Differences in near miss incident reports across clinical experience levels in nurses: using national wide data base from the Japan council for quality healthcare

Document Type : Original Article


1 Department of Patient Safety, Iwate Medical University Hospital, Morioka, Iwate, Japan.

2 School of Nursing Iwate Medical University, Yahaba-cho, Iwate, Japan.

3 Department of Medical Informatics and Management, Hospital of the University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.

4 Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan.

5 Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Saitama, Japan.

6 Aino University, Ibaraki, Osaka, Japan.


Introduction: Medical incidents occur frequently, necessitating a more effective prevention policy. Nurses have the highest employment rates in the healthcare occupations; therefore, they are a key to improving patient safety. Most reports of errors have focused on medicine errors by nurses or patient falls; however, the effects of different types of error and nurses’ experience have not been examined. The present study aimed to elucidate the factors that influence differences in reported near-miss incidents across clinical experience levels and department assignments.
Material and Methods: A quantitative study was conducted using published data from the Japan Council for Quality Health Care. We analysed clinical experience level by near miss types.
Results: A total of 17,105 cases were analysed (14,896 drug near misses, 1,857 medical device near misses, and 162 nursing near misses). Participants had a mean of 7.4 years of experience and a mean of 2.3 years within the department. Statistically significant differences between clinical experience level, events, drug administration, and medical devices used were observed. However, no differences were found in terms of nursing care near misses. Length of department assignment was related to the “human factors” in participants at Novice/Advanced beginner levels, as well as “environment/facilities and devices” in those at Competent and Proficient/Expert levels. The percentage of “environment/facilities and devices” that caused near misses with drugs and medical devices increased as clinical experience increased.
Conclusion: The present study described the characteristics of clinical experience levels, providing meaningful information useful for developing new educational paradigms for effective training.


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