A near miss event (NME) in healthcare is an event that did not happen but would have caused serious harm if it did. The operating room (OR) is prone to risk and incidents, with estimates that 50% of all hospital adverse events occur in the OR, yet reporting of NME is uncommon in ...
While schemes for reporting Near Misses have been institutionalized in aviation and many High Reliability Organizations (HROs), such a scheme is less rigorously practiced in the healthcare industry. While Near Miss management is usually associated with error and safety management, there is a growing...
NEAR MISS OBSTETRIC EVENTS AS A REFLECTION OF QUALITY OF MATERNAL HEALTH CARE Objective: To determine frequency and nature of near-miss cases in obstetric patients in a tertiary care hospital. Study Design: Cross-sectional descriptive study. Place and Duration of Study: The study was conducted in...
Determinants of Maternal Near-Miss in Morocco: Too Late, Too Far, Too Sloppy? The majority of near misses demonstrated a third delay with many referrals. The women's perceptions of the quality of their care highlighted the importance of information, good communication, and attitude.Women and new...
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and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed in this centre over a 3-year period. The review is expected to serve as a complementary method for auditing the quality of maternal healthcare in this institution...
Maternal near miss in Ethiopia ranges from 4.97% to 29.7% [15, 16], one study reported a 50.4 per 1000 live births ratio [17]. Studying MNM is very important, as maternal mortality is more likely to be underreported by healthcare providers and managers, especially in low-income countries ...
Root cause analysis is a technique used in determining the real cause of an event. The Sentinel Event Policy of the Joint Commission on Accreditation of Healthcare Organizations requires a root cause analysis of a sentinel event but not a "near miss." However, root cause analysis is an import...
In 2007, Blue Mountain Health System committed to becoming a high-reliability organization and focused on high-risk processes such as medication management, including BCMA. Thereafter, the Authority recognized a pattern of BCMA workflow-related near-miss events reported by the health s...
An event was defined as any occurrence that could have, or had, resulted in a deviation in the delivery of patient care. The aim of the system was to support process improvement in patient care and safety. The reporting tool was designed so individual events could be quickly and easily ...