Robinson Deborah L, Heigham Melissa, Clark Jeanenne
Division of Pediatric Hematology and Oncology, St Louis Children's Hospital, USA.
Jt Comm J Qual Patient Saf. 2006 Mar;32(3):161-6. doi: 10.1016/s1553-7250(06)32021-1.
The administration of chemotherapy to hospitalized children with cancer is a complex and high-risk process. A team divided the process into three areas--prescribing, dispensing, and administration--and used Failure Mode and Effects Analysis (FMEA) to identify the elements of risk and implement appropriate strategies. For each area, potential failures within subprocesses were assigned risk priority numbers (RPNs), reflecting their frequency, severity, and detectability.
The team made prescribing and administration, the areas with the highest RPNs, the focus of most of its strategies, which were introduced and completed in 2002.
The potential prescribing error rate decreased from 23% to 14%; use of preprinted standard order sets increased from 22% to 45% in 2003 (one year after the FMEA was conducted) and 76% in 2005. Actual dispensing errors decreased from 3 to 1, and the actual administration errors from 4 to 3.
Computerized order entry systems would only affect prescribing, dispensing, and administering, which would still be done manually, resulting in potential for failure. The FMEA project will be an ongoing part of providing safe chemotherapy treatments.
对住院癌症患儿进行化疗是一个复杂且高风险的过程。一个团队将该过程分为三个领域——开处方、配药和给药，并使用失效模式与效应分析（FMEA）来识别风险因素并实施适当策略。对于每个领域，子流程中的潜在故障被赋予风险优先数（RPN），以反映其发生频率、严重程度和可检测性。
该团队将开处方和给药这两个RPN最高的领域作为其大部分策略的重点，这些策略于2002年推出并完成。
潜在开处方错误率从23%降至14%；预印标准医嘱集的使用在2003年（进行FMEA一年后）从22%增至45%，在2005年增至76%。实际配药错误从3起降至1起，实际给药错误从4起降至3起。
计算机化医嘱录入系统仅会影响仍需人工完成的开处方、配药和给药过程，仍存在失败的可能性。FMEA项目将是提供安全化疗治疗的一个持续部分。
