The Washington State Penitentiary established a successful near miss reporting system, a method of reporting -- and correcting -- potential hazards before an adverse event occurs. Reporting is voluntary and can be confidential. Hazards reported can include unsafe acts, environment, or equipment. While major medical systems use near miss reporting systems, this is likely the first of its kind to be implemented in a large correctional facility. The result was a paradigm shift to a just culture of inclusion, initiative, communication, ownership, trust, and proactively working for safety.

Educational Objectives

• Define a near miss reporting system
• Describe the steps to implementing a near miss reporting system
• Outline the benefits of a near miss reporting system

Level: Basic