Near Misses in Schools: Why Recording What Almost Happened Matters

New direction from the DfE

In March 2026, the DfE consulted on revised statutory guidance for Supporting pupils with medical conditions at school. One of the key proposals was to strengthen schools’ arrangements for recording, reporting and learning from serious incidents and near misses.

The Government published its consultation response on 6 July 2026. The existing statutory guidance remains in force for now, but the Government has confirmed that it will be revised following the consultation.

This creates an important distinction between what schools are legally required to do today and the direction of travel of the revised guidance.

That direction is clear: schools are expected to become more systematic in recording near misses and, crucially, learning from them.

What is a near miss?

The DfE’s proposed definition is particularly helpful:

A near miss is an event relating directly to a medical condition or allergy that did not result in harm but had the clear potential to do so.

This can include an error, omission or system failure that could reasonably have resulted in a serious incident if it had not been identified or circumstances had been different.

This is much broader than simply recording that medication was not administered.

Examples involving medication

A medication near miss could include:

• The wrong medication being selected but the error being spotted before administration.
• The wrong dose being prepared but identified during a checking process.
• Medication being prepared for the wrong pupil but the mistake being recognised immediately.
• Medication being administered at the wrong time, but with no resulting harm.
• A missed dose being identified before it could cause harm.
• Expired or incorrectly stored medication being discovered before it is administered.
• Required medication being unavailable when needed.
• An error being identified in a Medication Administration Record (MAR).
• An untrained or unauthorised member of staff being about to administer medication.
• A communication failure that nearly results in medication being administered incorrectly.

Examples involving allergies

The same principle applies to allergy-related events. Examples might include:

• The wrong food being supplied but the allergen being identified before the pupil eats it.
• A pupil’s allergy information being missing or incorrect in a relevant system.
• An emergency adrenaline auto-injector being unavailable or incorrectly located.
• Staff not being aware of a pupil’s allergy or Individual Healthcare Plan (IHP).
• Incorrect allergy information being communicated to catering staff.

None of these examples necessarily results in harm. However, each represents an opportunity for a school to identify a potential weakness before a more serious incident occurs.

From recording incidents to learning from them

The proposed DfE guidance places considerable emphasis on what happens after a serious incident or near miss.

It proposes that relevant incidents and near misses should be recorded as soon as feasible and, where appropriate shared with parents, discussed with the individual involved and considered as part of a lessons-learned review.

The review should consider questions such as:

• Could the incident reasonably have been foreseen?
• Did the pupil’s policies or IHP provide adequately for the situation?
• Were the correct procedures followed?
• Were the school’s procedures and policies adequate?
• What changes are necessary to prevent a recurrence?

This represents an important change in emphasis.

Rather than simply recording that something went wrong, schools are being encouraged to record what nearly went wrong, why it happened and what has been done to prevent it happening again.

Medication near misses deserve particular attention

There is already a strong precedent for schools recording medication near misses as part of their internal medication procedures. Some local authority guidance explicitly requires schools to record such incidents.

The approach also reflects wider developments in patient safety. Although NHS patient-safety requirements do not directly apply to schools, NHS England’s approach provides a useful example of good practice. It recognises and records prevented medication incidents, including situations where an incorrect medication was selected but the error was identified before the medication was administered.

The principle is simple:

A medication error that is caught before it reaches the pupil is still valuable information.

In fact, it may be more valuable from a preventative perspective because the school has identified a weakness without anyone having suffered harm.

Why near-miss recording matters

A single near miss may appear relatively insignificant. However, patterns can reveal systemic problems.

For example, several near misses involving medication might reveal unclear medication storage arrangements, similar-looking medication packaging, inadequate checking procedures, staff training or poor communication issues and inaccurate or incomplete MAR records or even weaknesses in a pupil’s Individual Healthcare Plan.

Individually, these events might be dismissed as mistakes that were caught in time. Collectively, they could provide an early warning of a significant risk.

This is why recording the near miss is only the first step. Schools need to be able to analyse their records, identify patterns and take action.

Moving towards a culture of prevention

The emerging DfE approach reflects a broader shift towards a culture of prevention rather than reaction.

An incident resulting in harm will, understandably, receive attention. But waiting for harm to occur before identifying a weakness in a school’s procedures is clearly undesirable.

Near misses provide schools with an opportunity to intervene earlier.

The challenge for schools is therefore not simply to create another form or another administrative process. It is to establish a reliable way of capturing near misses, identifying contributing factors, allocating actions and demonstrating that lessons have been learned.

For schools, particularly specialist and SEND settings where pupils may have complex medical needs, this can be an important part of effective risk management.

How technology can help

Traditional paper-based incident records can make it difficult to identify patterns across multiple incidents. A secure online system can provide a much more effective way of recording and analysing near misses.

For example, schools can distinguish between:

Incident with harm → Incident without harm → Near miss / prevented incident

They can then analyse near misses by pupil, medication, location, staff, time, type of error or contributing factor.

More importantly, an online system can link the original record to actions, reviews and lessons learned, creating a complete audit trail from the initial near miss through to the action taken.

This changes the purpose of recording from simply “what happened?” to: “What happened, why did it happen, what could have happened, and what are we going to do to make sure it doesn’t happen again?”

That is ultimately the value of recording near misses.

The DfE’s developing guidance suggests that schools should increasingly view near misses not as administrative events, but as early warnings and opportunities to improve safety.

Book a demo to see how IRIS Adapt helps schools record incidents, manage communication and maintain secure audit trails.

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