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No evident harm


Maintaining trust

No evident harm


Sometimes unexpected events in healthcare delivery result in no evident harm. This can occur in the following situations:
  • No harm incident: The event reached the patient, but no harm occurred at the time and no potential for harm realistically exists in the future. However, sometimes an incident has the potential for harm, that is, harm might manifest in the future. No harm incidents require disclosure.
  • Near miss: The event did not reach the patient because of timely intervention or good fortune. In general, a near miss need not be disclosed, although there are exceptions. The patient should be informed if there is a similar, ongoing safety risk for that patient, or if the patient is aware of the near miss and an explanation will allay concern and promote trust.
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  • No evident harm

    • No harm incident

    • Near miss

No evident harm

Case: A patient is exposed to unsterilized equipment
Concerned looking mother and daughter listening to male physician

Background

A patient is exposed to medical equipment that has been inadequately sterilized.  

The equipment has been used to treat other patients, some of whom are known to carry HIV infection.

You determine that a small risk of transfer of the virus from the equipment exists.

Suggestions

If a potential for harm from the event exists in the future, then generally this should be discussed with the patient. The likelihood and severity of future harm should be considered.

You may wish to seek the advice of other clinical and ethical experts, and legal counsel.

You may also want to arrange for follow up, further clinical testing, and post-exposure prophylaxis treatment as appropriate.

If the event reached the patient, typically a patient should receive knowledge of the event even if it resulted in no harm.

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Case: A patient with allergy to penicillin
Close up of vial with liquid medicine

Background

A patient has a known allergy to penicillin, and this fact is recorded on the medical record. Despite this, you administer penicillin to the patient, yet there is no allergic reaction

Suggestions

In this case, a discussion with the patient would enable the patient to understand an allergy may not exist.

It is not always easy to decide whether to make your patient aware of an incident in which there is no harm. Ask yourself: What facts would the patient want to know?

Another approach is to use the "substitution test" — would you want to know if you were the patient or if one of your family members was the patient?

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Near miss

Case: A near miss that need not be disclosed
Close up of syringe

Background

You draw up a vial of penicillin to administer to a patient with a known allergy to penicillin.

As you approach the bedside you become aware of the potential medication problem, and do not give the drug. No medication enters the patient.

Suggestion

As no medication enters the patient, you need not discuss this near miss with the patient.
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Case: A near miss that might be communicated to a patient

Background

Two patients on a ward have identical last names and you almost give a medication to the wrong patient.  

The mix-up of patient names is recognized just in time and nothing is administered to the wrong patient.

Suggestions

  • In this situation, it would be sensible to alert both patients to the fact that they share the same name so that the patients themselves can be more vigilant, contributing to their own risk management.
  • It would also be important to make system improvements so a similar occurrence would be less likely in future.
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