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First Do Less Harm

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Title: First Do Less Harm

Edited by: Ross Koppel and Suzanne Gordon

Publisher: Cornell University Press, 2012

Reviewer:  Suzette Woodward, (former) director of patient safety, National Patient Safety Agency

What was it like?

First Do Less Harmis a collection of essays exploring a vast array of patient safety issues including teamwork, communication, sleep deprivation, patient involvement, tackling cleanliness and healthcare associated infections, whether information technology helps or hinders patient safety and the complexities of medication safety. There are a number of themes the book focuses on including safety and cost, safety culture and the role of frontline staff in patient safety initiatives. 


What were the highlights? 

The concluding chapter is an outstanding summary of the current challenges we all face in improving patient safety.  First Do Less Harm doesn’t try to put a definition on patient safety but it steers the reader into realising that it involves everything we do. This is rarely understood. The key paragraph is found in the conclusion; ”Patient Safety is something we strive to ensure but cannot achieve by doing any one thing, or even by improving many things. Patient Safety requires fixing everything we can think of and many things we do not yet know about.”’ The essays support this conclusion by highlighting the problems that arise if patient safety is seen as simply a top down initiative and asks some key questions that each reader should grasp and ask for themselves.These include whether staff have enough time to cope with “a dazzling array of safety initiatives” andif true culture change can be achieved through episodic interventions rather than through constant repetition and reiteration. And crucially, it also questions whether nurses can cope with significant changes to healthcare, with a potentially diminished workforce being asked to deliver an expanding volume of care to an increasingly ageing population while at the same time coping with an ever-increasing patient safety movement. 

Strengths & weaknesses:

The strength of First Do Less Harm is that it is divided up into a series of standalone essays, which means the book can be dipped into and out of at the reader’s leisure. Chapter six, ”Excluded Actors in Patient Safety” is an insightful contribution to the debate on change and the involvement of frontline clinicians. Because each essay offers something in its own  right, there is some repetition, which is the only weakness I could find.

Who should read it?

The book is aimed at all healthcare professionals but it feels like it primarily talks to nurses and the sources of evidence and stories are from both the US and the UK. This book is a must read for all nurses but would be especially useful as essential reading in the first year for a student nurse. By reading it at this formative time it will enhance their knowledge about patient safety but more crucially enable them to speak out and ask the right questions about what they experience when they go into practice. We already know the solutions to the patient safety problems.Not involving student nurses at the outset is a wasted opportunity to truly aim to embed patient safety into everything we do. If we get this right, we may produce much bigger improvements in outcomes and patient safety than we have seen to date. 


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