Near-miss and hazard reporting: promoting mindfulness in patient safety education

Patient safety efforts advocate for transforming healthcare from a culture of blame to a non-punitive "culture of safety." One of the most challenging hurdles is to encourage healthcare practitioners to be mindful about their activities. To promote mindfulness during clinical education for entry-level nurses, we developed a web-based dangerous situation and near miss reporting system for a cohort of baccalaureate nursing students (N=156). For this curricular innovation project, we provided wireless handheld devices to students who were required to submit one report for each of their clinical days in the medical-surgical, pediatric, psychiatric, obstetrics and community settings. During a ten-week period, students submitted 1487 reports. Of these, 63% were dangerous situations and 37% were near misses. The most frequently occurring dangerous situations were poor infection control practices. The most commonly reported near misses were medication errors. Free text comments from students identified inadequate patient identification and poor documentation as commonly occurring dangerous situations observed.