Emotional Impact of Medical Errors Victims of medical mistakes—patients, families, and professionals—are similar in many ways to victims of other types of traumas as they experience frequent images and/ or thoughts of the events that are triggered by nonspecific occurrences. But the sense of betrayal, loss of trust, isolation, and heightened vulnerability felt by both patients and their families is exacerbated in most cases because continued care is needed within the same system that harmed them. Patients and families perceive indifference from caregivers and feel isolated because emotional support is not typically provided when treatment ends (Delbanco & Sigall, 2007). Emotional support and trauma-focused cognitive-behavioral therapy have been suggested as strategies to ameliorate the negative effects of surviving medical error. All victims—be they patients, families, or professionals—express the desire to connect with others who have experienced similar trauma (Delbanco & Sigall, 2007). Involving patients and families in the processing of an adverse event in a structured manner may provide better communication with those affected by the event (Etchegaray et al., 2014). As
nursing staff represent that the majority of healthcare staffing, researchers have examined the safety culture within specific units, such as psychiatric inpatient units, to understand if unit safety culture is most salient for promoting patient safety. The research of Cho and Choi (2018) in this domain appears to verify that specific unit safety culture is among the most important factors, especially in the area of communication openness. Feedback and communication about errors, especially with family members, was associated with specific unit safety culture learning and practice. Because little research has been done to measure or identify patient safety competency among acute unit nursing staff, Cho and Choi (2018) sought to define measure and evaluate these factors, identifying attitudes, skills, and knowledge as the core of this type of competency. The authors concluded that nursing safety competency is plastic and can be improved with the right inputs. Case processing and debriefing related to adverse events were identified as useful measures to increase the safety competency of nursing staff.
CONCLUSION
The 1999 IOM report broke through the secrecy surrounding medical errors and fostered the growth of the patient safety movement, creating the research and clinical landscape that exist today. Patient safety has been the focus of many well-intentioned initiatives for more than a decade, but healthcare safety is still a work in progress and needs continual improvement. Few in the scientific and clinical community would dispute this claim. While many admirable projects have been studied and implemented, the overall field of patient safety suffers, as do many clinical fields, from fragmented definitions, insufficient regulatory oversight, and the clinical inertia that allow current practice to simply keep operating. The culture of medicine pervades most behavioral health settings. This cultural attitude can blame clinicians for adverse events rather than focusing on systems. To be safe, healthcare must learn from HROs, which perform high-risk activities with few accidents and adopt the human factors approach that acknowledges human fallibility, focusing on designing work processes that prevent harm and improve patient safety. Strategies to improve patient safety include safety briefings, root cause analysis, and full disclosure to patients and families about the circumstances surrounding adverse events. Al Madani, R., Al-Rayes, S. A., & Alumran, A. (2020). Policies vs practice of medical error disclosure at a teaching hospital in Saudi Arabia. Risk Management and Healthcare Policy, 13, 825-831. https://doi.org/10.2147/RMHP.S253275 Alshehri, G. H., Keers, R. N., & Ashcroft, D. M. (2017). Frequency and nature of medication errors and adverse drug events in mental health hospitals: A systematic review. Drug Safety, 40, 871-886. https://doi.org/10.1007/s40264-017-0557-7 Amalberti, R., & Vincent, C. (2020). Managing risk in hazardous conditions: Improvisation is not enough. BMJ Quality & Safety, 29(1), 60-63. Ayer, L., Horowitz, L. M., Colpe, L., Lowry, N. J., Ryan, P. C., Boudreaux, E., ... & Schoenbaum, M. (2022). Clinical pathway for suicide risk screening in adult primary care settings: Special recommendations. Journal of the Academy of Consultation-Liaison Psychiatry, 63(5), 497-510. https://doi.org/10.1016/j.jaclp.2022.05.003. Bates, D. W., & Singh, H. (2018). Two decades since to err is human: An assessment of progress and emerging priorities in patient safety. Health Affairs, 37(11), 1736-1743. References Beckett, P., Holmes, D., Phipps, M., Patton, D., & Molloy, L. (2017). Trauma-informed care and practice: Practice improvement strategies in an inpatient mental health ward. Journal of Psychosocial Nursing and Mental Health Services, 55(10), 34-38. Bennett, S. A. (2019). The training and practice of crew resource management: Recommendations from an inductive in vivo study of the flight deck. Ergonomics, 62(2), 219-232. Boothman, R. C., Blackwell, A. C., Campbell, D. A., Commiskey, E., & Anderson, S. (2009). A better approach to medical malpractice claims? The University of Michigan experience. Journal of Health Life Science Law, 2(2), 125-159. Brickell, T. A., & McLean, C. (2011). Emerging issues and challenges for improving patient safety in mental health: A qualitative analysis of expert perspectives. Journal of Patient Safety, 7(1), 39-44. Burlison, J. D., Scott, S. D., Browne, E. K., Thompson, S. G., & Hoffman, J. M. (2017). The Second Victim Experience and Support Tool: Validation of an organizational resource for assessing second victim effects and the quality of support resources. J Patient Saf, 13(2), 93-102. Cash, R. E., Anderson, S. E., Lancaster, K. E., Lu, B., Rivard, M. K., Camargo Jr, C. A., & Panchal, A. R. (2020). Comparing the prevalence of poor sleep and stress metrics in basic versus advanced life support emergency medical services personnel. Prehospital Emergency Care, 24(5), 644-656. Castro-Rodríguez, C., Solís-García, G., Mora-Capín, A., Díaz-Redondo, A., Jové-Blanco, A., Lorente-Romero, J., ... & Marañón, R. (2020). Briefings: a tool to improve safety culture in a pediatric emergency room. The Joint Commission Journal on Quality and Patient Safety, 46(11), 617-622. Chassin, M. (2019). To err is human: The next 20 years. The Joint Commission High Reliability Healthcare Blog. www.jointcommission.org/resources/news-and-multimedia/ blogs/high-reliability-healthcare/2019/11/to-err-is-human-the-next-20-years/
Preventable mistakes are just beginning to get the attention they deserve in behavioral health settings. Adverse events that are common in behavioral health settings include suicide, unreported abuse and neglect, and medical illnesses that are misdiagnosed as psychiatric conditions. The Joint Commission has placed these as top priorities for client safety in behavioral health. Licensed behavioral health professionals are advised to check with their licensing boards as to specific continuing education requirements on medical error prevention. Behavioral health professionals can play an important role in creating a safety culture by providing mental health services for victims of medical error. Victims experience symptoms similar to those experienced by other trauma survivors, such as burdens of betrayal, loss of trust, isolation, and heightened vulnerability. Professionals involved in adverse events that harm their clients are called second victims, and they may suffer from guilt, sleep disturbance, depression, anxiety, and decreased self-esteem. Behavioral health professionals can provide safer care by learning to identify vulnerable clients and error-prone conditions in the work setting and by providing psychosocial services to victims of medical mistakes. Cheema, F., Mckechnie, P., Carlyle, A., Ross, J., Renwick, C., & Hall, D. (2013). Improving patient safety in mental health through quality risk management. European Psychiatry, 28(Suppl. 1), 1. Cho, S. M., & Choi, J. (2018). Patient safety culture associated with patient safety competencies among registered nurses. Journal of Nursing Scholarship, 50(5), 549. https:// doi.org/10.1111/jnu.12413 Delbanco, T., & Sigall, K. B. (2007). Guilty, afraid, and alone: Struggling with medical error. New England Journal of Medicine, 357, 1682-1683. Deng, M., Chen, W., Pang, T., & Lin, C. (2019). Effect of daily safety briefing huddles on the reporting of adverse events and near-misses. American Journal of Nursing, 8(3), 92-96. D'Lima, D., Crawford, M. J., Darzi, A., & Archer, S. (2017). Patient safety and quality of care in mental health: A world of its own? BJPsych Bulletin, 41(5), 241-243. Etchegaray, J. M., Gallagher, T. H., Bell, S. K., Dunlap, B., & Thomas, E. J. (2012). Error disclosure: A new domain for safety culture assessment. BMJ Quality & Safety, 21(7), 594- 599. Ferguson, M., Rhodes, K., Loughhead, M., McIntyre, H., & Procter, N. (2022). The effectiveness of the safety planning intervention for adults experiencing suicide-related distress: A systematic review. Archives of Suicide Research, 26(3), 1022-1045. Flick, C., & Schweitzer, K. (2021). Influence of the fundamental attribution error on perceptions of blame and negligence. Experimental Psychology, 68(4), 175-188. https://doi. org/10.1027/1618-3169/a000526 Frogner, B. K., Fraher, E. P., Spetz, J., Pittman, P., Moore, J., Beck, A. J., ... & Buerhaus, P. I. (2020). Modernizing scope-of-practice regulations: Time to prioritize patients. N Engl J Med, 382(7), 591-593. Frueh, B. C., Knapp, R. G., Cusack, K. J., Grubaugh, A. L., Sauvageot, J. A., Cousins, V. C., ... & Hiers, T. G. (2005). Special section on seclusion and restraint: Patients' reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services, 56(9), 1123-1133. Helmchen, L. A., Richards, M. R., & McDonald, T. B. (2011). Successful remediation of patient safety incidents: A tale of two medication errors. Healthcare Management Review, 36(2), 114-123. Institute for Safe Medication Practices. (2011, July). Too many abandon the “second victims” of medical errors. ISMP Medication Safety Alert. http://www.ismp.org/Newsletters/ acutecare/articles/20110714.asp Jayaram, G., Doyle, D., Steinwachs, D., & Samuels, J. (2011). Identifying and reducing medication errors in psychiatry: Creating a culture of safety through the use of an adverse event reporting mechanism. Journal of Psychiatric Practice, 17(2), 81-88. Jedick, R. (2022). Human factors in medicine: A medical error model that isn't full of holes. Emergency Medicine News, 44(11), 24. The Joint Commission. (2022a). Comprehensive accreditation manual for behavioral health care and human services: Sentinel event policy. https://www.jointcommission.org/-/
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