Jan Stewart Memorial Wellness Lecture Presents What Happens After a Medical Error
The Jan Stewart Memorial Wellness Lecture (“Another Day of Surgery: Lessons at the Sharp End of Care”) will feature Maria Van Pelt, PhD, CRNA, Linda Kenney, and Rick Van Pelt, MD, MBA, in an interactive session that explores the patient’s and anesthesia professional’s perspectives and experiences following a medical error. The session will be held Sunday, September 23 from 7:30 a.m. to 9 a.m. in the Auditorium at Hynes Convention Center. AANA spoke with Maria Van Pelt to find out more.
AANA: What is the Second Victim phenomenon and how prevalent is it in the nurse anesthesia profession?
Maria Van Pelt: The consequences of adverse events on healthcare providers have been described for several decades. In the 1980s, the impact was documented in the literature in the form of personal stories that described the emotional distress associated with adverse events, such as feelings of incompetence and guilt in the aftermath. The effect of an adverse event, such as a medical error, was formally recognized by Albert Wu (and colleagues) when they described the emotional and functional impact a medical error can have on a resident physician. Wu subsequently coined the term “second victim” in an editorial that described a resident physician who was subject to scrutiny from his peers after he made a medical error.
The scope of the second victim premise was expanded by Vincent and Denham to include members of other healthcare professions, such as nurses and pharmacists. Scott and colleagues in 2009 further defined the premise of a second victim to include exposure to clinical events beyond medical errors, and also studied the impact on all healthcare providers (now to include support personnel, students, and volunteers). They validated that when healthcare providers are involved in adverse events, emotional distress is prevalent. This definition published by Scott and colleagues in 2009 ultimately formalized use of the term “second victim” in the literature.
Unfortunately, second victim phenomenon is quite prevalent in the nurse anesthesia profession. In 2015, I conducted a national study that examined nurse anesthetists’ experiences with a catastrophic perioperative memorable event, including their perceptions of the emotional and cognitive impact, the coping strategies used, and their perceptions of institutional support and institutional response to the event following a catastrophic perioperative memorable event. In this study, the top three emotional impact items with the highest frequency rates reported by nurse anesthetists after a perioperative catastrophic memorable event were reliving of the event (72 percent), guilt (70 percent), and anxiety (67 percent). (These frequencies were similar to findings of Gazoni and colleagues for anesthesiologists who experienced a perioperative catastrophe.) After the adverse event, many of these CRNAs took months to emotionally recover, and approximately 20 percent of them stated that they have never emotionally recovered after the event.
AANA: What are the signs that someone may be experiencing a second victim phenomenon?
Van Pelt: These emotional reactions that someone with second victim phenomenon may experience include feelings of guilt, anxiety, reliving the event, fear and embarrassment, fear of loss of reputation, and wishing to make amends to the patients or families of patients who were harmed. In addition, depression, and/or concerns about their ability to perform their jobs, as a result of being a second victim, are common.
AANA: What is most important for someone undergoing this phenomenon to keep in mind, and what kind of help is available?
Van Pelt: It is important for someone undergoing this phenomenon to keep in mind the six stages of recovery after an adverse event. Scott in 2009 described that clinicians typically experience many, if not all, six stages of recovery as they move through the aftermath of an event (Table). These stages are not fixed and may occur in random order.
Table. Six Stages of Recovery After an Adverse Event or Medical Error
- Chaos and accident
- Intrusive reflection
- Restoring personal integrity
- Enduring the inquisition
- Obtaining emotional first aid
- Moving on – dropping out, surviving and thriving
In the aftermath of an adverse event, it is important for the nurse anesthetist to seek emotional support during any one of these stages of recovery. One of the most frequent coping mechanism that is reported to be helpful is peer support, support from anesthesia colleagues, other members of the surgical team and spouse, family, or friends. In addition, nurse anesthetists should always consider established referral network systems within their organization such as: employee assistance programs, chaplains, social work, and/or a clinical psychologist.
AANA: What will someone learn by coming to your session?
Van Pelt: Attendees will learn to:
- Understand the emotional impact that catastrophic medical events have on caregivers, patients and families;
- Appreciate the magnitude of the catastrophic medical event challenge;
- Understand the implications that catastrophic medical events have on quality, safety and well-being;
- Understand the value of peer support programs with introduction of proven models, tools and training venues that can be applied to participant home organizations.