Review: Patient safety: a core value of nursing - so why is achieving it so difficult?

Abstract

Issues of patient safety have had greatest effect when responding to failures in safety or poor performance at particular hospitals or by particular individuals. Florence Nightingale was no different. Her understanding about what we now term as patient safety grew out of her own experiences of adverse events in healthcare. She learned from those patients that died unnecessarily and she learned about what worked in order to minimise risk and harm. These lessons were so profound for her that she devoted the rest of her life to improving patient safety through, amongst other things, good basic nursing care. Interestingly, however, the need for a systematic effort to address patient safety only really began to emerge in the 1990s, both in the United Kingdom and internationally, when concern about patient safety began to rise among healthcare professionals. This paper describes the journey from the publication of the US Institute of Medicine’s seminal report To Err is Human (Kohn et al., 1999), to today. To Err is Human set out the scale of the problem for the first time, saying that deaths due to ‘medical error’ in hospitals were more common than deaths due to vehicle accidents, breast cancer or HIV/AIDS, and argued for a system-wide, nationally led response to improve patient safety. Over the last 10 years inquiries into failures in care provided by institutions or individuals have taken place regularly, along with a number of national reviews of patient safety in the NHS. This paper describes eloquently the challenges faced by the NHS as identified by these inquires and reviews; a culture of indifference or blame, acceptability that complications of care are the norm, the struggle to gain sustained implementation of change. The paper then goes on to view patient safety through the lens of perioperative care, providing a focus on culture, training, communication and team work. This is skilfully described by authors who clearly have an expert understanding and knowledge related to this field. Despite the efforts of the last decade, the authors conclude that the same challenges faced by Florence Nightingale and her peers in the 1860s remain today and calls for perioperative nurses to embrace safety science and human factors.