The theoretical framework chosen for this study would be follow the Eindhoven model. This model was adapted by Henneman and Gawlinski (2010), investigating “near-miss” events, and conceptualize the role of the nurse at point of care in preventing adverse events and outcomes for patients. The reason for choosing this model, that it clearly demonstrates the relationship between human operator, organizational, and technical failures, because of the development of incidents that may or may not lead to adverse outcomes (Henneman et al., 2010). In the healthcare setting, if a high-risk condition is not prevented by adequate defenses system, it will not be interrupted, therefore places a threat on the patient’s safety (Henneman et al., 2010). Bedside