[Failure mode effect analysis for safety improvement in the automatic drug dispensing systems].

Autor:	Prado-Mel E; Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España. Electronic address: elenapradomel@gmail.com., Mejías Trueba M; Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España., Reyes González I; Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España., Gallego Espina MA; Servicio de Medicina Física y Rehabilitación, Hospital Universitario Virgen del Rocío, Sevilla, España., Martín Márquez MT; Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España., Alfaro Lara ER; Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España.
Jazyk:	Spanish; Castilian
Zdroj:	Journal of healthcare quality research [J Healthc Qual Res] 2021 Mar-Apr; Vol. 36 (2), pp. 81-90. Date of Electronic Publication: 2021 Jan 22.
DOI:	10.1016/j.jhqr.2020.08.003
Abstrakt:	Objective: To identify the risks in automated dispensing cabinet use in order to improve routine procedure safety. Methods: We used the Failure Mode Effect Analysis (FMEA) methodology. A multidisciplinary team identified potential failure modes of the procedure through a brainstorming session. We assessed the impact associated with each failure mode with the Risk Priority Number (RPN), which involves three variables: occurrence, severity, and detectability. Improvement measures were established for failure modes with RPN>100 considered critical. The final RPN (theoretical) that would result from the proposed measures was also calculated. Results: The process was divided into five sub-processes: automatic delivery of order replacement, to prepare order in a pyramidal cart, transport of the pyramidal cart from the pharmacy service to the automated dispensing cabinet, replacement of the automated dispensing cabinet by the pharmacy technician and dispensing/returning by nursing staff. Twenty-two failure modes, with 25 cases and with varying effects (severity 2-8) were evaluated. The sub-process with more failure modes with NPR>100 was dispensing/returning by nursing staff. Conclusions: The FMEA methodology was a useful tool when applied to automated dispensing cabinet system use. The implementation of improvement actions significantly reduced the risk. (Copyright © 2020 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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