Schiechtl B, Hunger M S, Schwappach D L, Schmidt C E, Padosch S A
Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
Anaesthesist. 2013 Sep;62(9):734-41. doi: 10.1007/s00101-013-2215-5.
Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events.
A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures.
In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified.
The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.
临床医学中的危急事件可能对患者健康产生深远影响。在严重医疗差错的情况下，可能会严重伤害患者，甚至导致死亡。参与此类事件可能会引发应激反应，即医疗服务提供者中所谓的急性创伤后应激障碍，也就是不良事件的所谓“第二受害者”。心理困扰不仅可能对相关医生或护理人员的生活质量产生长期影响，还可能影响在不良事件发生后提供安全患者护理的能力。
进行文献综述，以获取护理人员对医疗差错的反应信息，并确定可能的支持策略，以减轻不良事件对“第二受害者”的负面影响。使用关键词“第二受害者”“医疗差错”“危急事件应激管理”（CISM）和“危急事件应激报告系统”（CIRS）在互联网和Medline/Pubmed上搜索科学研究。对提供危机管理项目的学术医学协会和公共机构的资料进行分析。数据按主要类别和与医院的相关性进行分类。采用描述性方法进行分析。
在灾难医学和航空导航服务中，实施CISM项目是一种有效的干预措施，可帮助工作人员在创伤事件后恢复，并恢复正常功能和行为。还确定了其他几个临床危机管理计划的概念。
在临床环境中整合CISM及与CISM相关的项目，可能在急性危机中提供有效的支持，并可能帮助护理人员有效应对未来的差错事件和员工安全问题。
