Literature DB >> 28934401

Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations.

Jose Joaquin Mira1,2, Susana Lorenzo3, Irene Carrillo2, Lena Ferrús4, Carmen Silvestre5, Pilar Astier6, Fuencisla Iglesias-Alonso7, Jose Angel Maderuelo8, Pastora Pérez-Pérez9, Maria Luisa Torijano10, Elena Zavala11, Susan D Scott12.   

Abstract

PURPOSE: To summarize the knowledge about the aftermath of adverse events (AEs) and develop a recommendation set to reduce their negative impact in patients, health professionals and organizations in contexts where there is no previous experiences and apology laws are not present. DATA SOURCES: Review studies published between 2000 and 2015, institutional websites and experts' opinions on patient safety. STUDY SELECTION: Studies published and websites on open disclosure, and the second and third victims' phenomenon. Four Focus Groups participating 27 healthcare professionals. DATA EXTRACTION: Study characteristic and outcome data were abstracted by two authors and reviewed by the research team. RESULTS OF DATA SYNTHESIS: Fourteen publications and 16 websites were reviewed. The recommendations were structured around eight areas: (i) safety and organizational policies, (ii) patient care, (iii) proactive approach to preventing reoccurrence, (iv) supporting the clinician and healthcare team, (v) activation of resources to provide an appropriate response, (vi) informing patients and/or family members, (vii) incidents' analysis and (viii) protecting the reputation of health professionals and the organization.
CONCLUSION: Recommendations preventing aftermath of AEs have been identified. These have been designed for the hospital and the primary care settings; to cope with patient's emotions and for tacking the impact of AE in the second victim's colleagues. Its systematic use should help for the establishment of organizational action plans after an AE.
© The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Entities:  

Keywords:  medical errors; nurses; organizational policy; patient safety; physicians; professional–patient relations; safety management; second victim; third victim

Mesh:

Year:  2017        PMID: 28934401     DOI: 10.1093/intqhc/mzx056

Source DB:  PubMed          Journal:  Int J Qual Health Care        ISSN: 1353-4505            Impact factor:   2.038


  11 in total

1.  The Effect of Second-Victim-Related Distress and Support on Work-Related Outcomes in Tertiary Care Hospitals in Kelantan, Malaysia.

Authors:  Ahmad Zulfahmi Mohd Kamaruzaman; Mohd Ismail Ibrahim; Ariffin Marzuki Mokhtar; Maizun Mohd Zain; Saiful Nazri Satiman; Najib Majdi Yaacob
Journal:  Int J Environ Res Public Health       Date:  2022-05-26       Impact factor: 4.614

Review 2.  A call to alarms: Current state and future directions in the battle against alarm fatigue.

Authors:  Marilyn Hravnak; Tiffany Pellathy; Lujie Chen; Artur Dubrawski; Anthony Wertz; Gilles Clermont; Michael R Pinsky
Journal:  J Electrocardiol       Date:  2018-07-29       Impact factor: 1.438

3.  The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers' Emotional Responses After a Clinical Error.

Authors:  José Joaquín Mira; Irene Carrillo; Mercedes Guilabert; Susana Lorenzo; Pastora Pérez-Pérez; Carmen Silvestre; Lena Ferrús
Journal:  J Med Internet Res       Date:  2017-06-08       Impact factor: 5.428

4.  Prioritising recommendations following analyses of adverse events in healthcare: a systematic review.

Authors:  Kelly Bos; Maarten J van der Laan; Dave A Dongelmans
Journal:  BMJ Open Qual       Date:  2020-10

5.  Victims of medical errors and the problems they face: a prospective comparative study among the Dutch population.

Authors:  Peter G van der Velden; Carlo Contino; Arno J Akkermans; Marcel Das
Journal:  Eur J Public Health       Date:  2020-12-11       Impact factor: 3.367

Review 6.  Addressing Acute Stress among Professionals Caring for COVID-19 Patients: Lessons Learned during the First Outbreak in Spain (March-April 2020).

Authors:  José Joaquín Mira; Ángel Cobos-Vargas; Maria Pilar Astier-Peña; Pastora Pérez-Pérez; Irene Carrillo; Mercedes Guilabert; Virtudes Pérez-Jover; Cesar Fernández-Peris; María Asunción Vicente-Ripoll; Carmen Silvestre-Busto; Susana Lorenzo-Martínez; Jimmy Martin-Delgado; Carlos Aibar; Jesús Aranaz
Journal:  Int J Environ Res Public Health       Date:  2021-11-16       Impact factor: 3.390

7.  Translation and Validation of the Malay Revised Second Victim Experience and Support Tool (M-SVEST-R) among Healthcare Workers in Kelantan, Malaysia.

Authors:  Ahmad Zulfahmi Mohd Kamaruzaman; Mohd Ismail Ibrahim; Ariffin Marzuki Mokhtar; Maizun Mohd Zain; Saiful Nazri Satiman; Najib Majdi Yaacob
Journal:  Int J Environ Res Public Health       Date:  2022-02-11       Impact factor: 3.390

8.  Health care workers' experiences of workplace incidents that posed a risk of patient and worker injury: a critical incident technique analysis.

Authors:  Emma Nilsing Strid; Charlotte Wåhlin; Axel Ros; Susanne Kvarnström
Journal:  BMC Health Serv Res       Date:  2021-05-27       Impact factor: 2.655

9.  Second victims in health care: current perspectives.

Authors:  Ozcan Ozeke; Vildan Ozeke; Ozlem Coskun; Isil Irem Budakoglu
Journal:  Adv Med Educ Pract       Date:  2019-08-12

10.  Humanizing harm: Using a restorative approach to heal and learn from adverse events.

Authors:  Jo Wailling; Allison Kooijman; Joanne Hughes; Jane K O'Hara
Journal:  Health Expect       Date:  2022-03-23       Impact factor: 3.318

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