An exploratory mixed-methods study of Scottish midwives’ understandings and perceptions of clinical near misses in maternity care

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. Design: anoymous self-completion questionnaire and follow-up group interviews. Setting/participants: cinically based midwives working in four maternity units in Scotland (questionnaire [n ¼ 34]; interviews [n ¼ 26]). Findings: 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/implications for practice: 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.