Near Miss Assessment


Near miss is a common problem in the medical field and the related fields. Many patients have suffered or died due to errors carried by the doctors. Near miss occurs nearly every day in hospitals around the world. It is been observed that many of the patients are not aware that they may be victims of near misses. This is because of the general belief that doctors are always right. It has also been noted that in over the past years a lot of efforts is being dedicated to the resolving of this problem. A lot of organizations and governments have been positioned on high alert to guarantee that this problem has being resolved. There are a lot of areas where by near miss cases are reported, for example, on drug administration

A report released from the world health organization (W.H.O) based on the general nursing practices on drug taking, revealed that a lot of people die due to drug omission. Near miss cases due to omission have been rising and are raising serious questions. In a bit, to understand and evaluate the concept of near miss evidence based finding is being carried out, to deeply look into it. The assessment of this research may have focused on the role of the doctor or nurse during the occurrence of the near miss. The roles of the doctors or nurses would have been put into test to verify if an error had occurred during the medication of drug. Based on accepted medical and clinical risk assessment procedures, the patient records had to provide the following information: -

  • The period of pains from the time it started to the time she started having drugs.
  • The history of the patient, during and after delivery whether or not she ever suffered any of serious effects or complications
  • The dosages of given to the patient before and after the omission.
  • The mode of drug taking whether tablet or injection
  • The condition of the patient when she arrived at the hospital.
  • The outcome of the omission (whether it was intentional or accidental).
  • The date of the occurrence of the near miss.
  • The physiological conditions of the patient.
  • The lifestyle if the patient i.e., smoking, if she takes alcohol, exercise and diet.

The patient, a 93year old mother, is a survivor of an omission near miss suffered on October 2011 at a certain medical facility. The patient who on lunch time drug taking was found with her drugs on the bed side table. It was indicated on the drug chart she had taken the drug (MELNICK & EVERITT 2008 pg 44).

During the assessment, of the patient records, the patient herself gave some of the required information needed. The patient may have been analyzed if she could withstand the assessment. Her willingness to give the general ordeal during and after the delivery was considerer before the assessment. A thorough physical examination and history of the patient was carried focusing on the maternal parts of the patient. The patient’s anxiety levels were carried out to make sure that she does not raise her blood pressure. This was to ensure that there would be no risks during the examination of the patient. The patient was assessed to ensure that she was psychologically fit to engage in the assessment of the research.

Physical examination

The patient fracture was observed to analyze the situation and degree of damage during the fall. The patient was given reasons for the assessment as required by the national clinical guidelines on the assessment of patients. The patient was given adequate privacy as required by law. She was given a chance to ask any questions she felt were important to ask.

Risk management

Having finished the assessment of the patient it was time to embark on the analysis of the patient risks and establishment of the patients risks contributory factors. It was observed that the patient who was admitted due to a fracture she incurred during a fall did not undergo right procedures drug taking. The patient was also a subject of carelessness on the side of the doctor who was on duty that day. The patient was badly injured and suffered pubic ramous .She also suffered a lot of drug reaction complications in the process of healing her wound. Other contributory factors included the patients’ inability to access quality first aid

The patient did not get adequate attention to her pregnancy prior to her delivery. The problem could have been easily detected and proper attention given to her.

Ethical risk

It was noted that the doctor involved in the delivery of the baby committed malfeasance. The doctor also did not practice the general principles of beneficence. He/she did not accord the patient the attention. Accurate medical prescription required by general principle of clinical practices, for instance, were not given. The doctor failed to give the patient antibiotics which should not be stopped or discontinued in 48 hours.

Prevention of the risk

The severe drug omission could have been prevented ensuring that the elderly woman had taken the drug before marking the drug chart. This is a globally accepted form of preventing omission of drug taking.

Advantages of the evidence of risk assessment

The evidence presented in the risk assessment process has a lot of advantages to any medical field. For instance, in nursing, the evidence presented is of great importance during my career as a medical practitioner. It is relevant now as a student, and in the future when the knowledge will be in action (WAITE & KEENAN 2010 pg 64). The evidence based risk assessment has provided the following advantages;

  • It has presented a good platform for me to understand the importance of carrying out a thorough medical assessment of a patient before issuing the drug.
  • It has also helped me understand the cost of negligence on carried out by personnel and patient and how to avoid it.
  • The evidence presented also has helped me to provide quality skills on the basis of knowledge and fact rather than on material knowledge of books. This is a very good ground to base the knowledge of practice
  • The risk assessment evidence ensures one is equipped with accurate information on the field of his or her study to cope with future challenges.
  • The evidence can also be used on my further learning and career as a reference to base arguments .It can be used to validate research proposal and thesis.
  • These evidences can also assist me work with other members of the health care fraternity to improve the health of many people.
  • The evidence presents a room to question existing healthcare practice and improve care basing on these evidences.

Although these near miss or error assessments alone cannot be entirely used to create a significant change in the medical practice, it can be used to give suggestions. Suggestions entirely arise from the evidence based findings (CHRVALA & SHARFSTEIN 1999 pg 64). These findings which have been achieved from, generally accepted clinical procedures can be used to give the following suggestions;

Doctors should visit the patients immediately to ensure they have taken drugs (MCPHEE, STEPHEN, PAPADAKIS, MAXINE, & RABOW, MICHAEL 2011 pg 34). To ensure that the elderly patients get enough medical attentions required by standards, they should be helped in taking drugs. This can be achieved by ensuring that the government has enough medical officers who carry on minute by minute nursing of the elderly.

  • Dedication should be given to the elderly during medication. The nurses and doctors should ensure they have gotten all the medical history of the patient during labor pains.
  • Nurses should be regularly up dated on new development on the drugs administration and dosage. This will equip them with adequate knowledge to make them accurate in their work.
  • Well equipped wards. This is to cater for elderly cases should be used to cater for the severely affected women who have suffered different cases of complications.


In the case presented above of a patient who suffered a near miss, in this case, from severe omission, it is clear that there should be a lot of attention during drug taking and medication (CROSKERRY 2009 pg 54). It provides an evidence based argument document by findings and suggestions made on the basis of the findings.

Omission is one of the conditions that can lead to death in the maternal field. (www. According to the world health organization (WHO) report on maternal health in 2006, a lot of people succumbed to illness caused by drug omission and post delivery. Many patients end up dead or continue to suffer due negligence or errors. These are errors made by the nurses or doctors treating them. It is a bad practice of medical doctors and clinical nurses to continue using practices that are outdated. New technologies have developed and will continue to be improved on the basis of different problems in the health sector (www.genetics .org/content). A lot of the problems sometimes arise from the doctor’s failure to apply appropriate tactics and medical procedures during assessment and assessment management.

In modern days technology is changing so fast and every person must keep in touch with the progress of the technological change. New knowledge and skills arise every day. People’s behaviors have changed and so do their lifestyles. A lot of complications arise due to these changing lifestyles.

These lifestyle habits include, exercise, diet and alcohol taking. Alcohol taking in pregnant women is can lead to serious complications to the baby. Lack of exercise in pregnant women can lead to complications during birth. Elderly people are therefore advised to be regularly doing exercise in order for them to reduce the possibility of getting a complication.

A good principle of clinical assessment should always be carried out by doctors and nurses to ensure that no casualty arises. A thorough assessment and its understanding should be carried. An understanding of the assessment and its good interpretation  are a key tool in diagnosis of the delivery.

Good drug medication practices should be encouraged by public health workers to ensure that the pregnant women are so much efficient. The public health officials should research and analyze the similarities of people who died and those who survived the near miss. These assessments provide a complete assessment of the quality of health in the society or community around the patients’ backgrounds.

The near miss assessment and findings have been used to provide and understand the information on drug omission health in general using the Swiss model. Although near miss concept does not require direct contact with the patient it sometimes requires one to verify the extent of the error and analyze it accurately. All information obtained in the near miss assessment and report is often retrieved from the hospitals records without the patients’ name. It, therefore, follows that the patients need no interviews whatsoever and

Depending on the complexity of the near miss health workers should make several follow ups to the patients to ensure that efficiency and accountability on their part is achieved.

After every initial assessment every step should be dedicated to ensuring that measures are put into action from the evaluations. Reassessments should be carried out every few months to make sure that quality medical attention of patients is guaranteed in that health facilities.

The near miss assessment should be classified according to the degree of seriousness of the cases. This separation helps the doctor’s deal with the cases with different strengths and therefore techniques. The serious cases which require special techniques should be accorded the desired attention. In regard to drug omission, the cases should be classified;

Severe drug omission complications which are complications that poses a great danger to the patients. These are complication that threatens the life of patients during and after the omission. These complications include severe heart failure, worsening of the wounds, body or organ dysfunction. Each of this complication is a very serious complication and can lead to death. (www.askthe Necessary attention should be given to prevention of these cases in sequence to diminish the chances of arising of any of these complications.

In the assessment of patient before treatment, their medical history can be an vital tool to facilitate the doctor analyze the possibility of the patient ever contracting any of the problems.

Contributory factors, such as a disease, that can lead to a severe maternal complication but were not on the list of those that led to a near miss, should be noted. It is also advisable to note if the patient went into the intensive care unit. The patients’ assessment should also take note of any involvement of life assistance equipment in the treatment. These include, use of radiology, blood transfusion and surgical operations due to an organ dysfunction.

These contributory factors however, sometimes go un- noticed and it is very important to critically analyze each and every situation. In order to deliver accurate and sound judgments as to whether there are any contributory factors, the doctor or clinical officer are advised to utilize all the knowledge at their disposal. The situations can also be noticed easily from the patients’ records from previous hospitalization.

Elderly high risk wards for women with birth complications should be given a priority to ensure maximum protection in case of an emergency. These include surgical rooms and life supporting equipments for those with special cases like elderly blindness.

All the major clinical procedures should be followed. For example, beneficence should be given a priority to ensure that patients do not suffer side effects. This should, however, be used in the case of whereby the patient if of sound mind. 

Non-malfeasance is another area, whereby; nursing should be reduced to ensure that there is no near miss in the future treatment.. Nurses should know whether a certain procedure will do great harm or would be beneficial to the patient of woman in question. Certain procedures like in surgery often cause other serious problems. For example in carotid endarterectomy increases the possibility of getting a stroke compared to patients who do not undergo it. These however should not make the doctors or nurses fail to provide good and quality medical care. This is because the patient must get certain treatment to make sure that he /she survives or delivers well.

In some situations, there are certain conditions whereby there are no clear studies to enable the doctor know the consequence of his or her treatment. These are mainly due complexity of the area of study or the medical field. There are also incidences whereby a positive effect of treatment may cause a lot of harm at the same time or aside effects (GREAT 2007 pg 72).

An informed consent should be applied to the patient to ensure that she is aware of the treatment. This should be done by the patient herself to ensure she is aware of what is going on. In a case whereby the patient cannot respond, a family member should take that responsibility and sign for her.

It is also advisable to maintain high confidential procedures according to clinical procedures. It is required also by law that doctors should maintain confidential records of patients and their names. In every state or country, there should be rules and regulations that ensure people get their privacy (JOINT COMMISSION RESOURCES, INC, & AMERICAN SOCIETY OF HEALTH-SYSTEM PHARMACISTS. 2006 pg 46). However, these rules and procedures should not deter the family members or the patient herself from accessing relevant information for future diagnosis. Although sometimes information might be given, it usually concentrated on serious cases like the case of HIV AIDS, sexually transmitted diseases and alcohol driving. This information might be given to other parties to enable them monitor the spread and or stop certain behaviors’. These behaviors include alcohol drinking which might be reported to police.

In order to deliver quality healthcare, students should also be given good and relevant education based on a day to day activity. This education should be incorporated with adequate research (THOMAS & HAYNES 2005 pg 44).

In conclusion, the assessment of near miss findings based on the evidence is a wide area of interest in any medical field. It should be accorded the necessary degree of seriousness. Near miss reports around the states should be analyzed and all the recommendations’ should be implemented. There are very many reports on risk assessment and all of them need to be analyzed and interpreted to give the patients’ quality health care.

Lessons should be learned from cases like those above in order to serve as a warning to negligent doctors.  Tight actions should be put in place to deal with medical teams which are not serious with their work. Laws should be put in place to discipline any   clinical mistake on the side of doctors. In addition, all the medical personnel should have a mandatory refresher cause on their area of interest. This improves on the quality of the health care to the population.

Finally it is important to acknowledge the contribution of online medical assistance provided by a private organization like the world health organization. These organizations have achieved many milestones in the areas of health care. They continue to help many patients for free. They also carry out quality researches which are very useful in every area or health care.  They usually carry follow up services for free on complicated cases and try to arise with answers to these issues.

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