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Purpose: To summarize the knowledge about the aftermath of adverse events (AEs) and develop a recommendation set to reduce their negative impact in patients, health professionals and organizations in contexts where there is no previous experiences and apology laws are not present.Data Sources: Review studies published between 2000 and 2015, institutional websites and experts' opinions on patient safety.Study Selection: Studies published and websites on open disclosure, and the second and third victims' phenomenon. Four Focus Groups participating 27 healthcare professionals.Data Extraction: Study characteristic and outcome data were abstracted by two authors and reviewed by the research team.Results Of Data Synthesis: Fourteen publications and 16 websites were reviewed. The recommendations were structured around eight areas: (i) safety and organizational policies, (ii) patient care, (iii) proactive approach to preventing reoccurrence, (iv) supporting the clinician and healthcare team, (v) activation of resources to provide an appropriate response, (vi) informing patients and/or family members, (vii) incidents' analysis and (viii) protecting the reputation of health professionals and the organization.Conclusion: Recommendations preventing aftermath of AEs have been identified. These have been designed for the hospital and the primary care settings; to cope with patient's emotions and for tacking the impact of AE in the second victim's colleagues. Its systematic use should help for the establishment of organizational action plans after an AE. [ABSTRACT FROM AUTHOR]

Construction of ITER remote experimentation centre (REC) based on the broader approach (BA) activity of the joint program of Japan and Europe (EU) is progressing. In order to make the future experiments of ITER and JT-60SA effectively and efficiently implemented, development of a remote experiment system by using the Satellite Tokamak (JT-60SA) facilities was planned and the development of software for the remote experiment is ongoing, including the systems for the remote connection and the communication between the remote site and the on-site facility. The network system from REC in Rokkasho-site of Japan to the network in EU was established in collaboration with the National Institute of Informatics (NII). Effective data transfer method that is capable of fast transfer speeds in the gigabit range is investigated. Data transfer at the rate of several Gbps was successfully obtained between the institutes in Japan. The preliminary versions of the software for data analysis are developed, such as for visualization of time dependent experimental data and transport simulations, visualization of plasma boundary/equilibrium and spatial profiles of diagnostic data. The remote data access program and an integrated platform for Documentation and Experiment Management are also being developed. A remote experiment room in the Rokkasho-site in Japan was designed and the construction started. The function of REC will be tested and the total system will be demonstrated by the middle of 2017. [ABSTRACT FROM AUTHOR]

Background: Adverse events (AE) are also the cause of suffering in health professionals involved. This study was designed to identify and analyse organization-level strategies adopted in both primary care and hospitals in Spain to address the impact of serious AE on second and third victims. Methods: A cross-sectional study was conducted in healthcare organizations assessing: safety culture; health organization crisis management plans for serious AE; actions planned to ensure transparency in communication with patients (and relatives) who experience an AE; support for second victims; and protective measures to safeguard the institution's reputation (the third victim). Results: A total of 406 managers and patient safety coordinators replied to the survey. Deficient provision of support for second victims was acknowledged by 71 and 61 % of the participants from hospitals and primary care respectively; these respondents reported there was no support protocol for second victims in place in their organizations. Regarding third victim initiatives, 35 % of hospital and 43 % of primary care professionals indicated no crisis management plan for serious AE existed in their organization, and in the case of primary care, there was no crisis committee in 34 % of cases. The degree of implementation of second and third victim support interventions was perceived to be greater in hospitals (mean 14.1, SD 3.5) than in primary care (mean 11.8, SD 3.1) (p < 0.001). Conclusions: Many Spanish health organizations do not have a second and third victim support or a crisis management plan in place to respond to serious AEs. [ABSTRACT FROM AUTHOR]

Background In 2002, Spain introduced new legislation regulating the rights of patients. Spaniards have thus seen an increase in their capacity for decision-making, bringing them into line with many other countries. However, the law changes do not mean to be acquainted with the new legislation and therefore, putting it into practice. Objective To analyse whether the rules governing patients' rights in Spain are sufficiently well known among patients and to identify the profile of those patients most aware of their rights. Design Cross-sectional quota-sampled survey study. A total of 790 patients discharged from hospitals or attended in primary care took a telephone survey, 773 replayed. Results Twenty per cent had some knowledge of the rules governing patients' rights. Respondent characteristics that were associated with better knowledge of basic rights included: age of medical responsibility (P < 0.001), cases in which a doctor may inform family members (P < 0.001), whether or not a patient can refuse treatment (P < 0.001) and what is constituted by advance directives (P < 0.001). Patients who opt for a more active role in consultations with medical professionals show greater knowledge of their rights (P < 0.01). Age was related to greater ignorance of these rights (P < 0.01). Conclusions Patients' knowledge of their rights is quite limited, making it difficult for them to assert those rights in specific medical encounters. The youngest patients, the most demanding, and those who prefer to have the last word in decisions are those with the best knowledge of their rights as patients. [ABSTRACT FROM PUBLISHER]

Background: The second victim phenomenon refers to the emotional trauma healthcare professionals experience following adverse events (AEs) in patient care, which can compromise their ability to provide safe care. This issue has significant implications for patient safety, with AEs leading to substantial human and economic costs. Analysis: Current evidence indicates that AEs often result from systemic failures, profoundly affecting healthcare workers. While patient safety initiatives are in place, the psychological impact on healthcare professionals remains inadequately addressed. The European Researchers' Network Working on Second Victims (ERNST) emphasizes the need to support these professionals through peer support programs, systemic changes, and a shift toward a just culture in healthcare settings. Policy Options: Key options include implementing peer support programs, revising the legal framework to decriminalize honest errors, and promoting just culture principles. These initiatives aim to mitigate the second victim phenomenon, enhance patient safety, and reduce healthcare costs. Conclusion: Addressing the second victim phenomenon is essential for ensuring patient safety. By implementing supportive policies and fostering a just culture, healthcare systems can better manage the repercussions of AEs and support the wellbeing of healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore the theoretical relationship between the social reputation and the perceived safety of a hospital. Subjects and Methods: A random sample of 316 patients and 27 relatives of patients who were unable to respond themselves at four public hospitals in Madrid, Barcelona and Alicante were interviewed to establish a measure of reputation and perceived safety. Results: There were no different perceptions between patients and relatives regarding hospital reputation or safety perception (p > 0.05). The perception of patients or relatives of health professionals' competence (β = 0.07, 95% CI 0.01-0.12), the perception of a positive treatment output of surgical or medical treatment (β = 0.35, 95% CI 0.22-0.49) and hospital reputation (β = 0.08, 95% CI 0.02-0.14) were directly and positively associated with their perception that the hospital was a safe clinical environment in which few clinical errors are committed. Conclusions: The data suggested that the social reputation of these hospitals and the perceptions of patients or relatives of patient safety were indeed correlated. Future research should assess whether efforts to enhance hospital reputation, by improving patients' perceptions of clinical safety, may contribute to reducing the frequency of litigation cases. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article discusses the Ebola virus disease (EVD) which has been declared by the World Health Organization (WHO) on August 2014 as a Public Health Emergency of International Concern. It cites the epidemiological characteristics of infectivity and virulence that define the severity of the disease. The assurance of the importance of the EVD protocols in protecting the health professionals from the threats that are linked to their work is also emphasized.

Background: Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims. Methods: A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals. Results: A total of 430 health professionals (39.6%) had informed a patient of an error. Reporting to patients was carried out by those with the strongest safety culture (Odds Ratio -OR- 1.1, 95% Confidence Interval -CI- 1.0-1.2), nurses (OR 1.9, 95% CI 1.5-2.3), those under 50 years of age (OR 0.7, 95% CI 0.6-0.9) and primary care staff (OR 0.6, 95% CI 0.5-0.9). A total of 381 (62.5%, 95% CI 59-66%) and 346 (72.5%, IC95% 69-77%) primary care and hospital health professionals, respectively, reported having gone through the second-victim experience, either directly or through a colleague, in the previous 5 years. The emotional responses were: feelings of guilt (521, 58.8%), anxiety (426, 49.6%), re-living the event (360, 42.2%), tiredness (341, 39.4%), insomnia (317, 38.0%) and persistent feelings of insecurity (284, 32.8%). In doctors, the most common responses were: feelings of guilt (OR 0.7 IC95% 0.6-0.8), re-living the event (OR 0.7, IC95% o.6-0.8), and anxiety (OR 0.8, IC95% 0.6-0.9), while nurses showed greater solidarity in terms of supporting the second victim, in both PC (p = 0.019) and hospital (p = 0.019) settings. Conclusions: Adverse events cause guilt, anxiety, and loss of confidence in health professionals. Most are involved in such events as second victims at least once in their careers. They rarely receive any training or education on coping strategies for this phenomenon. [ABSTRACT FROM AUTHOR]

Objective: Toanalyse information about the errors made by diabetic and renal patients based on information provided by professionals (general practitioners, specialists, and nurses) and the patients themselves. Subjects and Methods: A descriptive study was carried out by interviewing 199 patients and 60 professionals from the Spanish provinces of Alicante and Madrid. The interview explored the frequencies and types of oversights, confusions, and misinterpretations and the factors that contributed to them. Results: Among the 199 patients, 59 (29.5%) and 42 (70%) of the 60 professionals considered that patients frequently made errors that affected the success of their treatment. There were no differences in the frequency of the reported errors based on gender (p = 0.7), educational level (p = 0.9), or marital status (p = 0.5). The most commonly reported errors were taking the wrong medication (n = 70; 35%) and mixing up medicines (n = 15; 7.5%). Diabetics who had not been adequately informed, compared to renal patients, reported a higher number of errors (p = 0.02). Conclusions: Patient errors were frequent because of communication failures and confusions. Diabetic patients had a higher chance of committing an error than renal patients. Patient education must include clear and personalized instructions for improving self-care and reducing risks when using medicines. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assure the application, in our primary care health district, of the World Health Organisation and Spanish Ebola virus disease (EVD) guidelines, and to identify and resolve gaps, in order to protect professionals from the risks associated with attending to patients with Ebola. Materials and Methods: A checklist was drawn up and an audit procedure of the structural, functional and operational conditions was designed for managing a self-presenting patient suspected with EVD in general practice. This audit was applied twice (before and after assessment) in 9 health centres of a health district in Spain. The checklist was structured according to 9 categories (51 elements in total). This tool was designed to avoid errors in the management of EVD patients that are considered very serious in view of their potential consequences. Results: Of the 51 elements on the checklist, 7-26 (14-51%) required direct intervention to rectify deficits in the first audit. The following elements requiring improvement were identified: the incorporation of memory aids to ensure the correct application of the EVD protocol, defining what information should be provided to the patient and (where applicable) anyone accompanying them as well as incorporating advice on how to deal with any individuals with whom they might have come into contact. A second audit assured the adequacy of the proposed solutions. Conclusion: In this study, the tool achieved the successful application of EVD protocol, assuring that primary care centres were able to handle an Ebola suspect patient safely. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assure the application, in our primary care health district, of the World Health Organisation and Spanish Ebola virus disease (EVD) guidelines, and to identify and resolve gaps, in order to protect professionals from the risks associated with attending to patients with Ebola.Materials and Methods: A checklist was drawn up and an audit procedure of the structural, functional and operational conditions was designed for managing a self-presenting patient suspected with EVD in general practice. This audit was applied twice (before and after assessment) in 9 health centres of a health district in Spain. The checklist was structured according to 9 categories (51 elements in total). This tool was designed to avoid errors in the management of EVD patients that are considered very serious in view of their potential consequences.Results: Of the 51 elements on the checklist, 7-26 (14-51%) required direct intervention to rectify deficits in the first audit. The following elements requiring improvement were identified: the incorporation of memory aids to ensure the correct application of the EVD protocol, defining what information should be provided to the patient and (where applicable) anyone accompanying them as well as incorporating advice on how to deal with any individuals with whom they might have come into contact. A second audit assured the adequacy of the proposed solutions.Conclusion: In this study, the tool achieved the successful application of EVD protocol, assuring that primary care centres were able to handle an Ebola suspect patient safely. [ABSTRACT FROM AUTHOR]

Background There are doubts on whether patients feel that they have sufficient information for actively participating in clinical decisions. Objective To describe the type of information that patients receive. To determine whether patients consider this information sufficient, and whether it contributes or not to improve clinical safety. To identify the barriers for patient participation in clinical decision making. Study Design Cross-sectional study with 764 patients and 327 physicians. Study Setting and participants Fourteen health centres belonging to three primary care districts and three hospitals in Spain. Principal Findings Just 35.1% (268) (95% CI 32.2, 39.1%) of patients preferred to have the last word in clinical decisions. Age (39 vs. 62%, P < 0.001) and severity of illness (38 vs. 46%, P = 0.002) increased the tendency to take a passive role. In 85.1% (650) (95% CI 83.3, 88.3%) of the cases, patients reported having received sufficient information. Lack of consultation time (29.6%, 95% CI 25.8, 32.5%) and patients' use of Internet or other sources (19.2%, 95% CI 16.4, 22.2%) were identified as new obstacles to doctor-patient communication by the patients. Only 19.6% (64) (95% CI 15.4, 24.2%) of doctors considered that they could intervene to involve patients in the decisions. Discussions and Conclusions The majority of patients prefer the decisions to be made by their doctor, especially those with more severe illnesses, and older patients. Patients are not normally informed about medication interactions, precautions and foreseeable complications. The information provided by general practitioners does not seem to contribute enough to the patient involvement in clinical safety. [ABSTRACT FROM AUTHOR]