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


Por: Mira JJ, Lorenzo S, Carrillo I, Ferrús L, Silvestre C, Astier P, Iglesias-Alonso F, Maderuelo JA, Pérez-Pérez P, Torijano ML, Zavala E, Scott SD and RESEARCH GROUP ON SECOND AND THIRD VICTIMS

Publicada: 1 ago 2017
Resumen:
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. Review studies published between 2000 and 2015, institutional websites and experts' opinions on patient safety. Studies published and websites on open disclosure, and the second and third victims' phenomenon. Four Focus Groups participating 27 healthcare professionals. Study characteristic and outcome data were abstracted by two authors and reviewed by the research team. 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. 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.

Filiaciones:
:
 Alicante-Sant Joan Health Department, Alicante, Spain

 Miguel Hernandez University, Elche, Spain

Lorenzo S:
 Fundación Alcorcón University Hospital, Madrid, Spain

:
 Miguel Hernandez University, Elche, Spain

Ferrús L:
 Integrated Health Organisation, L'Hospitalet de Llobregat, Spain

Silvestre C:
 Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain

Astier P:
 Family and Community Medicine, Tauste Health District, Aragon Health Service (SALUD), Zaragoza, Spain

Iglesias-Alonso F:
 Castilla La Mancha Health Service (SESCAM), Toledo, Spain

Maderuelo JA:
 Salamanca Primary Care Management, Castilla y León Health Service (SACYL), Salamanca, Spain

Pérez-Pérez P:
 Patient Safety Observatory, Andalusian Agency for Healthcare Quality, Seville, Spain

Torijano ML:
 Castilla La Mancha Health Service (SESCAM), Talavera de la Reina, Spain

Zavala E:
 Donostia University Hospital, Donostia, Spain

Scott SD:
 University of Missouri Health System, Columbia, MO, USA
ISSN: 13534505





INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE
Editorial
OXFORD UNIV PRESS, England, Reino Unido
Tipo de documento: Review
Volumen: 29 Número: 4
Páginas: 450-460
WOS Id: 000411455800003
ID de PubMed: 28934401
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