Adverse Health EventsI met Tina Hilmas last spring in Washington D.C. when both speaking at a professional conference. As we talked, we got on the topic of second victims. More attention has been paid to patient safety and preventing harm, not much attention has been paid to how patient safety events can affect healthcare providers.  Home health and home care providers affected by patients’ safety events can become the second victims of an adverse health event.

Dr. Susan Scott at the University of Missouri defines second victims as “health care providers who are involved in an unanticipated adverse patient event, in a medical error or a patient-related injury.” They become victimized in the sense that they are traumatized by the event. These providers feel responsible for the patient outcome.  They believe they have failed the patient, second-guessing their professional expertise. The second victim phenomenon can occur to any provider, in any organization along the continuum of care including long-term care, home health, home care, and hospice.

As with many issues of safety, much of the initial research into second victims has been completed in hospitals. Home care providers are just as susceptible to the second victim phenomena as those health workers working within hospital walls. Home care agencies should consider implementing those programs as part of the continuum of care.  

Providers experiencing the aftermath of an adverse medical event report feeling anxious and depressed. They become concerned about being able to perform their job.  It is distressing to know that two third of providers involved in a patient safety event reported receiving no support from their organization.

In 2010, a nurse with 27 years’ experience accidentally administered a calcium chloride overdose to a pediatric patient who eventually died. The nurse was suspended and then fired from her job. Despite agreeing to a four-year probation on her license, the nurse could not find employment and committed suicide seven months after the incident.  The investigation could not determine with certainty that the overdose was the cause of death. The nurse was a healer at heart according to family members and former patients. She made a terrible error and paid the ultimate price for it.

In home-based care, many home health patients become long-term clients, especially if they are older and suffering from chronic conditions. It is very common for caregivers to form an attachment to their patients. They tend to blame themselves if a patient safety event occurs when they are involved in the care.  Medication changes can easily lead to adverse reactions or overdoses.  Wound care turning into infections. Those are common situations encountered by home health providers which can lead to patient safety events and the rise of second victim syndrome.

Caregivers have strong emotional defenses that carry them through difficult clinical events. They are able to “get the job done.” Yet sometimes the emotional aftershock (or stress reaction) can be difficult. If a client takes a turn for the worse unexpectedly, the provider can experience reaction very similar to PTSD, making them a ‘second victim’ of the patient safety event.

The provider may be emotionally traumatized by the event, and have lasting effects that persist for months or years afterward. If not treated, a second victim experience can harm the emotional and physical health of the provider. Second victim effects include difficulty sleeping, reduced job satisfaction, guilt and anxiety (including fear of litigation or job loss). For some, recurrent memories of the event contribute to burnout, depression and suicidal ideation. After an adverse event, the healthcare worker may experience characteristics of post-traumatic stress disorder. This emotional aftershock may last a few days, a few weeks, a few months, or longer.