such events may cause them to become second victims; further,

To recognize that a just culture and a healthy culture of safety embrace a support system for second victims; further,

To encourage healthcare organizations to establish programs to support second victims; further,

To educate healthcare professionals (including those in training), health organization administrators, and regulatory agencies about the second-victim effect and available resources.

Rationale

The University of Missouri Health System has defined second victims as “healthcare providers who are involved in an unanticipated adverse patient event, in a medical error and/or a patient-related injury and become victimized in the sense that the provider is traumatized by the event.” Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second-guessing their clinical skills and knowledge base. Individuals involved in a serious adverse patient event may experience the symptoms of post-traumatic stress disorder and may require support to successfully manage the experience.

Healthcare organizations have emphasized establishing a just culture environment to encourage individuals to speak up when they are aware of medication errors. Studies have indicated that many second victims did not feel they received organizational support after these events, however. The Joint Commission, the Institute for Healthcare Improvement, the Institute for Safe Medication Practices (ISMP), and others have advocated for support systems for second victims. The Joint Commission Leadership Standards state that leaders will “make support systems available for staff that have been involved in an adverse or sentinel event.”

Healthcare organizations will have to tailor these support system to their needs. Such support systems may, for example, be tiered, with the first tier being unit or department support; the second tier, trained peer support, including patient-safety and risk-management staff; and the third tier, professional counseling support, such as employee assistance programs or social workers. Education of staff on resources available to support the second victim is critical to avoiding adverse impact on the second victim.