Coping with medical error: The case of the health professional

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Background. Mistakes are inevitable in medicine' (Wu, 2003)850,000 errors, 40, 000 deaths each year in UK (Aylin et al , 2004) HP's accompany each of these mistakesPost-event investigations = devastating personal

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Coping with medical error: The case of the health professional

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1. Reema Sirriyeh EMAIL: [email protected] Bradford institute for health research / university of leeds Supervisors: Rebecca Lawton, Gerry Armitage & Peter Gardner Coping with medical error: The case of the health professional

2. Background ‘Mistakes are inevitable in medicine’ (Wu, 2003) 850,000 errors, 40, 000 deaths each year in UK (Aylin et al , 2004) – HP’s accompany each of these mistakes Post-event investigations = devastating personal & professional consequences for HP’s (Scott et al, 2009)

3. Cases of error Wayne Jowett 18 year old cancer patient SHO wrongly injected intravenous drug intrathecally Gerry Armitage previously Ward Manager (acute paediatric ward) Over dose of lactulose administered to a baby

4. Research Questions What is the psychological response of healthcare professionals who have been involved in an error? How do health professionals cope with the experience of making an error? Does professional group or the type of error affect the response to making an error or coping strategy selected? What kinds of strategies might be effective in providing support for health professionals to help them recover from making an error?

5. Systematic review Findings from 24 studies : Significant distress : anxiety/depression/shame,/guilt/self-doubt Gains to be made: attention to safety/ assertiveness/ communication – team & organisational Lack of info support & coping Methodological issues

6. Mixed-methods approach Studies:

7. Study 1: Questionnaire in NHS Trust Multi-disciplinary sample of 155 health professionals Assessed: emotional responses, common experiences, coping strategies & perspectives of existing support service Main findings: Most common feelings: anxious, unhappy, worried, guilty Nurses experience greater negative emotions after an error than doctors Different coping strategies relate to different types of error Reappraisal of the error promotes emotional well-being

8. Study 2: Questionnaire in USA hospital Comparable sample of 165 health professionals Same questionnaire tool Main findings: Similar to UK in many ways: Nurses experience greater negative emotions after an error than doctors Coping strategy selected predicts later emotional state; reappraisal of the error promotes emotional well-being BUT greater discussion of the impact of fears of litigation = increased value of shared responsibility

9. Study 3: Manager interviews Aim: to explore the context of error and gain insight into the experience of managing these events Pilot study : hospice sector (N = 15) Main study: NHS sector (N = 26) Qualitative in-depth semi-structured interviews

10. Main findings

11. Study 4: Focus group work Currently in progress Aim: to gather additional data from service users about useful sources of support and the nature of intervention which is required Multi-disciplinary groups of health professionals from UK trusts

12. Recommendations for providing support

13. Implications

14. References Aylin P; Tanna S; Bottle A; Jarman B. (2004). How often are adverse events reported in English hospital statistics?. BMJ. 329:369 Scott SD, Hirschinger LE, Cox KR et al. The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Quality and Safety in Health Care 2009; 18: 325-330. Sirriyeh, R., Lawton, R., Gardner, P & Armitage, G. (2010). Coping with medical error : a systematic review of papers to assess the impact of involvement in medical errors on health professional’s psychological well-being. Quality and Safety in Health Care, 19: 1-8. Sirriyeh, R., Armitage, G., Lawton, R., & Gardner, P,. (2010). Medical error in the hospice setting: exploring the perspectives of management staff. International Journal of Palliative Nursing , 16(8):377-86 Wu AW, Folkman S, McPhee SJ, et al. Do house officers learn from their mistakes? Quality & Safety in Health Care 2003; 12: 221-27.

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