The Application of Failure Modes and Effects Analysis Methodology to Intrathecal Drug Delivery for Pain Management

Use of failure mode and effect analysis to improve the monoclonal antibody drugs management process in pharmacy intravenous admixture services

Monoclonal antibodies (mAbs) constitute a new form of immunotherapy that has shown great success in long-term tumour control. These injectable drugs are managed and compounded by the Pharmacy Intravenous Admixture Services (PIVAS) staff in a specified sterile environment. This study utilized failure mode and effect analysis (FMEA) as a risk management tool to manage mAb drugs within the PIVAS. The nine-member multidisciplinary team mapped the processes; evaluated the severity, occurrence, and detection of each subprocess; and calculated the risk priority number (RPN). Further corrective actions were taken for high-risk steps, followed by re-evaluation and scoring to achieve a low-risk process. We identified seven major processes and twenty-eight subprocesses involved in the management of mAb drugs in PIVAS. A total of thirteen high-risk failure modes with an assigned RPN 1 were selected. This selection represents the first calculated RPN values, resulting in a total score of 3375. After a first round of evaluation and implementation of corrective actions, the RPN 2 score decreased to 464. Following a second round of the FMEA process, the RPN 3 score was further reduced to 51. Through refinement, we successfully mitigated the occurrence of high-risk failure modes of mAb drugs in PIVAS. These efforts are aimed at enhancing the safety and efficacy of mAb drugs, ultimately ensuring patient safety.

Healthcare Application of Failure Mode and Effect Analysis (FMEA): Is There Room in the Infectious Disease Setting? A Scoping Review

Background: Failure mode and effect analysis (FMEA) is a valuable risk analysis tool aimed at predicting the potential failures of a system and preventing them from occurring. Since its initial use, it has also recently been applied to the healthcare setting, which has been made progressively more complex by technological developments and new challenges. Infection prevention and control (IPC) is an area that requires effective strategies. The aim of this study is to review the literature on the employment of FMEA in the healthcare environment, with special consideration for its application in the infectious disease setting. Methods: An extensive search was carried out in two international and public databases, PUBMED and EMBASE; we included all studies regarding the use of FMEA in hospital settings and human patient care processes. Results: A total of 163 studies published over the period from 2003 to 2023 were included for data extraction. These studies were analyzed regarding bibliometric data (publication year and country of origin), the healthcare issues to be addressed, the application fields, and the utilized FMEA methods. Among these, 13 studies were found that took an interest in infectious diseases. Conclusions: FMEA can be effectively used for healthcare risk assessment. Its implementation as a standard tool in healthcare settings, though demanding, may serve as an important tool for preventing the risk of biohazard incidents, epidemics, and environmental contamination, thereby improving safety for both patients and healthcare workers.

A Clinical Risk Assessment of a 3D-Printed Patient-Specific Scaffold by Failure Modes and Effects Analysis

This study aims to carry out a risk assessment to identify and rectify potential clinical risks of a 3D-printed patient-specific scaffold for large-volume alveolar bone regeneration. A survey was used to assess clinicians' perceptions regarding the use of scaffolds in the treatment of alveolar defects and conduct a clinical risk assessment of the developed scaffold using the Failure Modes and Effects Analysis (FMEA) framework. The response rate was 69.4% with a total of 41 responses received. Two particular failure modes were identified as a high priority through the clinical risk assessment conducted. The highest mean Risk Priority Number was obtained by "failure of healing due to patient risk factors" (45.7 ± 27.7), followed by "insufficient soft tissue area" (37.8 ± 24.1). Despite the rapid developments, finding a scaffold that is both biodegradable and tailored to the patient's specific defect in cases of large-volume bone regeneration is still challenging for clinicians. Our results indicate a positive perception of clinicians towards this novel scaffold. The FMEA clinical risk assessment has revealed two failure modes that should be prioritized for risk mitigation (safe clinical translation). These findings are important for the safe transition to in-human trials and subsequent clinical use.

Application of Failure Mode and Effects Analysis in Managing Medical Records for Accuracy of INA-CBGs Health Insurance Claims in a Tertiary Hospital in Indonesia

OBJECTIVE

Awareness of the importance of social security systems continues to grow in Indonesia, as mandated by the amendment of the 1945 Indonesian Constitution Article 34 paragraph 2, which states the obligation of the Indonesian government to develop and implement a social security system for all Indonesian people. This study aims to evaluate the effectiveness of applying failure modes and effects analysis (FMEA) in managing inpatient medical records at the Dr. M. Djamil Padang Central General Hospital.

MATERIAL METHODS

This is a comparative research study that uses a retrospective approach and compares the data between 2017 and 2018 inpatient National Health Insurance (NHI) patient medical records. Study samples include randomly selected 24,005 files.

RESULTS

The results showed a decrease in problematic claims by 13 percent and an increase in receipt of claims paid by 87 percent. There is a significant difference between the data in 2017 and 2018 in problematic claim decrease (p=0.000) and claim acceptance increase (p=0.000).

DISCUSSION

It was found that the redesign process of the formation of hospital claims will make hospitals more organized, precise, effective, and efficient, therefore positively impacting hospital income. In addition, the redesign was carried out because of the large number of Social Security Administrator for Health patients; thus, it greatly affected hospital income.

IMPLICATION FOR HEALTH POLICIES

The FMEA medical record flow process is very effective and can thus be implemented in hospitals.

An Integrated Approach-Based FMECA for Risk Assessment: Application to Offshore Wind Turbine Pitch System

Failure mode, effects and criticality analysis (FMECA) is a well-known reliability analysis tool for recognizing, evaluating and prioritizing the known or potential failures in system, design, and process. In conventional FMECA, the failure modes are evaluated by using three risk factors, severity (S), occurrence (O) and detectability (D), and their risk priorities are determined by multiplying the crisp values of risk factors to obtain their risk priority numbers (RPNs). However, the conventional RPN has been considerably criticized due to its various shortcomings. Although significant efforts have been made to enhance the performance of traditional FMECA, some drawbacks still exist and need to be addressed in the real application. In this paper, a new FMECA model for risk analysis is proposed by using an integrated approach, which introduces Z-number, Rough number, the Decision-making trial and evaluation laboratory (DEMATEL) method and the VIsekriterijumska optimizacija i KOmpromisno Resenje (VIKOR) method to FMECA to overcome its deficiencies in real application. The novelty of this paper in theory is that the proposed approach integrates the strong expressive ability of Z-numbers to vagueness and uncertainty information, the strong point of DEMATEL method in studying the dependence among failure modes, the advantage of rough numbers for aggregating experts’ diversity evaluations, and the strength of VIKOR method to flexibly model multi-criteria decision-making problems. Based on the integrated approach, the proposed risk assessment model can favorably capture and aggregate FMECA team members’ diversity evaluations and prioritize failure modes under different types of uncertainties with considering the failure propagation. In terms of application, the proposed approach was applied to the risk analysis of failure modes in offshore wind turbine pitch system, and it can also be used in many industrial fields for risk assessment and safety analysis.

Failure mode and effects analysis for proactive healthcare risk evaluation: A systematic literature review

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.

Scope and Applications of Nanomedicines for the Management of Neuropathic Pain

Neuropathic pain, resulting from the dysfunction of the peripheral and central nervous system, occurs in a variety of pathological conditions including trauma, diabetes, cancer, HIV, surgery, multiple sclerosis, ischemic attack, alcoholism, spinal cord damage, and many others. Despite the availability of various treatment strategies, the percentage of patients achieving adequate pain relief remains low. The clinical failure of most effective drugs is often not due to a lack of drug efficacy but due to the dose-limiting central nervous system (CNS) toxicity of the drugs that preclude dose escalation. There is a need for cross-disciplinary collaborations to meet these challenges. In this regard, the integration of nanotechnology with neuroscience is one of the most important fields. In recent years, promising preclinical research has been reported in this field. This review highlights the current challenges associated with conventional neuropathic pain treatments, the scope for nanomaterials in delivering drugs across the blood-brain barrier, and the state and prospects of nanomaterials for the management of neuropathic pain.

Systemic Error in Radiology

OBJECTIVE

Interpretive errors in diagnostic imaging result in significant patient morbidity and mortality, but the importance of errors and process failures in the imaging cycle other than during image interpretation is underappreciated. In this article, we describe these errors and potential solutions, providing a framework to improve patient safety and understand the changing roles of radiologists beyond image interpretation.

CONCLUSION

For comprehensive improvements to health care delivery, other failures in the cycle besides diagnostic interpretive error-such as ordering inappropriate studies, PACS failures, and a lack of accurate clinician contact information (with resultant communication failure)-should be recognized as contributors to patient harm because they lead to wasted resources and delayed care. By taking ownership of the entire imaging cycle, radiologists can increase their net worth to patient care and cement their roles as experts in the effective, evidence-based use of imaging technologies.