how do you report an error or near-miss that may have injured a patient?

by Mr. Donato Leuschke MD 6 min read

Near Miss Reporting – Examples and Procedure for Near …

27 hours ago  · Near Miss Examples. A few examples of a near miss at work can be seen below. An employee slips on condensation from an overhead pipe or water from cleaning that isn’t properly mopped up but doesn’t fall or otherwise injure themselves. A co-worker trips on … >> Go To The Portal


What is the process for reporting errors in patient care?

There are several steps to appropriately dealing with a medical error that are relatively straightforward:Let the patient and family know. ... Notify the rest of the care team. ... Document the error and report it to the hospital safety committee.

How do you deal with incident errors and near misses?

What you should do in the event of an incident/ adverse eventEliminate any immediate dangers as far as possible to make the situation safe.Follow the risk and Health & Safety measures which are in place, e.g. Fire Drills, etc.Move people to a safe place.Close off an area which poses risk.More items...

Should near misses be reported to patient?

In conclusion, near misses and no harm incidents can provide valuable information much of which cannot be captured by adverse event reporting systems, therefore, reporting such incidents should be encouraged; however, necessity of developing a large database and employing more staff for data management should also be ...

How do you address a medical error?

Disclosing medical errors the right wayBegin by stating there has been an error;Describe the course of events, using nontechnical language;State the nature of the mistake, consequences, and corrective action;Express personal regret and apologize;Elicit questions or concerns and address them; and.More items...

How do I report a near miss?

Near miss reporting procedures:Report the near miss incident, no matter how small or who it happens to.Make sure the scene of the incident is secured as fast as possible.Communicate the incident to supervisors and the safety department.Fill out a near miss reports with the exact details of the incident.More items...

Why should we report near misses?

A pattern of near misses provides an early warning that something needs attention. It makes good business sense to be proactive and take action early when problems are likely to be less serious. Near misses may seem trivial but they are a valuable source of information.

What is a near miss medical error?

Near-miss events are errors that occur in the process of providing medical care that are detected and corrected before a patient is harmed.

WHAT IS near miss example?

Some examples of near misses for employees working with heights include: Faulty scaffolding makes it dangerous for workers to walk across a roof. A worker stumbles over misplaced roofing tools and is not wearing any safety equipment.

Is near miss an incident?

A Near Miss is defined as an incident in which there was no injury or property damage but where the potential for serious consequences existed.

When should a medical error be disclosed?

Recommendations suggest that the disclosure be made soon after the mistake occurs. 36 Typically, patients do not expect a medical mistake to occur. Hence, the disclosure timing is important to consider, as are general precautions and best practices surrounding disclosure of all bad news.

Should you report a colleague who makes a medical error?

Here's how. Doctors who observe a colleague's medical mistake have a moral responsibility to disclose it and ensure that it is communicated to the affected patient, according to new guidelines published in NEJM this week.

What are error reporting systems?

Reporting systems that focus on safety improvement are "voluntary reporting systems." The focus of voluntary systems is usually on errors that resulted in no harm (sometimes referred to as "near misses") or very minimal patient harm.

What is near miss in healthcare?

Near-miss events are errors that occur in the process of providing medical care that are detected and corrected before a patient is harmed. The Institute of Medicine (IOM) and others have identified near-miss reporting and analysis as vital to understanding and correcting weaknesses in the health care delivery system and to preventing actual adverse events (AEs) that harm patients. 1,2 Although the majority of health care encounters take place in ambulatory settings, most attempts to record and address near-miss events to date have been carried out in hospitals. Few examples of such efforts can be found in the United States to date, even though reporting systems have been successfully implemented in other countries. 3-5 At least one voluntary, anonymous reporting system has been established in U.S. primary care settings; 6 others have demonstrated that near-miss reporting systems can increase awareness of patient safety. 7

Why is near miss important?

Near-miss events, where no actual harm comes to the patient, represent a lower‑risk opportunity to improve patient safety and address patient expectations regarding disclosure of medical errors, both factors associated with medical malpractice claims. The Institute of Medicine and others have called for the creation of voluntary reporting systems to detect near-miss events to allow for analysis of patterns of errors; widespread adoption of near‑miss reporting systems in primary care could improve safety in that setting where more than 70 percent of medical encounters occur. Barriers to reporting near-miss errors include the additional workload burden imposed by a reporting system, concern over punitive action arising from a report, lack of confidence that positive change will result from such reporting, and psychological barriers to admitting an error. Furthermore, unless practices find this information useful to correct errors, near-miss reporting will be unlikely to become a routine procedure in ambulatory practice.

What is the term for a patient who is exposed to a hazardous situation but does not experience harm?

A patient is exposed to a hazardous situation, but does not experience harm either through luck or early detection. Error: a broader term referring to any act of commission (doing something wrong) or omission (failing to do the right thing) that exposes patients to a potentially hazardous situation.

What did the physicians who reviewed his medical record judge?

The physicians who reviewed his medical record judged that proper diagnostic management might have discovered the cancer when it was still curable. They attributed the advanced disease to substandard medical care. The event was considered adverse and due to negligence.".

What happens when a nurse gives medication to another patient?

A nurse comes to administer his medications, but inadvertently gives his pills to the other patient in the room. The other patient recognizes that these are not his medications, does not take them, and alerts the nurse so that the medications can be given to the correct patient.

What was the first study to quantify the incidence of iatrogenic harm?

One of the first studies that sought to quantify the incidence of iatrogenic harm was the Medical Insurance Feasibility Study , funded by the California Medical Association and the California Hospital Association. This study, published in 1978, served as the model for the subsequent landmark Harvard Medical Practice Study.

Mistakes do happen

Our near miss error log and near miss error improvement tool, along with supporting guidance, can help you and your pharmacy team to work through the near miss errors (NMEs) and learn from them.

Reporting tool

The Near Miss Error Log (NMEL) can be used to record the near miss errors. By filling in the log, you can collect sufficient information to help capture/visualise the pharmacy environment at the time of the near miss error. For more details on how to use the tool, see our top tips for using a near miss error log.

Improvement tool

This reflection tool can be used to analyse and review the information reported in the near miss error log. Staff can identify trends in near miss errors, discuss possible causes/contributing factors and develop an action plan to help prevent similar future near miss errors. This action plan can be reviewed at a later date to review if successful.

What is a near miss?

According to the Institute of Medicine, a near miss is “an act of commission or omission that could have harmed the patient but did not cause harm as a result of chance, prevention, or mitigation” (1). “An error caught before reaching the patient” is another definition (3).

Why are reporters awarded?

Even, the reporters may be prized or awarded because of their efforts for preventing harm (2, 4). Reporting such incidents can provide a variety of information about successful error management practices as well as weaknesses. The type 1 incidents are not indicative of organizational weakness.

What is a type 3 incident?

Type 3: An incident that does reach to the patient but does not cause harm because of early detection, interventions and treatment. Type 4: An incident that does reach to the patient but does not cause harm because of chance. The importance of reporting such incidents. Patient safety experts argue that the root causes of near misses ...

Why is incident reporting important?

Without these essential insights, threats to safety could go unresolved and cause significant damage to a patient’s physical, mental, and financial health. (1)

How to encourage frequent reporting?

Leaders should strive to create a culture of safety where employees aren’t fearful to report incidents. In order to encourage frequent reporting, it is essential to foster a psychologically safe environment in which there is no fear of negative consequences for reporting mistakes or near misses. When staff report close calls and hazardous conditions, leaders should act quickly by addressing concerns and treating the event as an opportunity for learning, not blame. (3)

What is the responsibility of a nurse to report a near miss?

Nurses have a responsibility to immediately report all near misses and medication errors regardless of whether a patient has been harmed. Timely reporting allows clinicians and managers to examine current processes related to medication administration and identify areas for improvement.

What are near miss errors?

FOUR NEAR-MISS medication errors occurring within 40 minutes was unnerving even for me, an ED nurse with 22 years of experience. On a typically busy Monday afternoon, stretchers lined the hallways while healthcare providers hurried to evaluate, treat, and discharge patients. Then, this happened: 1 A medication was prescribed that didn't make sense for the patient's condition. When a nurse questioned the order, she learned it had been prescribed for the wrong patient. 2 A patient with diabetic ketoacidosis was receiving a continuous insulin infusion through a peripheral venous access, but the status of her implanted insulin pump hadn't been addressed. When questioned, the prescribing physician stated he wasn't aware that the patient had an insulin pump. 3 A medication was prescribed for a patient with a known allergy to it. The allergy had been documented in the electronic medical record (EMR). When the prescription was questioned, it was cancelled. 4 The ED pharmacist hand-delivered insulin for a patient who didn't have diabetes and whose lab values were normal. The medication had been prescribed for the wrong patient.

What is the American Nurses Association's goal in preventing medication errors?

The American Nurses Association (ANA) is working to quantify and describe nurses' interventions related to medication error prevention by capturing information about near misses. 8 Its survey encouraged nurse respondents to inform their colleagues, hospitals, and others of strategies to make patients safer through the medication process. Based on the results of its survey, the ANA's recommendations for avoiding errors include the following:

What were the organizational ramifications of the four near misses in a mere 40 minutes?

What were the organizational ramifications of the four near-misses in a mere 40 minutes? After the events were entered into the electronic incident reporting system, the quality department initiated an investigation of the events. While current practices continue to be examined, an agenda is in progress to further pair the CPOE with clinical decision support systems. This would prevent a medication from being released from the drug dispenser if a patient's allergy to it is documented in the EMR. Although technology can be helpful, minimizing interruptions also allows providers to safely enter and administer medications. A multifactorial approach to medication error reduction is essential.

What happens when a prescription is questioned?

The allergy had been documented in the electronic medical record (EMR). When the prescription was questioned, it was cancelled.

Can a nurse administer a drug if they don't know what it's for?

Medication safety is the responsibility of everyone on this continuum. Nurses should never administer a drug if they don't know what it's for, aren't able to explain it to the patient, don't understand the outcome of its administration, or can't recognize potential adverse reactions. 7 A multiprofessional, evidence-based approach to medication management is essential.

How many medical errors remain unreported?

When an event results in an injury to a person or damage to property, incident reporting becomes a must. Unfortunately, for every medical error, almost 100 errors remain unreported. There are many reasons for unreported medical incidents, but not knowing when to report is one of the most common ones. Unfortunately, many patients and hospital ...

What are near miss incidents?

#2 Near Miss Incidents 1 A nurse notices the bedrail is not up when the patient is asleep and fixes it 2 A checklist call caught an incorrect medicine dispensation before administration. 3 A patient attempts to leave the facility before discharge, but the security guard stopped him and brought him back to the ward.

What is an incident in healthcare?

An incident is an unfavourable event that affects patient or staff safety. The typical healthcare incidents are related to physical injuries, medical errors, equipment failure, administration, patient care, or others. In short, anything that endangers a patient’s or staff’s safety is called an incident in the medical system.

Why is incident reporting important?

Improving patient safety is the ultimate goal of incident reporting. From enhancing safety standards to reducing medical errors, incident reporting helps create a sustainable environment for your patients. Eventually, when your hospital offers high-quality patient care, it will build a brand of goodwill.

Why is reporting important in healthcare?

Reporting can also make healthcare operations more economically effective. By gathering and analyzing incident data daily, hospitals’ can keep themselves out of legal troubles. A comprehensive medical error study compared 17 Southeastern Asian countries’ medical and examined how poor reporting increases the financial burden on healthcare facilities.

What is clinical risk management?

Clinical risk management, a subset of healthcare risk management, uses incident reports as essential data points. Risk management aims to ensure the hospital administrators know their institution performance and identify addressable issues that increase their exposure.

How much of healthcare is wasted?

Even the World Health Organisation (WHO) has estimated that 20-40% of global healthcare spending goes waste due to poor quality of care. This poor healthcare quality leads to the death of more than 138 million patients every year. Patient safety in hospitals is in danger due to human errors and unsafe procedures.

Abstract

  • Introduction.Near-miss events, where no actual harm comes to the patient, represent a lower‑risk opportunity to improve patient safety and address patient expectations regarding disclosure of medical errors, both factors associated with medical malpractice claims. The Institute of Medicine and others have called for the creation of voluntary reporting systems to detect near-m…
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Introduction

  • Near-miss events are errors that occur in the process of providing medical care that are detected and corrected before a patient is harmed. The Institute of Medicine (IOM) and others have identified near-miss reporting and analysis as vital to understanding and correcting weaknesses in the health care delivery system and to preventing actual adverse events (AEs) that harm patie…
See more on ahrq.gov

Methods

  • We recruited seven diverse practices to participate in the 1-year pilot project. The intervention itself had four components: (1) develop and conduct a standardized orientation for each practice with regards to reporting near-miss events; (2) collect and analyze near-miss reports from each of the practices for 6 to 9 months; (3) facilitate a practice improvement collaborative with the parti…
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Results

  • Near-Miss Event Reporting by Practices
    The practices were all largely successful in reporting near-miss events. The original target was for the combined enrolled practices to produce at least 300 near-miss reports over a 6-month period or seven reports per practice per month. The practices reported a total of 632 near-miss events …
  • Table 1. Near-Miss Events Reports by Practice, per month and per 1,000 patient visits
    The 632 reports that were logged in during the study period were coded and analyzed for type of event and seriousness. This analysis has been reported elsewhere.15
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Discussion

  • As previously noted, others have reported a number of potential barriers and facilitators to implementing near-miss event reporting generally. Our pilot built on a number of those facilitators, including anonymous reporting and using an online near-miss reporting form that had been previously tested and shown that it could be reliably completed by most users in 2 minute…
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Limitations

  • The practices that participated in this pilot project were selected and not randomized. We purposely chose practices to represent a diversity of size, ownership, specialty, and range of clinical services, but these practices are not necessarily representative of “average” practices in the region. Also, because this was a pilot project, we wanted to keep the number of practices co…
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Conclusions

  • This pilot demonstrated that a near-miss reporting and remediation system can be successfully implemented in primary care practices representing a range of size, ownership, and clinical mission, and that practice leaders find the information useful and appear willing to act on this information to improve care processes. Practices demonstrated consistent reporting numbers d…
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Acknowledgments

  • This project was funded by Grant No. HS19558 from the Agency for Healthcare Research and Quality. Key administrative support was provided by the North Carolina Office of Rural Health and Demonstrations, Community Care of Western North Carolina. Consultation on research methods and analytic support was provided by Generativity LLC. The Near-miss Reporting and Tracking s…
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Author Affiliations

  • Steven Crane, MD, Professor of Medicine, UNC-Chapel Hill; Assistant Director, Division of Family Medicine, Mountain Area Health Education Center (MAHEC); Medical Director of Primary Care, Mission Health System, Asheville, NC. Phillip D. Sloane MD, MPH, University of North Carolina, Chapel Hill, NC. Nancy C. Elder, MD, MSPH, University of Cincinnati, Cincinnati, OH. Lauren W. Co…
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References

  • 1. Kohn KT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington, DC: Committee on Quality of Health Care in America. Institute of Medicine, National Academy Press; 2000; p 87. 2. Riley W, Liang BA, Rutherford W, et al. The Patient Safety and Quality Improvement Act of 2005: developing an error reporting system to improve patient safet…
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