Moradi L, Emami Sigaroudi A, Pourshaikhian M, Heidari M. Risk Assessment of Clinical Care in Emergency Departments ByHealth Failure Modes and Effects Analysis. JHNM 2020; 30 (1) :35-44
URL:
http://hnmj.gums.ac.ir/article-1-677-en.html
1- Nursing (MSN), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
2- Associate Professor, Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran , emamisig@gmail.com
3- Assistant Professor, Social Determinants of Health Research Center (SDHRC), Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
4- Associate Professor, Department of Occupational Health, Research Center of Health and Environment, School of Health, Guilan University of Medical Sciences, Rasht, Iran
Abstract: (2518 Views)
Introduction: Medical errors are among significant health system problems. The best method to detect errors is to identify the root and systemic causes of errors.
Objective: This study aimed to investigate the failures of clinical care in emergency departments using the Healthcare Failure Modes and Effects Analysis (HFMEA).
Materials and Methods: This was an analytical and cross-sectional study. The required data were collected qualitatively and quantitatively using focus group discussions in emergency departments. The study population consisted of all emergency department nurses. Study samples were selected by purposive sampling technique. By the HFMEA method, Risk Priority Number (RPN) was calculated to reach failure modes and those with RPN>216 were identified as the most frequent and risky errors.
Results: A total number of 67 failure modes were identified for 26 clinical care processes.The errors with the highest RPN were “the lack of oxygenation during airway suctioning” and “the lack of airway suctioning during ventilator weaning process”; they related to the respiratory system care with RPN=336. The error with the lowest RPN was “the lack of signing verbal orders by two nurses”; related to the general practice with RPN=8.
Conclusion: Investigating the causes and effects of these errors, controlling, and suggesting measures indicate the high efficiency of the HFMEA method. It also suggested the preventability of these errors by increasing the knowledge and awareness of the training staff by providing training courses.
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● Errors in clinical care processes account for a significant percentage of complaints, injuries, and even deaths.
● The Healthcare Failure Modes and Effects Analysis (HFMEA) is validfor detecting human errors in clinical care processes.
● By the HFMEA method, we take advantage of the available resources for implementing corrective and preventive measures.
Plain Language Summary
Errors in clinical care processes highly impact treatment-related problems, such as decreased patient safety, service quality complaints, physical injuries, and death. Accurate identification of clinical care processes and detection of failures and analysis of the effects of these failures and executing corrective measures can reduce the incidence of medical errors of service providers and their related issues. Given the importance of emergency services and the nature of clinical care processes, this study aimed to fully identify the processes, tasks, sub-tasks, and possible error modes in service delivery and their effects in the emergency department. In the risk assessment phase of detected errors, the three indices of occurrence, severity, and detection were scored by experts, and through focus group discussions,the errors with a risk priority number ˃216 were considered with risk priority. The highest risk priority scores in the respiratory system care category were related to the lack of suctioning and attention to oxygenation. Controlling the risks associated with clinical care in the emergency department plays a crucial role in reducing treatment costs, dissatisfaction, and complaints related to medical errors.
Article Type :
Research |
Subject:
Special Received: 2019/10/25 | Accepted: 2019/11/28 | Published: 2020/01/1