AJHP Editorial Calls for Support of "Second Victims"


Peer involvement and open communication are key for intervention programs.


BETHESDA, MD—More well-designed, formalized efforts to help the “second victims” of medication errors, unanticipated adverse patient events, and/or patient-related injuries should be implemented, according to a recent editorial in the American Journal of Health-System Pharmacy (AJHP) authored by Natasha Nicol, Pharm.D., FASHP, Director of Global Patient Safety Affairs for Cardinal Health.

“Understanding why and how errors occur, and then working to reduce the chances they could happen again, are crucial to healing; this isn’t just about pharmacy, but we can certainly start in our own profession,” Dr. Nicol writes.

The editorial accompanies a case study in the April 1 issue of AJHP called “Implementation of a ‘Second Victim’ Program in a Pediatric Hospital” by Kara D. Krzan, Pharm.D., M.S.; Jenna Merandi, Pharm.D., M.S.; Shelly Morvay, Pharm.D.; and Jay Mirtallo, M.S., B.S.Pharm., BCNSP, FASHP, FASPEN. The study examines the outcomes of a successful ‘Second Victims’ program developed by Nationwide Children’s Hospital (NCH), a 435-bed pediatric hospital with a staff of over 9,000 in Columbus, OH.

The “Second Victim” phenomenon is quite common, according to the article. In a survey of 5,000 physicians, nurses, and medical students, 30 percent of the 898 survey respondents reported personal problems as a result of a clinical patient safety event during the past year.

In the editorial, Dr. Nicol shares her own experience as a second victim and points to the need to fight the natural human instinct to blame the individual, saying that a systematic approach is critical to solving medical errors. “Looking back, I realize that I am actually one of the fortunate second victims (if there can be such a thing),” she writes. “I received compassionate, timely, and much-needed support after the event, which is not the case for many who have experienced what I did.”

Dr. Nicol adds that many second victims within the healthcare community are too afraid and ashamed to speak out, adding that open and honest communication is key in reducing the personal blame and shame that a second victim suffers.

Dr. Nicol also makes recommendations for effective programs for second victims in healthcare organizations. She advocates for an intervention process centered around peers as the primary providers of initial support, policies that prevent punishment as the predominant response to human error, and the creation of a culture of learning in which stories are shared and disclosure at all levels becomes the norm.

“Human errors happen every day. Second victims are created every day. Understanding why and how medication errors occur, and then working to reduce the chances they could happen again, is crucial to healing,” says Dr. Nicol. “We need to create strategies to minimize risk, but also to provide effective, compassionate support for individuals involved in catastrophic events.”

The editorial points to the well-designed second victim support program at Nationwide Children’s Hospital. Nationwide has created the peer-based YOU Matter program, which trains staff members to identify second victims, serve as “first responders,” and provide referrals to behavioral health, social work, and employee assistance personnel as appropriate. Staff members involved in work-related events can seek support via a Web-based portal for event reporting and discussion.

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