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Choice of words ...



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What do hub members think about use of the term "near miss" vs "close call" vs "good catch" to describe errors that are caught before the reach or harm the patient? If you have a favorite, can you say why? 

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Hi .... I'm planning to do a project on this where I work.  I was thinking this very thing the other day.

I think it depends what the 'thing' is that you prevented and who found it and how serious the implication mitigated was.

In my experience so far, many people do not know what they are ....... we have become 'immune' to the near miss, we work in a system full of them, we work around them or 'dodge them' as we go.

I'm very excited about my up coming project...watch this space

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I think we can spend too much time determining e.g. what is a near miss, close call etc.  There are many differing definitions one may be that an existing safety procedure was not followed, another that some intervention of one kind or another prevented an error from occurring, or an event that didn't harm anyone but could have and so on.

We should concentrate on "Anything that may be a risk to safety" either in terms of identifying an issue through everyday work  where we may be able to make some improvement or something that causes a risk or poor outcome to a patient and requires a deeper enquiry.  I cant see much value in near miss per se as a term.

Keith

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I worked in the USA for 20 years and as an ED manager, we started a "Phew" campaign in my department. 

Basically, any near miss ,where inside, you literally have that "Phew, thank goodness that did not happen" moment, then that is reported as a near miss. 

Staff easily recognised that feeling, either kept it internally or shared with colleagues but we asked staff to  report these on our patient safety software,  so we could address patient safety issues, trends or system issues. 

Staff were commended for their openess and rewarded for their contribution to patient safety and prevention of a bad outcome.

Happy for anyone to emulate. 🙂

 

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