Identification and prioritisation of risks in a hospital pharmacy using healthcare failure mode and effect analysis

Abstract

ObjectivesThe goals of this project included identifying the processes and subprocesses performed in hospital pharmacies, identifying potential adverse events, detecting failure modes and the causes of errors, prioritising the risks identified and designing a map of risks for hospital pharmacies.MethodsA task force composed of hospital pharmacy staff was committed to update the diagram of processes and design a map of processes performed in hospital pharmacies. Risks were identified by failure mode and effect analysis annd prioritised according to their risk priority index (RPI) and criticality. A risk map of adverse events was designed based on the diagram of processes and/or primary activities where the prioritised failure modes were most frequent.ResultsIn total, 99 failure modes associated with 80 adverse events and 129 causes were identified in eight hospital pharmacy areas/subprocesses. The three areas with the highest percentages of failure modes were inpatient pharmaceutical care, pharmacy laboratory and pharmaceutical technology, and medication management. The 25 failure modes (first quartile) with the highest RPI scores (RPI≥20) and the 25 failure modes with the highest frequency and criticality scores were classified as priority.ConclusionsAccording to their RPI, priority failure modes mostly occurred in the area of inpatient pharmaceutical care (92%). However, according to their criticality, priority failure modes were found to homogeneously occur across all pharmaceutical care areas. As general recommendations pharmacists should assume responsibility and leadership in the implementation of safe medication use practices in healthcare centres.

Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals

“…Several studies have recognized the importance that HFMEA has when it comes to identifying failure modes (FMs), its causes and consequences in a variety of health-care processes, such as distribution and the administration of medicines, parenteral nutrition, and chemotherapy (31)(32)(33)(34)(35)(36)(37)(38)(39). As recently demonstrated in a study by Castro Vida et al (40), the HFMEA has been conducted in all processes and sub-processes in hospital pharmacies except for medicine-shortage management (40).…”

Research of the Main Components of Risk Management in Pharmacy

“…For risk assessment and decision making, it is necessary to have complete information on the internal and external environment and risk carriers [9]. In accordance with this, we conducted a content analysis [6,8,[10][11][12][13][14], which allowed us to identify the main sources of risk, to identify them, and to classify them by the degree of consequences ( Fig. 1).…”

Failure mode and effect analysis applied to improve the medication management process in a pharmacy of a teaching hospital and a proposal for a simplified rating system

“…To reduce the criticality, corrective actions have been proposed—mainly, the instauration of the double-checking before delivery. In the study of Castro Vida et al , 99 failures were identified, including 50 failures associated with medicine management and inpatient pharmaceutical care processes, with 11 failures considered as critical 29. The large number of failure modes identified in their study can be explained by more diversified pharmaceutical activities in comparison with our activity: pharmacotechnics and drug compounding, pharmacokinetics, nutrition and research.…”