Pharmacists may suffer great harm if they make errors, writes Curtis Ruhnau
There has been much talk over recent weeks about pharmacist stress in relation to the National Stress and Wellbeing Survey. Much of this has focused on stress which may lead to an increase in errors, or which leads pharmacists to be concerned that they may make an error.
This is worrying, but not unsurprising as pharmacists, like any health professional, have long been concerned about errors.
But there is another aspect to this. In the case that an error is made, sometimes the pharmacist involved becomes the second victim of the error.
The Australian Commission on Safety and Quality in Health Care covers this: “Healthcare professionals are committed to caring for patients. They are deeply affected by harmful incidents, even if they only played a small role. Providers involved in harmful incidents are sometimes called the ‘second victims’ because of the enduring effects the incident can have on them.” (Australian Commission on Safety and Quality in Health Care (2012), Short Guide to the Open Disclosure Standard Review Report, ACSQHC, Sydney.)
The stress of being involved in an error can lead pharmacists to feel some of the same emotions/feelings as the affected patient and their family members. Signs and symptoms can include “initial numbness, detachment, and even depersonalisation, confusion, anxiety, grief and depression, withdrawal or agitation, and re-experiencing of the event.
“Added symptoms related to medical errors include shame, guilt, anger and self-doubt.” (Wu and Steckelberg, BMJ Qual Saf 2012:21:267-270).
PDL incident reports and calls to the PDL Professional Officers bear this out.
PDL deals with pharmacists on some of their lowest days. Errors are a part of the human condition but when the error can have consequences (or even worse has had consequences) for another person the feelings of “shame, guilt, anger and self-doubt” (ibid) can be overwhelming.
We have lost good pharmacists from the profession because of this.
Added to this is the potential for the error to lead to a complaint to the regulators. With regulators currently swamped with an increasing number of complaints the investigation alone can take weeks or months, with a finding taking even longer—occasionally years.
This process in itself can cause more harm to these second victims. Even if the eventual outcome is that the pharmacist is found to have acted properly, the damage can be irreparable.
Although there are many support services available, they appear to be infrequently used by health professionals generally. There is no reason to believe that pharmacists are any different in this regard.
Many of us treat errors as a “rite of passage” and while we understand the emotions relating to making an error (and can cite them freely) we may not spend enough time supporting each other through these times.
This is not, I believe, a callousness on behalf of more experienced practitioners, rather a lack of awareness of how to properly support each other in the case of an error which leads to the pharmacist feeling like a second victim.
I would like to see the idea of pharmacists as second victims become a normal part of pharmacy education. It is certainly something of which PDL Professional Officers are aware, and the existence and use of the Pharmacists’ Support Service (PSS) suggests that there are pharmacists in need of such support.
We need to normalise the idea of looking after each other; of talking about our emotions with respect to errors and near-misses. We need a support structure (both formal and informal) which invokes the casual, but open, format of the RUOK? program.
As a tutor at Western Sydney University I am involved in helping medical students as they are taught self-care in relation to not just errors but also workloads and the stress of their daily duties. I would encourage the Australian pharmacy schools to consider a similar program for their students.
Mentoring is a formal part of the education and registering framework in many medical fields and while Intern Training Programs do foster mentorship, I feel that we can do better.
Peer support, long a hallmark of PDL, is available not just in a relationship with an insurer, but with each other. It doesn’t matter whether we talk to people from our own year group, current and previous employers, trained PSS counsellors, university lecturers and tutors, family, friends or other health professionals—it is crucial that if we are feeling stressed as a result of an incident or near-miss we talk to someone.
The ACSQHC puts it well: “It is very important that health care professionals are supported by their colleagues and the health service organisation after a harmful incident to cope and to ensure their emotional wellbeing”.
We need to look after ourselves, to seek help when we’re feeling stressed and to keep a watchful eye and ear out for signs of stress in each other.
PDL members can contact PDL on 1300 854 838.
Readers who are distressed can contact the Pharmacists’ Support Service on 1300 244 910.
Curtis Ruhnau is a Sydney pharmacy owner and PDL director for NSW.