Congratulations Kristen Mair & Ann Mary Vincent – winners of the quarterly ‘Good Catch’ Awards!

Good Catch Awards highlight individuals, groups or departments who demonstrate their commitment to keeping patients safe by reporting a near miss. A ‘good catch’ (or near miss) is an event or situation that could have resulted in harm, but did not reach the patient because of chance or timely intervention. Reporting these events can help to identify gaps in order to prevent future adverse events from happening.

Kristen works in Renal Services.  She reported a near miss related to an incorrect setup on a hemodialysis machine because the wrong patient chart had been placed at the machine. Due to her diligence she noticed the error and was able to correct the settings prior to the patient being put on the machine.

Ann Mary is a nurse on the 2C Cardiology, Stroke, Medical Inpatient Unit where she reported a near miss related to an order for Magnesium IV for a patient with a high magnesium level.  The order was meant for a different patient with a low magnesium level who coincidentally had the same initial and last name. This could have had serious implications for both the patient receiving an incorrect dose and the patient not receiving the required dose, but her catch avoided any adverse events occurring.

Each recipient has been awarded a certificate and a gift card to the Goods & Co Market.

New winners will be randomly selected every quarter. Continue submitting your near misses for a chance to win! Near miss reports are submitted through the Incident Learning System (patient safety incidents). Click on the ‘safety reporting’ icon from your Novell home page, or go to the iNtranet and choose ‘Safety Reporting’ under ‘Informational’.

For more information, contact Terry Fodë, Patient Safety Improvement Specialist (terry.fode@tbh.net).