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Nach dem Behandlungsfehler

Umgang mit Patienten, Angehörigen und dem involvierten Personal

In the aftermath of medical error

Caring for patients, family, and the healthcare workers involved

Zusammenfassung

Behandlungsfehler, insbesondere solche mit Schädigung, stellen für Patienten („first victims“) aber auch für das involvierte Fachpersonal („second victims“) eine schwerwiegende Situation dar, die langanhaltende und belastende Konsequenzen haben kann. Neben der fachlichen Aufarbeitung eines unerwünschten Ereignisses kommt dem angemessenen und empathischen Umgang mit allen Beteiligten eine zentrale Bedeutung zu, um eine „zweite Traumatisierung“ zu vermeiden. Patienten haben eine nahezu universelle Präferenz für die vollständige Offenlegung von unerwünschten Ereignissen, unabhängig vom Alter, Geschlecht oder Bildungsstand. Dazu gehören die persönliche, zeitnahe und eindeutige Offenlegung, Informationen über das Ereignis, seine Ursachen und Konsequenzen sowie eine Entschuldigung und der Ausdruck ehrlichen Bedauerns. Die meisten Fachpersonen unterstützen zwar grundsätzlich eine ehrliche und offene Kommunikation über Fehler und unerwünschte Ereignisse. Gleichzeitig gibt es verschiedene Barrieren, die ihre Umsetzung behindern (z. B. Sorge vor juristischen Konsequenzen). Trotz ihrer zentralen Bedeutung findet die Offenlegung von unerwünschten Ereignissen in der Realität nur selten in einer für Patienten akzeptablen Form statt. Beim involvierten Personal ruft ein medizinischer Fehler mit Schadensfolge oft akute Belastungsreaktionen und intensive Emotionen hervor, die bei einem Teil der Betroffenen chronifizieren und das Risiko für Depressionen, Burnout und posttraumatische Belastungsstörungen erhöhen. Insbesondere die Kommunikation mit „peers“ hat eine herausragende Bedeutung für einen konstruktiven und protektiven Umgang mit Fehlern. Befragungen von Fachpersonen zeigen allerdings, dass sie diesbezüglich meist keine ausreichende Unterstützung erhalten. Einrichtungen der Gesundheitsversorgung sollten die verschiedenen Anforderungen in einem Konzept und Ablaufplan für Behandlungsfehler und unerwünschte Ereignisse zusammenführen.

Abstract

Medical errors, in particular those resulting in harm, pose a serious situation for patients (“first victims”) and the healthcare workers involved (“second victims”) and can have long-lasting and distressing consequences. To prevent a second traumatization, appropriate and empathic interaction with all persons involved is essential besides error analysis. Patients share a nearly universal, broad preference for a complete disclosure of incidents, regardless of age, gender, or education. This includes the personal, timely and unambiguous disclosure of the adverse event, information relating to the event, its causes and consequences, and an apology and sincere expression of regret. While the majority of healthcare professionals generally support and honest and open disclosure of adverse events, they also face various barriers which impede the disclosure (e.g., fear of legal consequences). Despite its essential importance, disclosure of adverse events in practice occurs in ways that are rarely acceptable to patients and their families. The staff involved often experiences acute distress and an intense emotional response to the event, which may become chronic and increase the risk of depression, burnout and post-traumatic stress disorders. Communication with peers is vital for people to be able to cope constructively and protectively with harmful errors. Survey studies among healthcare workers show, however, that they often do not receive sufficient individual and institutional support. Healthcare organizations should prepare for medical errors and harmful events and implement a communication plan and a support system that covers the requirements and different needs of patients and the staff involved.

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Correspondence to David L. B. Schwappach MPH.

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David L.B. Schwappach gibt an, dass kein Interessenkonflikt besteht.

Der Autor ist wissenschaftlicher Leiter der Stiftung für Patientensicherheit. Die Stiftung ist eine gemeinnützige Organisation, die gebührenpflichtige Kaderschulungen zum Thema „Täter als Opfer“ anbietet.

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Schwappach, D. Nach dem Behandlungsfehler. Bundesgesundheitsbl. 58, 80–86 (2015). https://doi.org/10.1007/s00103-014-2083-4

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Schlüsselwörter

  • Patientensicherheit
  • Behandlungsfehler
  • Unerwünschtes Ereignis
  • Kommunikation

Keywords

  • Patient safety
  • Medical error
  • Adverse event
  • Communication