Near miss means it did not reach the client
A near miss is an incident that did not reach the client: an error or hazard was caught before it affected him. Whether harm occurred does not decide whether an event is a near miss; an error that reaches the client without causing harm is a no-harm incident. Of the four events, only the blood tube labeled with another client's name was caught before it was sent. The mislabeled specimen never produced a result in his record or led to treatment, so the error never reached him. That is a near miss.
Classifying the other events
In the other three events, the error reached the client. Another client's infusion ran into him for one minute before it was stopped. He received an aspirin dose meant for his roommate. His 09:00 aspirin was missed and given late at 11:00; an omitted or delayed dose is an error that reached him. None caused harm, so each is a no-harm incident, not a near miss. If any had caused harm, it would be classified as an adverse event or harmful incident.
| Event | Reached him? | Classification |
|---|
| Mislabeled tube caught before sending | No | Near miss |
| Wrong infusion for 1 minute | Yes | No-harm incident |
| Roommate's aspirin given | Yes | No-harm incident |
| Aspirin given 2 hours late | Yes | No-harm incident |
Why all four are still reported
Incident reporting is not only for events that cause harm. Near misses and no-harm incidents are reported too, because they reveal weaknesses in the system, such as patient identification and labeling practices, before an error causes harm. In this week, several events involve patient identification, which suggests a pattern the risk management team should study. Reports are factual and nonpunitive, focusing on what happened and how to prevent it.
Prevention
Using two client identifiers when giving medications and collecting specimens, labeling tubes at the bedside in the client's presence, and scanning wristbands where available all reduce these errors.
Exam takeaway
Watch out "No ill effect" does not make an event a near miss. Ask whether the error reached the client: if it did not, it is a near miss; if it did without harm, it is a no-harm incident.