Application of the Failure Mode and Effects Analysis (FMEA) to identify vulnerabilities and opportunities for improvement prior to implementing a computerized prescription order entry (CPOE) system in a university hospital oncology clinic

2021 ◽  
pp. 107815522110532
Author(s):  
Thomas Joly-Mischlich ◽  
Serge Maltais ◽  
Amélie Tétu ◽  
Marie-Noëlle Delorme ◽  
Brigitte Boilard ◽  
...  
Keyword(s):  
Failure Mode ◽  
Potential Risk ◽  
Failure Modes ◽  
University Hospital ◽  
Management Technique ◽  
Patient Scheduling ◽  
Order Entry ◽  
Medication Process ◽  
Potential Risk Factors ◽  
Potential Risks

Introduction Prior to implementing a new computerized prescription order entry (CPOE) application, the potential risks associated with this system were assessed and compared to those of paper-based prescriptions. The goal of this study is to identify the vulnerabilities of the CPOE process in order to adapt its design and prevent these potential risks. Methods and materials Failure mode and effects analysis (FMEA) was used as a prospective risk-management technique to evaluate the chemotherapy medication process in a university hospital oncology clinic. A multidisciplinary team assessed the process and compared the critical steps of a newly developed CPOE application versus paper-based prescriptions. The potential severity, occurrence and detectability were assessed prior to the implementation of the CPOE application in the clinical setting. Results The FMEA led to the identification of 24 process steps that could theoretically be vulnerable, therefore called failure modes. These failure modes were grouped into four categories of potential risk factors: prescription writing, patient scheduling, treatment dispensing and patient follow-up. Criticality scores were calculated and compared for both strategies. Three failure modes were prioritized and led to modification of the CPOE design. Overall, the CPOE pathway showed a potential risk reduction of 51% compared to paper-based prescriptions. Conclusion FMEA was found to be a useful approach to identify potential risks in the chemotherapy medication process using either CPOE or paper-based prescriptions. The e-prescription mode was estimated to result in less risk than the traditional paper mode.

Application of Fuzzy Logic in Design Failure Mode and Effects Analysis

2013 ◽  
Vol 371 ◽  
pp. 832-836 ◽  
Author(s):  
Nadia Belu ◽  
Daniel Constantin Anghel ◽  
Nicoleta Rachieru
Keyword(s):  
Fuzzy Logic ◽  
Failure Mode ◽  
Automotive Industry ◽  
Failure Modes ◽  
Fuzzy Model ◽  
Potential Problems ◽  
Fuzzy Logic Approach ◽  
Logic Approach ◽  
Promising Solution ◽  
Potential Risks

Failure Mode and Effects Analysis (FMEA) is one of the basic and the most used techniques of quality management that is used for continuous improvements in product or process designs. While applying this technique, determining the Risk Priority Numbers (RPN), which indicate the levels of risks associated with potential problems, is of prime importance for the success of application. A traditional RPN is obtained as product of three risk factors: occurrence, severity and detection. Values of these factors are generally attained from past experience and this way of risk assessment sometimes leads to inconsistencies and inaccuracies during priority numbering. Fuzzy logic approach is considered a promising solution in order to give a more accurate ranking of potential risks. This paper presented a fuzzy model, in order to assess and rank risks associated to failure modes that could appear in the functioning of a headlining product used in automotive industry.

Critical Care: Incidence and Risk Factors of Thrombocytopenia in Critically Ill Trauma Patients

1997 ◽  
Vol 31 (3) ◽  
pp. 285-289 ◽  
Author(s):  
Scott D Hanes ◽  
Deborah A Quarles ◽  
Bradley A Boucher
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Potential Risk ◽  
University Hospital ◽  
Minor Role ◽  
Trauma Patients ◽  
Icu Stay ◽  
Potential Risk Factors ◽  
Trauma Score ◽  
Type Of Injury

Objective To determine the incidence of thrombocytopenia (<100 platelets × 103/mm3) and potential risk factors, including medications, associated with the development of thrombocytopenia in critically ill trauma patients. Design Prospective, observational study. Setting A 20-bed trauma intensive care unit (ICU) at a university hospital. Patients Sixty-three critically ill trauma patients without baseline thrombocytopenia admitted to the trauma ICU for at least 48 hours. Interventions Patients were followed for up to 14 days. Platelet counts were determined daily. The following data were collected and analyzed as potential risk factors for the development of thrombocytopenia: medications, age, sex, race, trauma score, mode and type of injury, alcohol history, units of packed red blood cells (PRBC) and platelets transfused, surgical procedures, duration of ICU stay, and the development of systemic inflammatory response syndrome or disseminated intravascular coagulation. Results Thrombocytopenia occurred in 26 (41%) of the patients. Among risk factors studied, nonhead injury, age, trauma score, duration of ICU stay, and the number of PRBC transfusions were significanüy associated with the development of thrombocytopenia (P < 0.05). However, nonhead injury, age, and trauma score were useful variables in predicting the development of thrombocytopenia by using multivariate analysis. Medications were not associated with the development of thrombocytopenia. Conclusions The type of injury sustained, the quantity of platelet-deficient transfusions, and age are the greatest risk factors associated with the development of thrombocytopenia in critically ill trauma patients. Drug-induced thrombocytopenia appears to play a minor role in the development of thrombocytopenia; therefore, medications should not be automatically discontinued or substituted when thrombocytopenia occurs.

The Risk Management of Reducing Merger and Acquisitions Risks for Construction Enterprise

2014 ◽  
Vol 584-586 ◽  
pp. 2359-2362
Author(s):  
Fang Jing Ma
Keyword(s):  
Risk Factors ◽  
Risk Management ◽  
Potential Risk ◽  
Merger And Acquisition ◽  
Risk Level ◽  
Construction Enterprise ◽  
Construction Enterprises ◽  
Potential Risk Factors ◽  
Potential Risks ◽  
Merger And Acquisitions

In order to study the Merger and Acquisition (M&A) risk management for construction enterprise with the Hierarchical Holographic Modeling (HHM) is used to identify potential risks during different phases of M&A. In addition, Risk Filtering, Ranking and Management, which is short for RFRM, can also be used as a tool of risk level assessment to find more effective risks and find the suitable solutions. If M&A is used to identify the potential risks and analyze the risk factors of construction enterprises, they can be very helpful for finding out the solutions for the potential risk factors. At the same time it is useful for managing the M&A project potential risks and implementing well to increase the successful rate.

Developing a new BWM-based GMAFMA approach for evaluation of potential risks and failure modes in production processes

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Milad Kolagar ◽  
Seyed Mohammad Hassan Hosseini ◽  
Ramin Felegari
Keyword(s):  
Risk Assessment ◽  
Failure Mode ◽  
Failure Modes ◽  
Raw Materials ◽  
Mode Analysis ◽  
Reliability Engineering ◽  
Content Type ◽  
Production Processes ◽  
Failure Mode Analysis ◽  
Potential Risks

PurposeNowadays, the risk assessment and reliability engineering of various production processes have become an inevitable necessity. Because if these risks are not going to be evaluated and no solution is going to be taken for their prevention, managing them would be really hard and costly in case of their occurrence. The importance of this issue is much higher in producing healthcare products due to their quality's direct impact on the health of individuals and society.Design/methodology/approachOne of the most common approaches of risk assessment is the failure mode and effects analysis (FMEA), which is facing some limitations in practice. In this research, a new generalized multi-attribute failure mode analysis approach has been proposed by utilizing the best–worst method and linguistic 2-tuple representation in order to evaluate the production process of hemodialysis solution in a case of Tehran, Iran.FindingsAccording to the results, entry of waste to the mixing tanker, impurity of raw materials and ingredients and fracture of the mixer screw have been identified as the most important potential failures. At last, the results of this research have been compared with the previous studies.Originality/valueSome reinforcement attributes have been added to the traditional FMEA attributes in order to improve the results. Also, the problems of identical weights for attributes, inaccuracy in experts' opinions and the uncertainties in prioritizing the potential failures were improved. Furthermore, in addition to the need for less comparative data, the proposed approach is more accurate and comprehensive in its results.

scholarly journals Use of the failure mode and effect analysis tool in the clinical medication process in an intensive care unit

2021 ◽  
Vol 12 (3) ◽  
pp. 606
Author(s):  
Kamila M. SIDNEY ◽  
Elana F. CHAVES ◽  
Henrique M. COSTA ◽  
Geysa A. ROMEU ◽  
Marta F. FONTELES
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Interaction ◽  
Failure Mode ◽  
Failure Modes ◽  
Anatomical Therapeutic Chemical ◽  
Analysis Tool ◽  
Cross Sectional ◽  
Multiprofessional Team ◽  
Medication Process

Objective: To describe failure modes and establish contingency measures related to the clinical medication process using medical prescriptions of patients admitted to an Intensive Respiratory Therapy Unit (UTIR), using the Failure Mode and Effects Analysis (FMEA) tool. Methods: This is a descriptive and cross-sectional study carried out in an Intensive Care Unit of a public hospital in Fortaleza, Brazil, from November/2015 to March/2016. Study population included adults aging ≥ 18 years in intensive care at the UTIR. The study included the medical prescriptions released on Mondays, Wednesdays, and Fridays. The study was divided in five phases: situational diagnosis, formation of a multiprofessional team, assessment of failure modes (FM), monitoring of FM and calculation of the priority coefficient (PC). In the FM assessment, scoring of the three indicators of the FMEA was used within a range of 1-10, whereas a score of 10 characterized the most concerning situation. Therefore, the indicators gravity (G), prevalence (P) and detection (D) were analyzed. The study was carried out with an active interaction between the subjects of the group and several in-person and virtual sessions were performed. Drugs used in the study were categorized for therapeutic class, according to the Anatomical Therapeutic Chemical Classification System. Data analysis was performed using Microsoft Office Excel® 2013 software. Results: 301 prescriptions were analyzed, with the identification of 452 FMs, which related mostly to systemic antibacterials (21.6%, n = 8), psycholeptics (13.5%, n = 5) and antithrombotic agents (10.8%, n = 4). FMs were divided in eleven categories, from which “drug interaction” (36.8%; n = 14), “dose adjustment” (21.1%, n = 8) and “food-drug interaction” (7.9%, n = 3) were the most frequent. The PC of the detected FMs varied between 28 and 294, and 42.1% (n = 16) of them presented PC above 100. Median of the indicators G (6 – min: 3; max: 9), D (7 – min: 3; max 7) and priority coefficient (72 – min: 28; max: 294) indicate that FM had generally moderate gravity, low prevalence and low detection. For the majority of FMs (72.7%, n = 28), the chosen conduct was ‘not to accept’ and the established contingency measure included a sentinel event notification. Conclusion: The use of FMEA enabled the identification, classification, and prioritization of risks of the clinical medication process in the UTIR. This study indicates the need to implement measures that increase safety in the clinical practice of the study Intensive Care Unit.

scholarly journals A comparative study between a single-dose and 24-hour multiple-dose antibiotic prophylaxis for elective hysterectomy

2020 ◽  
Vol 14 (11) ◽  
pp. 1306-1313
Author(s):  
Khalid Mohammed Akkour ◽  
Maria Abdulrahim Arafah ◽  
Mais Mohammed Alhulwah ◽  
Rana Saeed Badaghish ◽  
Hani Abdulmohsen Alhalal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Single Dose ◽  
Antibiotic Prophylaxis ◽  
Potential Risk ◽  
University Hospital ◽  
Prophylactic Regimen ◽  
Effective Manner ◽  
Significant Difference ◽  
Potential Risk Factors

Introduction: Surgical site infections (SSIs) are a major health issue in surgical specialties in terms of health care costs and patients’ clinical outcomes. At the level of the patient, prolonged hospital stays or readmissions for SSIs, can affect the patient’s quality of life. At the level of the health care system, it exhausts the hospital’s resources and increases the burden on the medical staff due to the need for continuous wound care, microbiological cultures, laboratory tests and medications. In this study, we assessed the effectiveness of two antibiotic prophylaxis regimens for the prevention of SSIs in patients undergoing elective hysterectomy surgeries. Methodology: A retrospective cohort, analyzing 141 patients, was conducted between November 2016 and January 2019 at a university hospital. We compared the efficacy of a single dose vs. 24-hour multiple doses of Cefazolin in patients who underwent elective hysterectomy for benign or malignant indications. The secondary objective was to identify potential risk factors associated with SSIs. Results: There was no statistically significant difference between both groups (p = 0.872). Obesity and a laparotomy surgical approach are risk factors to the development of SSIs (p = 0.001 and 0.014, respectively). Other potential risk factors include the duration of hospital stay, the duration of the surgery and the amount of blood loss. Conclusions: Although the rate of SSIs is not significantly different between both groups, risk stratification can be done after screening patients and the prophylactic regimen must be tailored for each patient in a cost-effective manner and using a multidisciplinary approach.

scholarly journals Potential risk of MSMEs processing anchovies cluster in Lampung, Indonesia

2021 ◽  
Author(s):  
FM Saty ◽  
A Fitri
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Research Method ◽  
Low Risk ◽  
Salted Fish ◽  
Medium Risk ◽  
Potential Risk Factors ◽  
Potential Risks ◽  
Composite Rating ◽  
Risk Potential

This paper aims to analysis of potential risks in terms of capital, production, and marketing aspects at the SMEs center for salted fish manufacturing in Lampung. This research location was Pulau Pasaran Kota Karang, Teluk Betung, Bandar Lampung. The data was collected using questionnaires then processed. The research method is conducted by classifying the potential risk of SMEs, rating and predicate potential risk factors for MSMEs and establish a composite rating of potential risks of MSMEs. Based on 3 aspects of research, there is MSMEs no high and medium risk potency that is in capital aspect. Based on the production rating of the potential risks of MSMEs there are 7 MSMEs that have low risk potential, and 12 MSMEs have medium risk potential. Marketing aspect, there are 13 MSMEs with low risk potential and only 6 MSMEs with medium risk potential.

Premature Arterial Disease Associated with Familial Antithrombin III Deficiency

1990 ◽  
Vol 63 (01) ◽  
pp. 013-015 ◽  
Author(s):  
E J Johnson ◽  
C R M Prentice ◽  
L A Parapia
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Potential Risk ◽  
Antithrombin Iii ◽  
Arterial Disease ◽  
Coagulation System ◽  
Early Age ◽  
Arterial Thromboembolism ◽  
Potential Risk Factors ◽  
Antithrombin Iii Deficiency

SummaryAntithrombin III (ATIII) deficiency is one of the few known abnormalities of the coagulation system known to predispose to venous thromboembolism but its relation to arterial disease is not established. We describe two related patients with this disorder, both of whom suffered arterial thrombotic events, at an early age. Both patients had other potential risk factors, though these would normally be considered unlikely to lead to such catastrophic events at such an age. Thrombosis due to ATIII deficiency is potentially preventable, and this diagnosis should be sought more frequently in patients with arterial thromboembolism, particularly if occurring at a young age. In addition, in patients with known ATIII deficiency, other risk factors for arterial disease should be eliminated, if possible. In particular, these patients should be counselled against smoking.

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