Table 4 Types of events defined by WHO Guidelines [9]

Error

Error has been defined as "the failure of a planned action to be completed as intended (i.e. error of execution) or the use of a wrong plan to achieve an aim (i.e., error of planning)". Although reporting of errors, whether or not there is an injury, is sometimes done within institutions, if reporting of all errors is requested the number may be overwhelming. Therefore, some sort of threshold is usually established-such as "serious" errors, or those with the potential for causing harm (also called "near misses" or "close calls"). Establishing such a threshold for a reporting system can be difficult. Hence, most "error reporting systems" are actually "adverse events caused by errors" systems.

Adverse Event

An adverse event is an injury related to medical management, in contrast to a complication of disease. Other terms that are sometimes used are "mishaps", "unanticipated events" or "incidents", and "accidents". Most authorities caution against use of the term accident since it implies that the event was unpreventable. Adverse events are not always caused by an error. For example, one form of adverse drug event, "adverse drug reaction" is, according to the WHO definition, a complication that occurs when the medication is used as directed and in the usual dosage. Adverse drug reactions are, therefore, adverse drug events that are not caused by errors. Many adverse events are caused by errors, either of commission or omission, and do, in fact, reflects deficiencies in the systems of care. Some reporting systems require that only preventable adverse events be reported, while others solicit reports whether or not a medical error occurred. One advantage of focusing reporting on adverse events rather than on errors is that it is usually obvious when a mishap has occurred; actual events focus attention.

Comment by the authors of EG-CIRLS: An adverse event is the result of a care delivery problem related to chiropractic management, in contrast to complications of disease. Chiropractic management includes all aspects of care, including diagnosis and treatment, failure to diagnose or treat, and the systems and equipment used to deliver care. Adverse events may be preventable or non-preventable. Preventable adverse event: An adverse event caused by an error or other type of systems or equipment failure.

Near miss

or

Close call

A near miss" or "close call" is a serious error or mishap that has the potential to cause an adverse event, but fails to do so by chance or because it was intercepted. It is assumed (though not proven) that the underlying systems failures for near misses are the same as for actual adverse events. Therefore, understanding their causes should lead to systems design changes that will improve safety. A key advantage of a near miss reporting system is that because there has been no harm the reporter is not at risk of blame or litigation. On the contrary, he or she may be deserving of praise for having intercepted an error and prevented an injury. This positive aspect of reporting of near misses, has led some to recommend near miss systems for internal reporting systems within health-care organizations or other health-care facilities where a blaming culture persists. However, any hospital [or private chiropractic practice] that is serious about learning will also invite reports of near misses.