First, Protect the Patient from Harm-Applying Adult Learning Principles to Patient Safety

Published in the July/August Issue of Patient Safety & Quality Healthcare
By Barbara Duffy, RN, BS Ed, MPH, CPHQ, LHRM

“First, do no harm.”

Today, unlike in the time of Hippocrates, evidence of harm may not become immediately obvious during healthcare interventions. For example, a lapse in attention while inserting a central line may result in a blood stream infection that becomes apparent days later. A wrong site surgery may go unnoticed until after the effects of anesthesia subside. An incorrect dosage of medication may not be recognized until an adverse drug event occurs.

During the past decade, there has been no shortage of statistics showing the hazards awaiting those seeking healthcare services. As a consequence, hospitals have undertaken an abundance of initiatives to prevent harm among patients. Despite massive attempts to educate healthcare staff regarding patient safety measures, the Agency for Healthcare Research and Quality (AHRQ, 2007) reports patient safety is improving at a disappointing 1% per year.

Hospitals, anxious to meet accreditation standards, measure staff knowledge of the National Patient Safety Goals set forth by The Joint Commission since 2003. However, the AHRQ evidence suggests being knowledgeable of threats to patient safety is not sufficient to change the behavior in ways that are necessary to improve patient outcomes on a large scale. Higher levels of cognition are required by healthcare workers to comprehensively reduce medical error and effect culture change. To accomplish this, adult learning principles are coupled with higher levels of the cognitive domain and applied to patient safety situations in an effort to prevent error throughout the clinical setting. In other words healthcare workers learn how to first, protect the patient from harm.

Medical Errors in Healthcare

Medical errors have produced tragically high numbers of deaths and injuries to patients. An industry dedicated to protecting lives has become the eighth leading cause of death (Sexton, Thomas, & Helmreich, 2000; Vicente, 2002). As Table 1 shows, the magnitude of harm to human life is considerable. While most research has been performed in the in-patient setting, there is no reason to believe patient harm does not occur with disturbing frequency in other settings such as private practice, skilled nursing facilities, pharmacies, and ambulatory surgical centers. (Aspden, Wolcott, Bootman, & Cronenwett, 2007; WHO, 2007a).

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