• Dealing with adverse events

    With nearly half a million adverse events in healthcare being recorded in Australia every year [1], it is likely you will find yourself in a situation where a patient in your care has been harmed.

    Doctors can suffer extreme levels of stress and anxiety when something goes wrong. This can put doctors at greater risk of making another mistake, and may affect their ability to communicate with the patient. In addition to managing the patient’s needs, addressing the doctor’s feelings is an important part of managing an adverse event.

    Here we outline ways you can look after yourself when your patient suffers an adverse outcome. We also outline the steps in the open disclosure process, a process that not only benefits patients, but also may benefit you.

    Threats to doctors’ wellbeing after an adverse event

    An adverse event is any event or circumstance arising during care that could have or did lead to unexpected harm, loss or damage.

    Much work has been done on managing patients after an adverse event, particularly through the open disclosure process. But managing doctors’ wellbeing after an adverse event is often overlooked.

    Recent research shows that adverse events can affect doctors significantly. Both the incident itself and the way in which it is handled can impact upon those involved. Common responses include emotional reactions such as shock, disbelief, guilt and shame, loss of confidence and doubt about their professional judgment [5]. These impacts are not necessarily proportional to the impact on the patient. At Avant we have had cases where a relatively minor incident with minimal harm to the patient has had devastating impacts on the doctor, even to the point where they reconsider their career choice.

    The research emphasises the long lasting emotional effects of being involved in adverse events, and suggests that the extent and duration of the impact of an adverse event is linked to the support provided following an incident [4].

    However, other research shows that doctors tend to be unwilling to accept professional criticism or to receive support when an adverse event occurs [2]. Being open to help is important, emotional unburdening and receiving professional reassurance from peers plays a critical role in recovery. Without this, health professionals can become increasingly isolated [4] and even the threat of a complaint or claim can cause emotional distress [3].

    When you are involved in an adverse event it is important to look after yourself, and to access help and support. This will be better for you and for your patient.

    If you are involved in an incident involving an adverse outcome, you should also be aware of the need to notify your insurer in accordance with your insurance incident notification requirements.

    The Open Disclosure Process

    Open disclosure describes the way clinicians communicate with patients who have experienced harm during health care.

    Open disclosure involves a factual account of what happened, discussion of the potential consequences of the adverse event, and an exchange of information. Open disclosure may take place in one conversation or over one or more meetings, and the patient should be given an opportunity to relate their experience of the event.

    A key element of the open disclosure process is an apology or expression of regret, which should include the words “I am sorry” or “we are sorry”.

    The open disclosure process involves:

    • Acknowledging that an adverse event has occurred
    • Apologising or expressing regret for what has occurred (including the words ‘I am/we are sorry’)
    • Outlining the facts that are known about what has happened and outlining what further steps are planned (including side-effects, expected costs and any concessions you may make)
    • Actively listening to the patient’s clinical and personal experience of the event
    • Providing information on what steps are planned to determine what went wrong and how similar events may be prevented in the future and agree to give feedback on this when details are available.

     

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    Reminder from avant-learning-centre

    More information on open disclosure can be found in our Risk IQ factsheet “Open disclosure and how to say sorry”...more

    Cautionary Tale

    Tips

     

    Looking after yourself after an adverse event

    • Look after your physical health: eat well, get enough sleep, and increase the amount of exercise you do
    • Try not to worry or obsess about the adverse event – debrief, formally or informally, after an incident
    • Consider stress management techniques like yoga or meditation
    • Take an active role in the open disclosure process
    • Learn from the incident – consider what you can do proactively to prevent the same thing happening in the future. Avant’s Risk Advisory service can assist in identifying what may have led to the adverse event
    • Seek the advice of your GP if you are concerned about the effect an adverse event is having on your health
    • Contact Avant’s Medico-Legal Advisory Service for advice on how to handle an adverse event, including notifying your insurer about the incident.
     

    References

    1. Australian Institute of Health and Welfare, www.aihw.gov.au/haag11-12/adverse-events/ , accessed June 2014.
    2. Aasland O et al. Impact of feeling responsible for adverse events on doctors' personal and professional lives: the importance of being open to criticism from colleagues. Qual Saf Health Care 2005. 14(1): 13–17.
    3. Nash L et al. The psychological impact of complaints and negligence suits on doctors. Australian Psychiatry 2004 12(3) 278-281
    4. Ullstrom S, Sachs MA, Hansson J, Ovretveit J, Brommels M. (2014) Suffering in silence: a qualitative study of second victims of adverse events. BMJ Quality and Safety; 23: 325-331.