Zimonjić Ivana, Marinković Valentina, Mira José Joaquín, Djokic Borivoje-Boris, Odalović Marina
Faculty of Pharmacy, Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade, Vojvode Stepe 450, 11000, Belgrade, Serbia.
Galenika a.d. Beograd, Belgrade, Serbia.
Int J Clin Pharm. 2025 Feb;47(1):68-79. doi: 10.1007/s11096-024-01807-w. Epub 2024 Oct 10.
The second victim phenomenon, denoting the harmful effects of patient safety incidents on healthcare practitioners, remains insufficiently examined within the pharmacy workforce.
This study aimed to investigate the second victim phenomenon in community pharmacies, focusing on its triggers, impacts on pharmacists' well-being, and effects on pharmaceutical care and safety.
This consensus study with the Nominal Group Technique involved 27 community pharmacists in three equal groups. The final ranks of the statements scored by participants from 5 to 1 were recalculated using the Van Breda method, combining three distinct data sets with higher values for a higher impact on the output evaluated. Statistics were applied to ascertain event distribution and investigate the potential relationships between event categories and outcomes for patients and pharmacists.
"Patient-centric anxiety" (6.8) was the top mental health issue, followed by "Personal responsibility and resilience" and "Future concerns and career aspirations" (6.0 each). The dominant support was "Colleague/Peer support" (5.3). The most frequent patient safety incidents were "Inadequate pharmaceutical service" (8.0) and "Wrong drug dispensed" (7.8). Most errors (63%) were dispensing failures, primarily wrong drug dispensed (44.4%). Of these, 50% were near misses, 25.0% caused no harm, and 16.7% had serious consequences. Field notes suggest contributing factors like inadequate supervision, crowding, and storage issues.
This study revealed the second victim phenomenon among pharmacists, which potentially stems from breaches in practice standards. The impact on the quality and safety of pharmaceutical care and its influence on pharmacists' well-being should be studied in further studies.
二次受害者现象是指患者安全事件对医护人员产生的有害影响，在药学工作人员中仍未得到充分研究。
本研究旨在调查社区药房中的二次受害者现象，重点关注其触发因素、对药剂师幸福感的影响以及对药学服务和安全的影响。
本采用名义群体技术的共识研究涉及27名社区药剂师，分为三个相等的组。参与者对陈述从5到1进行评分，最终排名使用范·布雷达方法重新计算，该方法结合了三个不同的数据集，数值越高对评估产出的影响越大。应用统计学方法确定事件分布，并调查事件类别与患者和药剂师结果之间的潜在关系。
“以患者为中心的焦虑”（6.8）是首要心理健康问题，其次是“个人责任与恢复力”以及“未来担忧与职业抱负”（均为6.0）。主要的支持是“同事/同行支持”（5.3）。最常见的患者安全事件是“药学服务不足”（8.0）和“发错药”（7.8）。大多数错误（63%）是配药失误，主要是发错药（44.4%）。其中，50%是险些发生的失误，25.0%未造成伤害，16.7%造成了严重后果。现场记录表明促成因素包括监督不足、拥挤和储存问题。
本研究揭示了药剂师中的二次受害者现象，这可能源于实践标准的违反。在进一步研究中应探讨其对药学服务质量和安全的影响及其对药剂师幸福感的影响。
