What is second victim syndrome?

The concept of a second victim was proposed over 20 years ago to bring awareness to the health care professional providing care to a patient during a safety incident. The primary victim in these incidents is the patient or family/caregiver and deserves priority attention, having any ill-effects managed and mitigated. The second victim is/are the health care professional(s) engaged in the incident. In 2022, an international group of experts created a consensus definition.

A second victim is "any health care worker, directly or indirectly involved in an unanticipated adverse patient event, unintentional healthcare error, or patient injury, and who becomes victimized in the sense that they are also negatively impacted." Taking this further, second victim syndrome (SVS) is a phenomenon such as when a health care worker harbors feelings of personal responsibility for unexpected patient outcomes and feels that they have failed their patient, going so far as to discredit their own personal knowledge and clinical skills.

Medication errors are a leading cause of SVS

According to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP), a medication error is defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the health care professional, patient, or consumer."

As the medication experts, pharmacists and pharmacy support personnel ensure that the right medication reaches the right patient at the right time at the right dose via the right route (commonly known as the five rights. Pharmacists employ principles of medication and patient safety to decrease the likelihood of patient safety incidents. The World Health Organization's Global Patient Safety Action Plan recognizes that patient safety incidents seldom result from an error of a single individual, but rather due to the complexity of poor design and operation of systems, and may occur throughout the entire medication-use system. A vast majority of patient safety incidents can be linked to flaws in systemic, strategic, or organizational conditions which are beyond the control or influence of the health care professional engaged in the incident. Health care systems are in a constant state of improvement to prevent patient safety incidents and potential second victims.

Six stages of second victim recovery

1. Chaos and accident response
2. Intrusive reflections
3. Restoring personal integrity
4. Enduring the inquisition
5. Obtaining emotional first aid
6. Moving on

For more information on the six stages of second victim recovery please review this article.

Helpful resources and support

• Second Victim Support Resources

Education, peer-support models, and tools focused on recovery after patient safety events.

• University of Missouri (MU Health forYOU Team)
• Nationwide Children’s (YOU Matter Program)
• Deployment of a Second Victim Peer Support Program: A Replication Study

• Schwartz Rounds
• Schwartz Rounds Research
• Schwartz Rounds: Supporting the emotional wellbeing of our future healthcare workforce

• Institute for Healthcare Improvement (IHI)

Resources on health care workforce well-being, psychological safety, and responding to adverse events can be found on the IHI website.

• Peer-Support & Employee Assistance Programs (EAPs)

Many organizations offer confidential counseling, peer-support, and mental health services. Check with your employer to discover how an EAP can support you through challenges.

• Personal and Professional Support
• Seek peer support from trusted colleagues or trained peer supporters.
• Participate in reflective practice or debriefing after difficult events.
• Access counseling or mental health services early.
• Engage in self-care and resilience-building activities.
• Remember experiencing distress after a clinical event is human and support is available. You are not alone. Healing and recovery are possible with support.