Mental health, risk mitigation and compliance

At MedSecure, we place the mental health of caregivers at the core of work. We believe that compliance and risk mitigation should align the values of professional quality patient care with support for healthcare practitioners – the higher the quality of healthcare from an ethical and legal perspective, the better healthcare practitioners are supported.

We believe that this approach addresses all stages of the practitoner-patient relationship, from obtaining properly informed consent, to a clear understanding of what is expected as a professional in dealing with and  treating the patient, to having policies and procedures in place in the event of an adverse outcome.

MedSecure incorporates this thinking in all its policies and procedures in order to address these issues in order to produce world class, leading edge solutions to risk mitigation and compliance.

Caring for healthcare practitioners

Healthcare practitioners who are involved in an unanticipated adverse patient event, medical error and/or a patient-related injury can themselves be negatively affected due to being traumatised by the event.

Most health care providers adjust well to the enormous demands encountered during an unexpected or traumatic clinical event. Individual practitioners often have strong emotional defenses that carry them through and let them “get the job done.” Sometimes, however, the emotional “aftershock” (or stress reaction) can be challenging for the healthcare practitioner or support staff involved. Signs and symptoms of this reaction can last a few days, a few weeks, a few months, or longer.

Healthcare practitioners may:

Feel personally responsible for the unexpected patient outcomes

Feel as though they have failed the patient

Second-guess their clinical skills

Second-guess their knowledge base

Adverse outcomes: key points

The following key points apply when an adverse outcome occurs:

Each healthcare practitioner (even those involved in the same event) will have unique experiences and needs.

Regardless of job title, providers respond in predictable manners. The six stages of second victim recovery explain how the second victim is impacted by the clinical event

There are some events that are high risk for inducing a second victim response

First tendency of providers is self isolation

Providers tend to ‘worry’ in a predictable pattern

Sometimes the entire team is impacted by a clinical event

High-risk scenarios

There are several types of clinical events that can evoke a second victim response. Examples of high-risk situations that may induce a stress response include:

Patient who “connects” to a health care professional’s own family

Unanticipated clinical event involving a pediatric patient

Unexpected patient death

Preventable harm to patient

Multiple patients with bad outcomes within a short period of time within one clinical area

Long-term care relationship with patient death

Clinician experiencing his or her first patient death

Failure to detect patient deterioration in timely manner

Death in a young adult patient

Notification of pending litigation plans

Community high-profile patient or event

Health care professional who experienced needle stick exposure with high-risk patient

Death of a staff member or spouse of a staff member

Recovery  stages

Healing and recovery occurs in a predictable manner. The MedSecure Programme aims to provide a structure which supports the healthcare practitioner in progressing from the stage of Chaos and Accident Response to an outcome where the practitioner is able to thrive. The other Compliance Domains are all integrated into a structure which supports a positive outcome.

Photo of the recovery stages of second victims.

Six stages of recovery have been identified as:

Chaos and Accident Response

Intrusive Reflections

Restoring Personal Integrity

Enduring the Inquisition

Obtaining Emotional First Aid

Moving On

Dropping out

Surviving

Thriving

“Triggering” has been defined as reliving the initial event when an external stimulus, such as a similar clinical situation, is presented. Triggering may occur at any time following the event by a random number of variables that the caregiver encounters.

Different factors have been described as triggering fresh memories of an old event. Examples of common triggers are:

taking care of a patient in the exact location of the original event,

treating a patient with a similar name or similar diagnosis, or

treating of the original patient.

When the memory is triggered, similar physical or psychological symptoms may return.

Common responses and symptoms

Distressed car follow predictable patterns of worrying about:

PATIENT PRACTITIONER PEERS
Is the patient/family okay? Will I be fired? What will my colleagues think?
What have they been told? Will I be sued? Will I ever be trusted again
How did they respond? Will I be reported to the HPCSA? Will I still be a respected member of my team?

Next steps

Who will contact me to discuss the case?

If a lawsuit does happen, when will I know? How will I hear about it?

What do I need to do?

Common phrases

“I had a sickening realization of what happened.”

“I don’t deserve to be a doctor.”

“This will change the way I come to work from now on.”

“This has been a career-changing event.”

“I came to work today to help someone, not to hurt them.”

“This is a turning point in my career.”

“This event shook me to my core. I’ll never be the same again.”

Signs and symptoms

Healthcare practitioners may experience various physical and psychosocial symptoms. These symptoms are normal reactions to an abnormal and unanticipated patient event or outcome.

Common reactions reported by distressed practitioners include several psychological and physical symptoms.

 

PHYSICAL SYMPTOMS PSYCHOLOGICAL SYMPTOMS
Sleep disturbances Isolation
Difficulty concentrating Frustration
Eating disturbances Fear
Headache Uncomfortable returning to work
Fatigue Anger, Irritability
Nausea, vomiting Depression
Diarrhea Extreme Sadness
Rapid heart rate Self-doubt
Rapid breathing Flashbacks
Muscle tension Feeling numb