Near Misses in Healthcare: Real-Life Examples, Prevention, and Tips

In healthcare, even the smallest mistake can have serious consequences. So, what about the incidents and accidents that almost happen – the ones that could have harmed a patient but were prevented just in time? These are known as ‘near misses’, and while they don’t result in harm, they offer valuable insights into potential risks within the system. Near misses in healthcare reveal gaps in processes that might otherwise go unnoticed until a real error occurs. 

This blog will explore how healthcare professionals have a great opportunity to strengthen patient safety and create a culture that prioritizes learning over blame by paying attention to these close calls.

Understanding Near Miss Events in Healthcare

In healthcare, a ‘near miss’ refers to an event that could have led to patient harm but was averted before any injury occurred. These incidents serve as critical opportunities for healthcare systems to identify vulnerabilities and implement preventive measures, enhancing patient safety.

Common Causes of Near Misses

• Overcrowding and Staffing Issues: High patient volumes and insufficient staffing can overwhelm healthcare providers, increasing the likelihood of errors. Inadequate nurse-to-patient ratios, for instance, have been linked to higher rates of patient mortality and nurse burnout. 
• Lack of Standard Procedures: The absence of standardized protocols can lead to inconsistent practices, resulting in errors. 
• Communication Breakdowns: Failures in communication, such as unclear instructions or misinterpretation of information, can lead to near misses. In fact, inadequate communication has been identified as a root cause of serious adverse events in hospitals. 

Types & Examples of a Near Miss in Healthcare Settings

Below are common types of near misses in healthcare, along with illustrative examples:

1. Medication-Related Near Misses

These occur when errors in prescribing, dispensing, or administering medications are caught before reaching the patient.

Example: A nurse notices that a prescribed medication dosage exceeds the standard limit and consults the physician, who corrects the order, preventing a potential overdose.

2. Surgical and Procedure-Related Near Misses

These involve mistakes during surgeries or medical procedures that are identified and rectified before causing harm.

Example: A surgical team realizes just before incision that the patient is prepped for surgery on the wrong site, prompting a verification that averts the error.

3. Diagnostic Errors

Near misses in diagnostics happen when an incorrect or delayed diagnosis is corrected in time to avoid adverse outcomes.

Example: A radiologist initially misses a hairline fracture on an X-ray, but catches the oversight during a secondary review, ensuring the patient receives appropriate treatment.

4. Patient Care Near Misses

These involve lapses in routine patient care that are intercepted before affecting the patient.

Example: A patient is almost administered food despite being scheduled for surgery requiring fasting. A nurse double-checks the schedule and withholds the meal, preventing complications.

5. Communication Failures

Near misses due to miscommunication among healthcare providers or between providers and patients.

Example: A lab result indicating a critical condition is initially miscommunicated, but a follow-up call clarifies the correct information, leading to timely patient intervention.

6. Equipment Failures

These occur when medical equipment malfunctions or is used incorrectly, but the issue is detected before causing harm.

Example: A nurse discovers that a defibrillator is not functioning during a routine check and arranges for its repair, ensuring it’s operational when needed.

7. Environmental Hazards

Near misses arising from unsafe conditions within the healthcare environment.

Example: A spill in a hospital corridor is promptly cleaned up before anyone slips, preventing potential injuries. 

8. Maternal Health Near Misses in Obstetric Care

These involve situations where pregnant or postpartum women experience severe complications that could have resulted in serious harm or death but did not.

Example: A woman undergoing a cesarean section experiences unexpected heavy bleeding due to a uterine rupture. The surgical team quickly identifies the issue and performs an emergency hysterectomy, successfully controlling the bleeding and saving the patient’s life.

Examples of Near Misses in Hospital Settings

• A radiologist identifies a potential mislabeling of imaging results before they are reported, ensuring the correct patient receives the appropriate diagnosis.
• A lab technician catches a sample labeling error, preventing incorrect test results from being assigned to a patient.

Near Miss Examples in Nursing Homes

• A nurse double-checks a medication order and discovers a potential allergy interaction, preventing an adverse reaction.
• Before administering treatment, a nurse realizes that two patients with similar names are on the same ward and ensures correct identification to prevent errors.
• A nurse enters a patient’s room and notices that the bed rails are lowered, and the patient is attempting to stand up unassisted despite being at high risk for falls. The nurse quickly intervenes, assisting the patient back into bed. Additional fall prevention measures are implemented after the incident is reported to prevent future incidents.

Importance of Reporting Near Misses in Healthcare

Reporting these incidents is crucial for enhancing patient safety, whether they are in a hospital, nursing home, or any other healthcare setting. Here are some reasons why:

• Proactive Risk Identification

Documenting near misses enables healthcare providers to identify potential hazards before they result in harm. It allows for the implementation of preventive measures, thereby reducing the likelihood of future errors.

• Learning Opportunities

Analyzing near misses offers valuable insights into system vulnerabilities and human factors contributing to errors. It facilitates the development of targeted training programs and process improvements, enhancing overall patient care.

• Building a Culture of Safety

Encouraging the reporting of near misses fosters a culture that prioritizes patient safety. When healthcare professionals feel comfortable reporting errors without fear of retribution, it promotes transparency and collective responsibility for safety.

• Encouraging Open Communication

Openly discussing near misses encourages communication among healthcare teams. It helps in understanding the root causes of errors and promotes collaborative problem-solving, leading to more effective solutions.

• Data-Driven Decision-Making

Aggregating data from reported near misses provides a robust foundation for making informed decisions. Healthcare organizations can analyze trends and patterns to prioritize areas needing improvement and allocate resources effectively.

• Employee Engagement

Involving staff in the reporting and analysis of near misses increases their engagement and commitment to patient safety initiatives. When employees see that their input leads to tangible improvements, it boosts morale and job satisfaction.

• Reducing Blame Culture

Shifting the focus from individual blame to system improvement encourages more reporting of near misses. It helps in identifying systemic issues and fosters an environment where learning from mistakes is valued over assigning fault.

• Mitigating Legal and Financial Risks

Addressing near misses can prevent actual adverse events, reducing the potential for malpractice claims and associated financial costs. Proactive risk management through near miss reporting is a cost-effective strategy for healthcare organizations.

• Preventing Adverse Events

Each reported near miss is an opportunity to prevent a future adverse event. By analyzing and addressing the factors that led to the near miss, healthcare providers can implement changes to prevent recurrence, thereby enhancing patient safety.

• Reputation Management

Healthcare organizations that demonstrate a commitment to safety through near miss reporting can enhance their reputation. Patients are more likely to trust institutions that are transparent about errors and proactive in preventing harm.

Ensure Safety with Free & Customizable Care Audit Checklists

GoAudits offers a range of medical audit checklists for different healthcare settings. You can sign up for free and start using these checklists or customize them to meet your unique needs.

• Near Miss Incident Report
• Maintenance, Health & Safety
• Monthly Fire Safety Inspection
• Workplace Safety Audit Checklist
• Nursing Home Safety Checklist
• Home Safety Assessment for Elderly
• Care Home Safety Checklist
• Home Health Care Worker Safety Checklist

How to Prevent Near Misses in Healthcare Facilities

Preventing near misses in healthcare facilities is essential for ensuring patient safety and delivering high-quality care. Implementing the following strategies can significantly reduce the occurrence of near misses:

1. Establish a Culture of Safety

Creating a safety-oriented culture encourages open communication and shared responsibility among healthcare team members. Promoting a non-punitive environment where staff feel comfortable reporting errors and near misses without fear of retribution is crucial. Leadership commitment to safety and regular reinforcement of safety protocols are key components of this culture. 

2. Enhance Communication

Effective communication among healthcare professionals is vital to prevent errors, ensuring clear and concise information exchange. Regular interdisciplinary meetings and handoff procedures further enhance communication and reduce misunderstandings. 

3. Continuous Training and Education

Ongoing education keeps healthcare providers updated on best practices and emerging safety protocols. Regular training sessions, simulations, and competency assessments help staff maintain and improve their skills, ensuring they are well-prepared to handle various clinical scenarios. 

4. Conduct Root Cause Analysis (RCA)

After a near miss is reported, performing an RCA helps identify underlying system failures and human factors contributing to the incident. It facilitates the development of targeted interventions to prevent future occurrences.

5. Implement Incident Reporting Systems

Establishing user-friendly and anonymous incident reporting systems encourages staff to report near misses and errors, and identify patterns and areas for improvement. Confidentiality in reporting further encourages more staff to come forward with information about near misses. 

6. Conduct Regular Audits and Reviews

Regular audits and reviews of clinical processes and outcomes help identify potential safety hazards. They enable healthcare facilities to implement corrective actions promptly. 

7. Recognize and Reward Reporting

Acknowledging and rewarding staff for reporting near misses fosters a proactive approach to patient safety. Recognition programs can motivate employees to remain vigilant and engaged in safety initiatives. 

8. Engage in Continuous Monitoring and Feedback

Regularly reviewing reported near misses and providing feedback to healthcare teams promote continuous learning and system improvement. It helps in adapting strategies to emerging challenges in patient safety.