Reasons why an adverse event may be underreported:
(1) There is no mechanism of reporting.
(2) Reporting is too difficult (relative or absolute).
(3) The person does not know how (untrained).
(4) It is uncertain who to report the event to.
(5) Reporting is not required.
(6) The person is afraid about being involved in a malpractice suit or being retaliated against.
(7) Reporting is discouraged.
(8) The person is indifferent, does not think that it is important or does not think that it is his/her job.
(9) The person forgot.
(10) The causation of the adverse event is uncertain or ascribed to something else.
If adverse events are reported, then it may go unrecognized if the report does not reach someone who can act upon the information. Reporting needs to be designed to get the right information to the right person.
