title: An exploratory mixed-methods study of Scottish midwives' understandings and perceptions of clinical near misses in maternity care.
abstract: OBJECTIVE
  adverse outcomes and near misses are believed to share many characteristics in terms of clinical situations and care management problems. Little is documented concerning what prevents adverse outcomes from happening once the 'accident trajectory' begins. This two-stage pilot study set out to investigate midwives' understandings and recollections of clinical near misses.
  
  
  METHODS
  anonymous self-completion questionnaire and follow-up group interviews.
  
  
  METHODS
  clinically based midwives working in four maternity units in Scotland (questionnaire [n = 34]; interviews [n = 26]).
  
  
  RESULTS
  despite a low response rate to the questionnaire, the cited examples seem to confirm that near misses and adverse outcomes follow essentially similar routes until the former are halted by a saving intervention. Dangerous situations are created by heavy workloads, and are aggravated by sub-optimal skill-mix, poor communication and individuals making mistakes or not following accepted procedures. Overwhelmingly, what prevents this situation from resulting in an adverse outcome is an intervention by another practitioner--often reported to be by chance and not design. In the interviews, these situations were discussed with reference to unit culture, the causes of errors and near misses, helping to prevent mistakes, the consequences of near misses and staff confiding in one another.
  
  
  CONCLUSIONS
  this limited study reaffirms the view that clinical near misses have the same origins as actual poor outcomes. Practitioners need to be able to discuss clinical and operational matters openly with colleagues. Although the 'blame culture' was reported to be less prevalent when things go wrong, not all midwives feel comfortable about discussing incidents or near misses. This exploratory study makes no claim to encapsulate this complex and sensitive subject. Further detailed research into the nature and extent of near misses is required. Identifying what prevents a poor outcome from happening may be a valuable clinical resource.
authors.affiliation: School of Nursing and Midwifery, University of Dundee, Dundee DD1 9SY, Scotland, UK. a.g.symon@dundee.ac.uk
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Symon
authors.forename: Bernadette
authors.initials: B
authors.lastname: McStea
authors.forename: Tricia
authors.initials: T
authors.lastname: Murphy-Black
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000451:nursing*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000379:methods / Q000458:organization & administration*; D019300:Medical Errors / Q000451:nursing* / Q000523:psychology; D008508:Medication Errors / Q000451:nursing* / Q000523:psychology; D008880:Midwifery; D033262:Narration; D024802:Nurse's Role; D015404:Nursing Methodology Research; D011247:Pregnancy; D012449:Safety; D012606:Scotland; D011795:Surveys and Questionnaires