Q.01

What are some near miss examples at work?

A near miss is an unplanned event that could have injured someone, made them ill or caused damage, but didn't. OSHA's VPP manual defines it as "an unplanned event that did not result in injury, illness or damage but had the potential to do so" [1]. The examples below come from Japan's Ministry of Health, Labour and Welfare (MHLW) collection of reported near-miss cases. The originals are in Japanese and are summarised here in English.

Slips, trips and falls

  • Food retail, kitchen: a worker frying food slipped on tempura oil that had splashed onto the floor and fell [2].
  • Golf caddie: while going down a slope to fetch a ball, the caddie's foot caught in a divot and they nearly fell [3].
  • House moving: three workers were lowering a 68.5 kg refrigerator by rope from a second-floor window when the window guard came off, and they nearly fell out. The listed countermeasure is to check that rails and window guards are strong enough, remove aluminium guards beforehand, and use lifelines and fall-arrest equipment [4].
  • Roofing: a worker placing roof tiles from external scaffolding lost balance and nearly fell [5].

Caught in or struck by

  • Press operation: the operator stepped on the foot switch by mistake, the press came down, and their right hand was nearly trapped [6].
  • Directing traffic at roadworks: a worker guiding a truck stood between it and a utility pole and was nearly crushed [7].
  • Crane lift: the wire rope holding two H-beams broke and the steel fell [8].
  • Carrying by hand: a worker's hand slipped while carrying an aluminium sash frame with a colleague, and the frame nearly hit their face [9].
  • Wheel loader: a tyre threw a fist-sized stone towards the safety walkway. Nobody was hurt only because pedestrians had been kept out. The countermeasure is a mesh fence between the work area and the walkway [10].

Electrical

  • Substation inspection: while taking a photo during a monthly check, an inspector accidentally touched a live high-voltage switch. The countermeasure is to confirm whether equipment is energised first and to take shock precautions when it can't be switched off [11].
  • Freight depot: a broken outdoor socket had exposed wiring, and packing wrap caught on it, nearly giving the worker a shock [12].
  • Port, reefer container: connecting a refrigerated container to a power supply that didn't match its rating caused a bang and sparks. The worker's right ear was temporarily affected and their fingertips were nearly burned [13].

Fire and explosion

  • Hot work: a lit gas cutting torch was used right next to two kerosene containers [14].
  • Demolition: a cutting torch ignited solvent left inside a metal box at a separator-film plant. Countermeasures include no open flames where flammables may be present, gas and oxygen measurements, and the client telling contractors about the hazards [15].

Driving for work

  • Delivery truck: the truck skidded on an icy road and crossed into the oncoming lane [16].
  • Company car: on black ice the car spun once and ended up in a snowbank [17].
  • Motorbike: a rider collecting payments was dazzled by oncoming headlights and nearly hit a utility pole [18].

Why regulators care about near misses

  • US process safety: OSHA's refinery emphasis programme (CPL 03-00-010) says most major incidents were preceded by precursor incidents. Inspectors compare how many near misses an employer investigated with how many actual incidents it investigated [19].
  • US VPP sites: participants "must establish an incident and near-miss reporting system as well as investigate all incidents and all reported near-misses" [1].
  • Australia: under Safe Work Australia's model Code of Practice for healthcare and social assistance, a dangerous incident that exposes someone to serious risk is a notifiable incident "even if is a 'near miss' or if no one is injured" [20].

Approach: I used the MHLW workplace-safety site's near-miss case collection for the examples and OSHA directives plus Safe Work Australia's model Codes of Practice for the definitions and reporting expectations. I didn't look at GB RIDDOR dangerous-occurrence rules.

I can pull more cases for a particular industry (construction, manufacturing, logistics, healthcare) if that would help.

Q.02

What counts as a near miss in healthcare?

In healthcare, a near miss is the same idea as anywhere else: an unplanned event that could have caused death, injury or illness but didn't. OSHA defines it as "an unplanned event that did not result in injury, illness or damage but had the potential to do so" [1]. OSHA's safety management guidance uses "close call/near miss" for an incident that could have resulted in death, injury or illness but did not. It adds that such events "signal that hazards are not being adequately controlled or that new hazards have arisen" [21]. What matters in practice is which system the event falls under: worker safety or medical device vigilance.

1. Worker safety (staff in hospitals and care settings)

Examples from Japan's MHLW collection of reported near misses in hospitals and care facilities (summarised in English from the Japanese):

  • Sharps: a tray of used drip equipment from a surgical patient was knocked over during disposal, and a nurse almost pricked a finger on the needle [22].
  • Moving patients: a care worker lifting a resident alone from a floor futon into a wheelchair almost injured their ribs. The listed countermeasures are not to lift in a strained position and to consider doing the job with more than one person [23]. In another case, a worker lifting a resident out of a bath while bent forward almost hurt their back [24].
  • Repositioning a patient: on a night shift, a worker twisted their back while repositioning a patient in bed. The pain was gone the next day [25].
  • UV exposure: while adjusting a UV lamp in the room where ward nursing uniforms are sterilised, a worker got UV light in their eyes. An eye check the next day found no problem [26].
  • Hospital kitchen: a worker carrying a pot of boiling water slipped on a wet floor. They let go of the pot and avoided being scalded [27].
  • Home care: a worker carrying a client's electric wheelchair up stairs alone lost balance when it landed on their foot. The countermeasures are to use a lift where there is one and to carry it with more than one person [28]. In another case, a knife fell off a client's kitchen counter and nearly stabbed a worker's foot [29].
  • Cleaning and maintenance: a worker nearly slipped on soapy water in a care-home bathroom [30]. Another nearly fell from a stepladder set up on uneven ground [31].

Australia, notifiable incidents. Under Safe Work Australia's model Code of Practice for the healthcare and social assistance industry, a "notifiable incident" includes "a dangerous incident that exposes someone to a serious risk (even if is a 'near miss' or if no one is injured)". The incident must happen as a result of work: a patient dying of natural causes is not notifiable, but a patient dying from a medication mix-up is. You "must" report it to the WHS regulator immediately and keep the site as it is until an inspector arrives [20].

US, VPP sites. OSHA's Voluntary Protection Programs (VPP) participants "must establish an incident and near-miss reporting system as well as investigate all incidents and all reported near-misses", with documented root-cause investigations [1].

2. Medical device events (patient safety)

Device law doesn't use the term "near miss", but it covers the same ground. Under EU MDR/IVDR, a "serious incident" is any incident that "directly or indirectly led, might have led or might lead to" death, serious deterioration in health, or a serious public health threat [32].

  • No harm needed. MDCG 2023-3 rev.2 says it is enough that the incident was such that, "if it happened again, it might have led or might lead to" one of those outcomes [33]. So a device failure that harmed nobody can still have to be reported by the manufacturer.
  • Use errors. A use error caused by inattention, memory lapse or lack of knowledge is not an "incident". It "must" still be documented in the manufacturer's quality management system. A use error caused by the device's ergonomic features (displays, alarms, software menus) is an incident [34].
  • Great Britain. MHRA guidance on vigilance reporting uses the same "might have led or might lead to" definition. It states that "serious deterioration in health need not have occurred for a use error to be reportable, just the risk it could occur" [35].

Approach: I searched the MHLW near-miss case collection, OSHA directives, Safe Work Australia's model Codes of Practice, MDCG guidance and MHRA device guidance. I found no definition of near misses or intercepted medication errors in the medicines pharmacovigilance sources I searched, so that side isn't covered here.

Q.03