University of Massachusetts School of Medicine, USA.
J Oncol Pract. 2013 Jan;9(1):e1-7. doi: 10.1200/JOP.2012.000601.
Observational studies describe high rates of errors in home oral chemotherapy use in children. In hospitals, proactive risk assessment methods help front-line health care workers develop error prevention strategies. Our objective was to engage parents of children with cancer in a multisite study using proactive risk assessment methods to identify how errors occur at home and propose risk reduction strategies.
We recruited parents from three outpatient pediatric oncology clinics in the northeast and southeast United States to participate in failure mode and effects analyses (FMEA). An FMEA is a systematic team-based proactive risk assessment approach in understanding ways a process can fail and develop prevention strategies. Steps included diagram the process, brainstorm and prioritize failure modes (places where things go wrong), and propose risk reduction strategies. We focused on home oral chemotherapy administration after a change in dose because prior studies identified this area as high risk.
Parent teams consisted of four parents at two of the sites and 10 at the third. Parents developed a 13-step process map, with two to 19 failure modes per step. The highest priority failure modes included miscommunication when receiving instructions from the clinician (caused by conflicting instructions or parent lapses) and unsafe chemotherapy handling at home. Recommended risk assessment strategies included novel uses of technology to improve parent access to information, clinicians, and other parents while at home.
Parents of pediatric oncology patients readily participated in a proactive risk assessment method, identifying processes that pose a risk for medication errors involving home oral chemotherapy.
观察性研究描述了儿童在家中进行口服化疗时出现高错误率的情况。在医院中，主动风险评估方法可帮助一线医护人员制定预防错误策略。我们的目的是让癌症患儿的家长参与一项多中心研究，使用主动风险评估方法来确定在家中错误是如何发生的，并提出减少风险的策略。
我们从美国东北部和东南部的三个儿科肿瘤门诊招募家长参与失效模式和影响分析（FMEA）。FMEA 是一种基于团队的主动风险评估方法，用于了解流程可能出现故障的方式，并制定预防策略。步骤包括绘制流程图、头脑风暴和确定失效模式（出错的地方）的优先级，并提出减少风险的策略。我们重点关注剂量改变后的家庭口服化疗管理，因为先前的研究确定该领域存在高风险。
两个地点的家长团队由四位家长组成，第三个地点的家长团队由十位家长组成。家长们制定了一个 13 步的流程图，每个步骤有 2 到 19 个失效模式。优先级最高的失效模式包括在接受临床医生的指示时沟通不畅（由相互冲突的指示或家长疏忽引起），以及在家中不安全地处理化疗药物。建议的风险评估策略包括利用新技术提高家长在家中获取信息、联系临床医生和其他家长的便利性。
儿科肿瘤患者的家长很愿意参与主动风险评估方法，确定了在家中口服化疗涉及药物错误的风险流程。
