"Near miss"

[railroadrn]

Does your facility ask you to record "near misses"? I feel like as nurses we do enough documentation and double, triple, and quadruple checking to prevent adverse events. If we catch a mistake before it is made, is it actually legally required that we put it in a tracking manual that isn't actually a medical record, just a manual for our supervisor to look at? (Or an in-house tool as it's called where I work) I just think it's petty and too much "busy work" to sit down and record all the times during the day that something could have gone wrong but was corrected first. Is that not the point of being a licensed healthcare professional? I don't mind reporting an actual incident, so don't misunderstand. I guess my main question is can employees actually be made to report "near misses" or is it really on a voluntary basis? I've tried googling but I can only find that actual adverse events are mandatory when it comes to reporting.

[Wile E Coyote, ASN, RN]

It's part of an effort to be proactive towards patient safety.

Also, since medical professionals are people first, the idea that having a degree or experience somehow shields us from error doesn't hold much water. There is absolutely zero chance we can ever be error free, so since we know this, what does it say about those that choose to wait until actual harm comes to someone before we act?

[CCU BSN RN]

Legally, no. It could be a requirement of your institution if it's policy there. We had a way to report near misses but it wasn't required or policed. I would report something egregious or something I thought other staff should be aware of.

Example, I called an MD to change a patient's metoprolol from PO to IV since they were strict NPO for something or other. Order was for 25mg PO, she ordered 25mg IV. Pharmacy verified and tubed me 5 5mg vials for a total of 25mg. If I had been stupid enough to push 25mg of metoprolol, the patient would probably be dead. Or in complete heart block. I reported that because pharmacy and an MD ordered and verified something lethal.

[NurseCard, ADN]

Yeah, it never hurts to report something very serious that COULD have

happened. Better to catch a possible cause of a sentinel event, like pushing

ordered 25mg of Metoprolol :)... and eliminate it BEFORE it causes such

event.

[Pepper The Cat, BSN, RN]

Near misses are important to capture because they should areas that need improvement and show were things could possibly go wrong. By looking at near misses, we ca take steps to,prevent harm from occuring.

[That Guy, BSN, RN, EMT-B]

Aside from how much I hate the term near miss ( IT MEANS THEY HIT! ) we did not record them however we were encouraged to report them.

[klone, MSN, RN]

Aside from how much I hate the term near miss ( IT MEANS THEY HIT! ) .

I KNOW!! Who coined that term??

Actually, just discussed it with my husband and now it makes sense. It's a miss that came near to hitting (as opposed to the garden variety misses that aren't even close, I guess).

[Here.I.Stand, BSN, RN]

I'll be honest..I don't. That's the whole reason nursing school taught us to do our "rights" x3. To prevent med errors. An "oops, he was supposed to have 2 packets of Prostat -- gotta go grab another one!" as I'm doing my checks is not the same as actually giving the pt the wrong dose. It's not a med error, it's the med aministration "rights check" working. And if I don't even have time to take my 2 15 minute breaks in addition to my lunch, or don't have time to complete 100% of my charting before report, writing up my non-med-error is not a priority use of time.

I can see in a perfect world it can help identify potential error patterns, but we don't work in a perfect world.

That's just me.

[Been there,done that, ASN, RN]

Actually, it's a near hit. I understand your frustration with duplicate charting.

You are the professional involved in these near hits. If you feel the near hit could be prevented in the future, take the time to report it.

[RNNPICU, BSN, RN]

We call these "good catches". They are good because they did not make it to the patient. They are just as important as errors because they can expose vulnerabilities

[klone, MSN, RN]

I'll be honest..I don't. That's the whole reason nursing school taught us to do our "rights" x3. To prevent med errors. An "oops, he was supposed to have 2 packets of Prostat -- gotta go grab another one!" as I'm doing my checks is not the same as actually giving the pt the wrong dose.

I wouldn't consider that a "near miss."

Here are two examples from my own practice (outpatient clinic):

Provider asks me to administer Rocephin IM to a patient. As I had only been there about 6 months, I didn't realize there are two doses of Rocephin typically given in an OB/Gyn clinic: 250mg for gonorrhea or PID, and 1000mg for pyelonephritis. I gave 250 all the time, had never given 1000mg before. I assume it is 250mg (and of course, not following proper protocol that requires me to visualize a written order) and administer that amount. As I'm letting the provider know I gave it, it comes up that I was supposed to give 1000mg, not 250. So I prepare another dose and give that as well. Now, sometimes 1000mg is too much to give in one injection so we break it up into two doses, one on each side, anyway. So the patient got the full dose, no harm came. But that was still a "near miss" because she almost walked out without the proper dose.

Second example (and I shared that here after it occurred): we always reconstitute Rocephin with Lidocaine. I was giving Rocephin to a patient, and was verifying her allergies beforehand as I always do. One of the allergies is "-caine medications" and she mentioned that. But I was so focused on the medication I was giving her (antibiotics) and what people are typically allergic to (antibiotics) that I just passed right over it. As I'm JUST ABOUT to poke her in the glute, she says "Will this sting a lot?" and I said, "Not too bad because we mix it with Lidocaine." I caught myself right before I was about to plunge the needle in.

Those are both examples of "near misses" that warrant an incident report (and I did submit one on both incidents).

[Here.I.Stand, BSN, RN]

I wouldn't consider that a "near miss."

Here are two examples from my own practice (outpatient clinic):

Provider asks me to administer Rocephin IM to a patient. As I had only been there about 6 months, I didn't realize there are two doses of Rocephin typically given in an OB/Gyn clinic: 250mg for gonorrhea or PID, and 1000mg for pyelonephritis. I gave 250 all the time, had never given 1000mg before. I assume it is 250mg (and of course, not following proper protocol that requires me to visualize a written order) and administer that amount. As I'm letting the provider know I gave it, it comes up that I was supposed to give 1000mg, not 250. So I prepare another dose and give that as well. Now, sometimes 1000mg is too much to give in one injection so we break it up into two doses, one on each side, anyway. So the patient got the full dose, no harm came. But that was still a "near miss" because she almost walked out without the proper dose.

Second example (and I shared that here after it occurred): we always reconstitute Rocephin with Lidocaine. I was giving Rocephin to a patient, and was verifying her allergies beforehand as I always do. One of the allergies is "-caine medications" and she mentioned that. But I was so focused on the medication I was giving her (antibiotics) and what people are typically allergic to (antibiotics) that I just passed right over it. As I'm JUST ABOUT to poke her in the glute, she says "Will this sting a lot?" and I said, "Not too bad because we mix it with Lidocaine." I caught myself right before I was about to plunge the needle in.

Those are both examples of "near misses" that warrant an incident report (and I did submit one on both incidents).

That makes sense. :)