| Autor: |
M D, Santos-Rubio, R, Marín-Gil, R, Muñoz-de la Corte, M D, Velázquez-López, M V, Gil-Navarro, F J, Bautista-Paloma |
| Rok vydání: |
2015 |
| Předmět: |
|
| Zdroj: |
Revista de calidad asistencial : organo de la Sociedad Espanola de Calidad Asistencial. 31(2) |
| ISSN: |
1887-1364 |
| Popis: |
To proactively identify risks in the preparation of intravenous cytostatic drugs, and to prioritise and establish measures to improve safety procedures.Failure Mode Effect Analysis methodology was used. A multidisciplinary team identified potential failure modes of the procedure through a brainstorming session. The impact associated with each failure mode was assessed with the Risk Priority Number (RPN), which involves three variables: occurrence, severity, and detectability. Improvement measures were established for all identified failure modes, with those with RPN100 considered critical. The final RPN (theoretical) that would result from the proposed measures was also calculated and the process was redesigned.A total of 34 failure modes were identified. The initial accumulated RPN was 3022 (range: 3-252), and after recommended actions the final RPN was 1292 (range: 3-189). RPN scores100 were obtained in 13 failure modes; only the dispensing sub-process was free of critical points (RPN100). A final reduction of RPN50% was achieved in 9 failure modes.This prospective risk analysis methodology allows the weaknesses of the procedure to be prioritised, optimize use of resources, and a substantial improvement in the safety of the preparation of cytostatic drugs through the introduction of double checking and intermediate product labelling. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
|
