Exploring the Accuracy of Near-Miss Reporting: A Mixed-Methods Study

To explore health care professionals' descriptions of near-miss events and assess the validity using the World Health Organization (WHO) patient safety classification framework.

A total of 2805 near-miss reports were reviewed from a tertiary hospital from 2021 to 2024 using a retrospective, mixed-methods approach. Descriptive statistics were used to examine reporting trends and patterns. Qualitative analysis was performed through evaluating each report's narrative using a structured decision-making process based on WHO criteria to determine whether it qualified as a near miss, adverse event, no-harm incident, or reportable circumstances.

Eighty-four percent were validated as true near misses, mostly related to medication safety. However, significant misclassification was observed in patient care and workplace safety reports, where many events were incorrectly labeled as near misses despite involving patient harm or reaching the patient without causing harm.

The findings reveal substantial near-miss detection and reporting by the pharmacy department, in particular, which signifies the pharmacists' role in validating prescriptions for patient safety. It simultaneously identifies critical reporting gaps related to the misunderstanding of safety event taxonomy by the reporting staff, which limits the accuracy of reported data and the potential resolution. Therefore, the study emphasizes the need for adopting a near-miss reporting framework that is comprehensive and standardized with a transparent definition, a structured analytical methodology, and a robust feedback mechanism to streamline the reporting process to ensure consistency of near-miss reporting across departments and optimize patient safety efforts.