Action after Adverse Events in Healthcare: An Integrative Literature Review

Liukka, Mari, Steven, Alison, Vizcaya Moreno, M Flores, Sara-aho, Arja M., Khakurel, Jayden, Pearson, Pauline, Turunen, Hannele and Tella, Susanna (2020) Action after Adverse Events in Healthcare: An Integrative Literature Review. International Journal of Environmental Research and Public Health, 17 (13). p. 4717. ISSN 1661-7827

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Official URL: https://doi.org/10.3390/ijerph17134717

Abstract

Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009–2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed.

Item Type: Article
Additional Information: Funding information: The sixth author would like to thank INVEST Research Flagship funded by the Academy of Finland Flagship Programme (decision number: 320162).
Uncontrolled Keywords: patient safety; adverse events; first victims; second victims; third victims; management
Subjects: A300 Clinical Medicine
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: John Coen
Date Deposited: 25 Jun 2020 09:52
Last Modified: 16 Dec 2022 16:01
URI: https://nrl.northumbria.ac.uk/id/eprint/43577

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