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Almazrou SH, Almoajil H, Alghamdi S, Althenyan G, Alqahtani A, Amer YS. Assessing Barriers and Facilitators for Implementing Clinical Practice Guidelines in Middle Eastern and North African Region: Delphi Study. J Clin Med 2023; 12:5113. [PMID: 37568515 PMCID: PMC10419468 DOI: 10.3390/jcm12155113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) improve clinical decision making and patient outcomes, but CPG implementation is poor. The success of CPGs is influenced by several factors related to barriers and facilitators. For this reason, it can be extremely useful to explore key barriers and facilitators of CPG implementation in the Middle East and North Africa (MENA). METHODS A three-round Delphi study was performed using the input of 30 experts involved in the clinical practice guidelines. In the first two rounds, participants were asked to score each statement relevant to barriers or facilitators for CPG implementation on a five-point Likert scale. These statements were identified from existing systematic reviews and expert input. In round three, participants ranked the most important barriers and facilitators identified from rounds one and two. A descriptive analysis was conducted on the barrier and facilitators statements using frequencies, percentages, and medians to summarize the variables collected. RESULTS We identified 10 unique barriers and 13 unique facilitators to CPG implementation within the MENA region. The two highest-ranked barriers related to communications and available research and skills. The most important facilitator was the availability of training courses for healthcare professionals. CONCLUSIONS Key barriers and facilitators to the implementation of clinical practice guidelines seem to exist in professional, organizational, and external contexts, which should all be taken into account in order to increase implementation success within MENA region. The results of this study are useful in the design of future implementation strategies aimed at overcoming the barriers and leveraging the facilitators.
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Affiliation(s)
- Saja H. Almazrou
- College of Pharmacy, King Saud University, Riyadh 14511, Saudi Arabia; (S.A.); (G.A.)
| | - Hajar Almoajil
- Physical Therapy Department, College of Applied Medical Sciences, Imam Abdulrahamn bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Sara Alghamdi
- College of Pharmacy, King Saud University, Riyadh 14511, Saudi Arabia; (S.A.); (G.A.)
| | - Ghadeer Althenyan
- College of Pharmacy, King Saud University, Riyadh 14511, Saudi Arabia; (S.A.); (G.A.)
| | - Abdulhadi Alqahtani
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Yasser Sami Amer
- Pediatrics Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia;
- Clinical Practice Guidelines & Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh 11421, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria 5424041, Egypt
- Guidelines International Network, Perth PH16 5BU, UK
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Shao XL, Wang YZ, Chen XH, Ding WJ. Impact of failure mode and effects analysis-based emergency management on the effectiveness of craniocerebral injury treatment. World J Clin Cases 2022; 10:554-562. [PMID: 35097081 PMCID: PMC8771373 DOI: 10.12998/wjcc.v10.i2.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/14/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Craniocerebral injuries encompass brain injuries, skull fractures, cranial soft tissue injuries, and similar injuries. Recently, the incidence of craniocerebral injuries has increased dramatically due to the increased numbers of traffic accidents and aerial work injuries, threatening the physical and mental health of patients.
AIM To investigate the impact of failure modes and effects analysis (FMEA)-based emergency management on craniocerebral injury treatment effectiveness.
METHODS Eighty-four patients with craniocerebral injuries, treated at our hospital from November 2019 to March 2021, were selected and assigned, using the random number table method, to study (n = 42) and control (n = 42) groups. Patients in the control group received conventional management while those in the study group received FMEA theory-based emergency management, based on the control group. Pre- and post-interventions, details regarding the emergency situation; levels of inflammatory stress indicators [Interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin (PCT)]; incidence of complications; prognoses; and satisfaction regarding patient care were evaluated for both groups.
RESULTS For the study group, the assessed parameters [pre-hospital emergency response time (9.13 ± 2.37 min), time to receive a consultation (2.39 ± 0.44 min), time needed to report imaging findings (1.15 ± 4.44 min), and test reporting time (32.19 ± 6.23 min)] were shorter than those for the control group (12.78 ± 4.06 min, 3.58 ± 0.71 min, 33.49 ± 5.51 min, 50.41 ± 11.45 min, respectively; P < 0.05). Pre-intervention serum levels of IL-6 (78.71 ± 27.59 pg/mL), CRP (19.80 ± 6.77 mg/L), and PCT (3.66 ± 1.82 ng/mL) in the study group patients were not significantly different from those in the control group patients (81.31 ± 32.11 pg/mL, 21.29 ± 8.02 mg/L, and 3.95 ± 2.11 ng/mL respectively; P > 0.05); post-intervention serum indicator levels were lower in both groups than pre-intervention levels. Further, serum levels of IL-6 (17.35 ± 5.33 pg/mL), CRP (2.27 ± 0.56 mg/L), and PCT (0.22 ± 0.07 ng/mL) were lower in the study group than in the control group (30.15 ± 12.38 pg/mL, 3.13 ± 0.77 mg/L, 0.38 ± 0.12 ng/mL, respectively; P < 0.05). The complication rate observed in the study group (9.52%) was lower than that in the control group (26.19%, P < 0.05). The prognoses for the study group patients were better than those for the control patients (P < 0.05). Patient care satisfaction was higher in the study group (95.24%) than in the control group (78.57%, P < 0.05).
CONCLUSION FMEA-based craniocerebral injury management effectively shortens the time spent on emergency care, reduces inflammatory stress and complication risk levels, and helps improve patient prognoses, while achieving high patient care satisfaction levels.
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Affiliation(s)
- Xiao-Lan Shao
- Department of Emergency Surgery Ward 48, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Ya-Zhou Wang
- Department of Emergency Surgery Ward 48, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Xiong-Hui Chen
- Department of Emergency Surgery Ward 48, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Wen-Juan Ding
- Department of Emergency Surgery Ward 48, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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Lima LAD, Silva LCDMA, Dantas JKDS, Lima MSMD, Dantas DV, Dantas RAN. Root Cause Analysis, Failures and Effects in pediatric total quality management: a scoping review. Rev Bras Enferm 2021; 74:e20200954. [PMID: 34431936 DOI: 10.1590/0034-7167-2020-0954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 03/23/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the applicability of Root Cause Analysis and Failure Mode and Effect Analysis tools, aiming to improve care in pediatric units. METHODS this is a scoping review carried out according to the Joanna Briggs Institute guidelines, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes extension for Scoping Reviews. Search took place in May 2018 on 15 data sources. RESULTS search totaled 8,254 studies. After using the relevant inclusion and exclusion criteria, 15 articles were included in the review. Of these, nine were published between 2013 and 2018, 12 used Failure Mode and Effect Analysis and 11 carried out interventions to improve the quality of the processes addressed, showing good post-intervention results. FINAL CONSIDERATIONS the application of the tools indicated significant changes and improvements in the services that implemented them, proving to be satisfactory for detecting opportunities for improvement, employing specific methodologies for harm reduction in pediatrics.
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Liu HC, Zhang LJ, Ping YJ, Wang L. Failure mode and effects analysis for proactive healthcare risk evaluation: A systematic literature review. J Eval Clin Pract 2020; 26:1320-1337. [PMID: 31849153 DOI: 10.1111/jep.13317] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Failure mode and effects analysis (FMEA) is a valuable reliability management tool that can preemptively identify the potential failures of a system and assess their causes and effects, thereby preventing them from occurring. The use of FMEA in the healthcare setting has become increasingly popular over the last decade, being applied to a multitude of different areas. The objective of this study is to review comprehensively the literature regarding the application of FMEA for healthcare risk analysis. METHODS An extensive search was carried out in the scholarly databases of Scopus and PubMed, and we only chose the academic articles which used the FMEA technique to solve healthcare risk analysis problems. Furthermore, a bibliometric analysis was performed based on the number of citations, publication year, appeared journals, authors, and country of origin. RESULTS A total of 158 journal papers published over the period of 1998 to 2018 were extracted and reviewed. These publications were classified into four categories (ie, healthcare process, hospital management, hospital informatization, and medical equipment and production) according to the healthcare issues to be solved, and analyzed regarding the application fields and the utilized FMEA methods. CONCLUSION FMEA has high practicality for healthcare quality improvement and error reduction and has been prevalently employed to improve healthcare processes in hospitals. This research supports academics and practitioners in effectively adopting the FMEA tool to proactively reduce healthcare risks and increase patient safety, and provides an insight into its state-of-the-art.
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Affiliation(s)
- Hu-Chen Liu
- School of Economics and Management, Tongji University, Shanghai, People's Republic of China.,College of Economics and Management, China Jiliang University, Hangzhou, People'sRepublic of China
| | - Li-Jun Zhang
- School of Management, Shanghai University, Shanghai, People's Republic of China
| | - Ye-Jia Ping
- School of Management, Shanghai University, Shanghai, People's Republic of China
| | - Liang Wang
- School of Management, Shanghai University, Shanghai, People's Republic of China
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Salih M, Swar M. Sudanese doctors continue to offer their lives around the globe fighting coronavirus (COVID-19) pandemic. Sudan J Paediatr 2020; 20:96-98. [DOI: 10.24911/sjp.106-1594303943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Clemente F, Faiella G, Rutoli G, Bifulco P, Romano M, Cesarelli M. Critical failures in the use of home ventilation medical equipment. Heliyon 2019; 5:e03034. [PMID: 32368632 PMCID: PMC7190690 DOI: 10.1016/j.heliyon.2019.e03034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 06/20/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Abstract
Home ventilation involves the use of medical devices at patient's home by personnel who are not healthcare practitioners. This implies new potential risks not fully addressed by current standards and guidelines. A methodological approach to investigate potential failures and define improvement actions to address the dangerous potential situations in HV is required. A multidisciplinary team performed an extended version of Failure Mode, Effect and Criticality Analysis (FMECA) to analyse the home ventilation service provided by the Local Healthcare Unit of Naples (ASL NA1) that assisted 60 homebound ventilator dependent patients. The failures were identified in three risk areas: device, electrical system & fire hazard, and indoor air quality. The corrective actions were formulated with two extra steps: identification of critical failures with a threshold applied to the risk priority number and analysis of causes by means of contributory factors (Organization, Technology, Information, and Structure) based on Reason's theory of failures. 22 of 86 potential failures were identified as critical. Specific corrective actions were addressed and proposed through contributory factors to improve the overall quality of home ventilation service. The use of this systemic approach oriented the improvements to reduce the harms caused by vulnerabilities in high-risk care service as life support home ventilation.
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Affiliation(s)
- Fabrizio Clemente
- Institute of Cristallography, National Research Council (IC-CNR), Rome, Italy
| | | | - Gennaro Rutoli
- Biotechnology Unit - Local Healthcare Unit of Naples, ASLNA1, Naples, Italy
| | - Paolo Bifulco
- Department of Electric Engineering and Information Technologies (DIETI), School of Engineering, University of Naples Federico II, Naples, Italy
| | - Maria Romano
- Department of Experimental and Clinical Medicine (DSMC), University "Magna Graecia", Catanzaro, Italy
| | - Mario Cesarelli
- Department of Electric Engineering and Information Technologies (DIETI), School of Engineering, University of Naples Federico II, Naples, Italy
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Amer YS, Wahabi HA, Abou Elkheir MM, Bawazeer GA, Iqbal SM, Titi MA, Ekhzaimy A, Alswat KA, Alzeidan RA, Al-Ansary LA. Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region. J Eval Clin Pract 2019; 25:550-560. [PMID: 29691950 DOI: 10.1111/jep.12927] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. METHODS Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. RESULTS In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. CONCLUSION This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity.
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Affiliation(s)
- Yasser S Amer
- Clinical Practice Guidelines Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt.,Guidelines International Network, Adaptation Working Group (Steering)
| | - Hayfaa A Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manal M Abou Elkheir
- Pharmacy Services, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Pharmacy Services, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Shaikh M Iqbal
- Pediatrics Department, King Khalid University Hospital, King Saud University, Hospital, Riyadh, Saudi Arabia.,Department of Pediatrics and Child Health, University of Manitoba, College of Medicine, Manitoba, Canada
| | - Maher A Titi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Patient Safety Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Aishah Ekhzaimy
- Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A Alswat
- Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Rasmieh A Alzeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lubna A Al-Ansary
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Guidelines International Network, Adaptation Working Group (Steering).,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Health Metrics and Measurement, World Health Organization, Geneva, Switzerland
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Gheibi M, Karrabi M, Eftekhari M. Designing a smart risk analysis method for gas chlorination units of water treatment plants with combination of Failure Mode Effects Analysis, Shannon Entropy, and Petri Net Modeling. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 171:600-608. [PMID: 30658295 DOI: 10.1016/j.ecoenv.2019.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
Today, all modern industrial units acknowledge the necessity of efficient and effective safety, health, and environment (HSE) systems. To become practical, these systems must be localized and customized to serve the exact needs of the industry. Nevertheless, most HSE plans are developed upon a set of common presumptions. In the water industry, gas chlorination units require strong HSE plans to mitigate the possibility of chlorine explosion and leak. This study aimed to provide an efficient HSE system for gas chlorination process within water treatment plants. This goal was achieved through a case study performed on a water treatment plant in Razavi-Khorasan province, Iran. In the first stage of this study, the researchers made combined use brainstorming sessions and modified Delphi technique to identify the risk factors of gas chlorination units and classify them into six groups in terms of association with chlorination unit building, gas cylinder storage, technical details of gas cylinders, gas cylinder transport, chlorinator connections, and chlorination unit management. In the second stage, the extracted factors were analyzed by Failure Mode Effects Analysis (FMEA) and Shannon Entropy approaches using two different panels of experts, and the results were compared for validation. Finally, the analysis results were structured by Petri Net modeling. The results showed that, according to FMEA, the risk factors with risk priority number (RPN) of over 46 are of highest importance for the studied unit. Once observed, these factors necessitate shutting down the operation until a risk mitigation solution is reached. Among the analyzed factors, (i) the presence of compounds such as NH3, O2, gas and liquid hydrocarbons and oil in gas chlorine cylinders and (ii) non-vertical and non-mechanized handling of full and empty cylinders during loading and unloading, with RPNs of respectively 160 and 120, were found to be significantly more important than others. In the SE analysis, in addition to the above factors, poor implementation of airflow control mechanism inside the chlorination chamber (W = 0.359), storage of chlorine cylinders near electrical and mechanical installations such as elevators or power panels (W = 0.327), poor pipe placement for connecting the injector to the water inlet and the possibility of air suction (W = 0.433), and failure to provide scientific and practical training to the chlorination staff (W = 0.342) were found to be of highest importance.
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Affiliation(s)
- Mohammad Gheibi
- Department of Civil Engineering, Faculty of Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mohsen Karrabi
- Department of Civil Engineering, Faculty of Engineering, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Mohammad Eftekhari
- Department of Chemistry, Faculty of Sciences, University of Neyshabur, Neyshabur, Iran
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Stravitz PE, Cibas ES, Heher YK. Targeting specimen misprocessing safety events with failure modes and effects analysis. Cancer Cytopathol 2019; 127:213-217. [PMID: 30689294 DOI: 10.1002/cncy.22096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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