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A Closer Look at Underreporting of Near Misses in Healthcare

near misses in healthcare


High-performing healthcare organizations adopt principles that support a strong safety culture. Near miss reporting is an important component of establishing a safety culture; it is a process designed to improve safety within health systems by providing insights into the root cause(s) of harm.

Why Should Near Misses Be Reported? 

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

By increasing the reporting frequency of near misses in healthcare, organizations can gain a greater understanding of safety challenges and prevent future harm. However, it’s common for healthcare organizations to experience underreporting of safety incidents. 

According to a study released by the US Department of Health and Human Services (HHS), roughly 86% of patient safety incidents occurring in healthcare organizations go unreported.

Reporting Barriers: Contributing Factors

There are many barriers that reduce the likelihood of staff members reporting incidents and near misses in healthcare. What factors might contribute to a decrease in incident reporting within an organization?

1. Staff might be hesitant to report an incident for fear of negative repercussions.

Blaming individuals for mistakes is one of the greatest impediments to incident prevention in the healthcare industry.

According to a study by the U.S. Agency for Healthcare Research and Quality (AHRQ) Patient Safety Surveys, 47 percent of respondents said that it feels like incident reports are held against them. 50 percent indicated that, after an incident is reported, it feels like the person is being written up, not the problem. 

When staff does not feel like they have a safe, supportive environment to speak up about incidents, patient safety is likely to suffer as a result.

2. Staff may not understand what qualifies as a “safety incident” or “near miss”.

Often, organizations fail to define which incident should be reported. Without a clear set of guidelines, staff may not recognize that a daily annoyance is actually an unsafe incident or unsafe condition. (3)

A near miss is defined as any error that occurs in the care delivery process that is corrected before the patient is harmed. An example of this may be a patient that received an unintentional shock during a bedside defibrillator check but was otherwise uninjured. It’s important for organizations to report near misses in addition to true incidents, so that they can learn from them and identify areas of improvement.

3. The process of how to report an incident and near miss is unclear.

Employees often lack the necessary training for how to report an incident or event. If incidents are reported on paper or Excel, it’s common for those files to quickly become unorganized or unclear. Additionally, organizations that have many different platforms for communication or loosely defined processes for reporting face an increased risk of underreporting.

4. Busier healthcare environments due to COVID-19.

During the COVID 19 pandemic, healthcare organizations may have seen a reduction in incident reporting due to the overwhelming intensity of the current work environment. As healthcare workers on the frontlines attempt to keep up with new procedures and information that changes daily, they simply may not be as aware of patient safety risks or incident.

 Additionally, patients with little or no injury (such as in the event of a near miss) may not be viewed as a high priority as the main focus is treating patients infected by the virus.

Download our How to Implement a Near Miss Program Webinar

Reporting Near Misses in Healthcare

There are several ways to improve the process of reporting near misses in healthcare. Having a system for reporting incidents will ensure that patients are receiving the highest quality of care possible:

1. Establish a just patient safety culture that encourages incident reporting, events, and near misses.

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 incident as an opportunity for learning, not blame. (3)

2. Educate staff members about the importance of reporting.

Every employee must understand their specific role and responsibilities involved with upholding organizational safety. In addition to training each employee on safety protocols, staff members should be updated regularly about any relevant policy changes. Learning from adverse incidents including near misses and minor safety issues  requires analyzing data, communicating findings, and taking action. Clearly communicating and enforcing these policies among all team members helps ensure that every employee understands his or her responsibility to protect patient safety by reporting harmful incidents and near misses. (5)

It is also important for leadership to provide education on how to report an incident during all new hire training, including education around the value it brings to care teams.

3. Implement a streamlined incident reporting solution 

Traditional incident reporting systems have been paper-based, which often makes it difficult for leadership to translate data into meaningful insights for prevention. Implementing an effective incident reporting software can help leadership teams quickly determine underlying causes that contribute to patient safety incidents and pinpoint exactly where they are occurring over time.

Digital data-entry is less time consuming than paper-based reporting and reduces the risk of compromised data from human error. Access to real-time patient information through EHR integration allows supervisors and risk management to conduct immediate follow-up documentation and analysis. User-friendly dashboards and analytics allow supervisors to see incidents as they occur. This makes it easy to track trends over time, identify areas of improvement, and proactively reduce risk.

Using the above methods, healthcare organizations can combat underreporting to improve patient safety outcomes and reduce harm across the organization.

Download Our Whitepaper on Streamlining Incident Management

Performance Health Partner’s Incident Reporting Software

Implementing an incident reporting software is an integral part of an effective patient safety initiative. With Performance Health Partner’s Incident Reporting Software, healthcare organizations can take action against the harmful effects of safety incidents and near misses in healthcare, while focusing on delivering safe and high-quality care. To learn more, request a demo. 

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