Feature
NURSING MANAGEMENTApril 2009 | Volume 16 | Number 130
Mike Williams and Jane Reid explain why the work of nurse leaders is key
to the success of the Patient Safety First Campaign, which aims to make
improvements in patient safety the highest priority of the NHS
Patient safety: leading improvement
Last year, a group of NHs clinicians and managers
launched the Patient Safety First Campaign in
response to the high number of patient adverse
events reported worldwide.
the aim of the campaign is to provide NHs
staff with the knowledge and support they need to
improve the safety of patients in their care. Key to
this is strong nursing leadership.
evidence suggests that hospitals throughout
the world have poor patient safety records
(de Vries et al 2008).
a landmark report in the United states, To Err
is Human (Kohn et al 2000), first brought the scale
of the problem of adverse events to the attention
of policy makers and professionals. this report
estimated that medical errors in the Us killed more
people than road traffic accidents, breast cancer
or aIDs/HIV.
More recently, de Vries et al (2008), in a review
of eight studies involving more than 74,000 patient
records from developed countries around the world,
found the median overall incidence of in-hospital
adverse events is 9.2 per cent.
the researchers described an adverse event as
`an unintended injury or complication resulting
in prolonged hospital stay, disability at the time
of discharge or death, caused by healthcare
management rather than by the patient's underlying
disease process'.
When extrapolating trends from a few casenote
review studies, however, the different contexts and
methodologies used must be taken into account.
Moreover, as Hogan et al (2008) argue, multiple
methods of studying adverse events are needed
because casenote reviews fail to capture the full
extent of harm caused through error.
the potential scale of the problem in the UK
can be discerned by applying the 9.2 per cent rate
of adverse incidents.
For example, the number of hospital admissions
planned for the typical primary care trust
in england in 2008/09 was 200,000. application
of the 9.2 per cent rate to this figure shows that
the number of patients in this population who could
have adverse events is 18,400.
research suggests that, while half of these
patients are unlikely to experience harm, or will
experience only minor disability, due to adverse
events (de Vries et al 2008), about one third will have
long-term disabilities and about 7 per cent of these
will die (sari et al 2007, Vincent et al 2001).
Zero tolerance
In the past five years, several campaigns have
been launched to improve the safety of patients
in hospitals, an approach that began in the Us in
2004 with the Save 100,000 Lives Campaign of the
Institute for Healthcare Improvement (IHI).
More recently, as commitment to this and
other campaigns has grown, and as improvement
methodologies have been disseminated, further such
campaigns have been launched in scotland, Wales
and most recently england.
In england, the Patient Safety First Campaign,
aims to make patient safety a top priority in all
healthcare systems, and to ensure zero tolerance
summary
This article explains how leadership, particularly
nurse leadership, at all levels is central to reducing
the number of patient adverse events. It describes
several ways in which nurses can make ward-level
and trust-wide improvements to patient safety by
influencing trust boards, providing visible leadership,
setting aims, monitoring progress, driving change
and disseminating safety knowledge.
Keywords
Patient safety, adverse incidents, leadership

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