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First, Do Less Harm: Confronting the Inconvenient Problems of Patient Safety
Book Review: First, Do Less Harm: Confronting the Inconvenient Problems of Patient Safety Ross Koppel and Suzanne Gordon, Editors © 2012 Cornell University Press ISBN: 978-0-8014-5077-8
Reviewed by Joanne Farley Serembus, EdD, RN, CCRN (Alum), CNE, Associate Clinical Professor, Drexel University, Philadelphia, Pennsylvania
F
irst, Do Less Harm views patient safety from the perspectives of twelve health care professionals and researchers and two former patients. Each contributor recounts a specific safety problem for which solutions have been provided. The problems include hospital cleanliness, the effects of sleep deprivation on the attentiveness of physicians and nurses, unchecked medication errors, and the lack of teamwork among health care professionals. The premise of the book is that the inadequate solutions are system failures that result from not including all stakeholders in planning, implementing, and evaluating safety initiatives. As the book suggests, a top-down approach causes hospitals to ignore the suggestions of those closest to the problems. Unlike many other books on the topic of patient safety, First, Do Less Harm admits what is obvious: We still have a long road ahead of us. Remedies that we thought addressed many problems have not done so; in some cases we find that more problems have surfaced. The book raises the veil cloaking many patient-safety problems and provides some direction for solving them. Included are the approaches of other industries, such as aviation and automobile production. One particularly interesting chapter discusses health information technology (HIT), which has been touted as a way to enhance communication among health care providers, ease access to care, improve efficiency, and decrease medical errors. However, many of these alleged benefits are not supported by research data or in everyday practice. The chapter on HIT also raises an issue not often mentioned in the literature: With the emergence of HIT, physicians and nurses are concentrating on operating the electronic medical record, dealing with the difficulty of opening and closing various pages or templates and completing required information. Clinicians find themselves
60
Journal of Nursing Regulation
staring at computer screens rather than looking at their patients while they are communicating with them. Not only does this hamper good communication but practitioners also miss the physical cues that can be observed by paying close attention to a person’s physical appearance. The chapter also poses the larger question: Is HIT helping or hindering the practice of health care? First, Do Less Harm highlights problems that have yet to be solved, despite our best efforts. The refusal to consider suggestions from frontline workers and the lack of teamwork are two system links that remain broken. The corresponding chapters provide examples from the forefront of health care and offer suggestions for righting them. The book concludes by offering 27 paradoxes, ironies, and challenges of patient safety meant to provide “the difficulties of preventing harm to patients, not the impossibilities.” One of the most important is Paradox #5: Patient safety cannot be fully routinized. While the health care community tries its best to set forth actions with predictable “safe” outcomes, we are reminded that patients are individuals who are always adjusting to their environment. Each medical event is new and, by its very nature, unpredictable. Thus, such standardized nursing activities as hand-offs, checklists, First Touch®, TeamSTEPPS™, 60-Second Situational Assessment, the eight rights of medication administration, and the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery cannot be fully relied upon to prevent errors. Using actual cases, First, Do Less Harm exposes the underbelly of the health care system, but the reader is not left feeling helpless. Suggestions are offered for correcting ongoing challenges, making the book both an interesting and educational read. It should be required reading for all health care providers.
Reviewed by Joanne Farley Serembus, EdD, RN, CCRN (Alum), CNE, Associate Clinical Professor, Drexel University, Philadelphia, Pennsylvania
F
irst, Do Less Harm views patient safety from the perspectives of twelve health care professionals and researchers and two former patients. Each contributor recounts a specific safety problem for which solutions have been provided. The problems include hospital cleanliness, the effects of sleep deprivation on the attentiveness of physicians and nurses, unchecked medication errors, and the lack of teamwork among health care professionals. The premise of the book is that the inadequate solutions are system failures that result from not including all stakeholders in planning, implementing, and evaluating safety initiatives. As the book suggests, a top-down approach causes hospitals to ignore the suggestions of those closest to the problems. Unlike many other books on the topic of patient safety, First, Do Less Harm admits what is obvious: We still have a long road ahead of us. Remedies that we thought addressed many problems have not done so; in some cases we find that more problems have surfaced. The book raises the veil cloaking many patient-safety problems and provides some direction for solving them. Included are the approaches of other industries, such as aviation and automobile production. One particularly interesting chapter discusses health information technology (HIT), which has been touted as a way to enhance communication among health care providers, ease access to care, improve efficiency, and decrease medical errors. However, many of these alleged benefits are not supported by research data or in everyday practice. The chapter on HIT also raises an issue not often mentioned in the literature: With the emergence of HIT, physicians and nurses are concentrating on operating the electronic medical record, dealing with the difficulty of opening and closing various pages or templates and completing required information. Clinicians find themselves
60
Journal of Nursing Regulation
staring at computer screens rather than looking at their patients while they are communicating with them. Not only does this hamper good communication but practitioners also miss the physical cues that can be observed by paying close attention to a person’s physical appearance. The chapter also poses the larger question: Is HIT helping or hindering the practice of health care? First, Do Less Harm highlights problems that have yet to be solved, despite our best efforts. The refusal to consider suggestions from frontline workers and the lack of teamwork are two system links that remain broken. The corresponding chapters provide examples from the forefront of health care and offer suggestions for righting them. The book concludes by offering 27 paradoxes, ironies, and challenges of patient safety meant to provide “the difficulties of preventing harm to patients, not the impossibilities.” One of the most important is Paradox #5: Patient safety cannot be fully routinized. While the health care community tries its best to set forth actions with predictable “safe” outcomes, we are reminded that patients are individuals who are always adjusting to their environment. Each medical event is new and, by its very nature, unpredictable. Thus, such standardized nursing activities as hand-offs, checklists, First Touch®, TeamSTEPPS™, 60-Second Situational Assessment, the eight rights of medication administration, and the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery cannot be fully relied upon to prevent errors. Using actual cases, First, Do Less Harm exposes the underbelly of the health care system, but the reader is not left feeling helpless. Suggestions are offered for correcting ongoing challenges, making the book both an interesting and educational read. It should be required reading for all health care providers.