Patient safety: Do nursing and medical curricula address this theme?

Summary

In this literature review, we examine to what extent patient safety is addressed within medical and nursing curricula. Patient safety is the foundation of healthcare practice and education both in the UK and internationally. Recent research and policy initiatives have highlighted this issue. The paper highlights the significance of this topic as an aspect of study in its own right by examining not only the fiscal but also the human costs such events invite.

In the United Kingdom patient safety issues feature prominently in the (Department of Health, 2000a. An organisation with a memory. The report of an expert group on learning from adverse events. The Stationery Office, London, Department of Health, 2000b. Handling complaints: monitoring the NHS complaints procedures (England, Financial year 1998–99). The Stationery Office, London.) policy documentation but this is not reflected within the formal curricula guidelines issued by the NMC and GMC. Yet if healthcare educational curricula were to recognise the value of learning from errors, such events could become part of a wider educational resource enabling both students and facilitators to prevent threats to patient safety. For this reason, the paper attempts to articulate why patient safety should be afforded greater prominence within medical and nursing curricula. We argue that learning how to manage errors effectively would enable trainee practitioners to improve patient care, reduce the burden on an overstretched health care system and engage in dynamic as opposed to defensive practice.

Introduction

Everyday more than one million people are treated safely and successfully in the NHS. But … in complex health care systems things will and do go wrong, no matter how dedicated and professional the staff. The effects of harming a patient are widespread … devastating consequences can ensue and staff can become demoralised and disaffected (National Patient Safety Agency, 2003a, p. 3)

According to the Chief Medical Officer’s Report, the vast majority of NHS care meets the high clinical standards expected by the public (Department of Health, 2000a, National Patient Safety Agency, 2003a). Although the vast majority of health professionals are committed to attaining excellence when caring for patients, enquiries into adverse events have too often shown that failure is largely tolerated by medical/nursing staff (Department of Health, 2000a, Lester and Tritter, 2001, Maddox et al., 2001, Neale et al., 2001; The Bristol Infirmary Inquiry 2001). The notion of failure when used in this context denotes an adverse event or error, which the Department of Health (2000a) defines as an event or omission arising during clinical care and causing physical or psychological injury to a patient. Thus, patient safety is defined as freedom from accidental injury of any kind (Kohn et al., 1999, Weinger et al., 2003).

Within the literature, there is a lack of a common definition for the terms error, adverse event and patient safety. While the Department of Health (2000a) do not distinguish between adverse events or errors, Kohn et al. (1999, p. 3) have attempted to distinguish between them by defining errors as the failure of a planned action to be completed as intended (an error of execution) or the use of the wrong plan to achieve an aim (an error of planning). For the purpose of this review, we define an adverse event as any occurrence leading to iatrogenic injury. When there are operational and organisational breakdowns, whatever their cause and however they are defined, devastating and distressing consequences can ensue not only for patients and their families, but also for staff (Houston and Allt, 1997, National Patient Safety Agency, 2003a). In particular, the psychological impact of failure exerts additional pressure upon organisations that are already challenged, given that such events have the potential to demoralise staff and undermine public confidence (Aron and Headrick, 2002, Department of Health, 2000a, Department of Health, 2001a, National Patient Safety Agency, 2003a; The Bristol Infirmary Inquiry, 2001). Nevertheless, the delivery of top quality evidence-based care ultimately depends on the competence of practitioners and the nature of the organisational milieu supporting their work (Ziv et al., 2000).