利用风险分析在医院药房搬迁过程中预测和减轻故障。
Using risk analysis to anticipate and mitigate failures during a hospital pharmacy relocation.
机构信息
Pharmacy of Eastern Vaud Hospitals, Rennaz, Switzerland.
Specialised Centre for Emergency and Disaster Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
出版信息
Eur J Hosp Pharm. 2021 Nov;28(Suppl 2):e164-e170. doi: 10.1136/ejhpharm-2020-002525. Epub 2021 Mar 16.
OBJECTIVES
Documented experiences of relocating hospital pharmacies are rare, but adequate preparation is vital to ensuring smooth pharmacy operation and patient safety. In the autumn of 2019, the Pharmacy of Eastern Vaud Hospitals, composed of four units (Logistics, Manufacturing, Clinical Pharmacy, and Nursing Home Supply), was relocated to a new hospital in just a few days. In this context, a failure modes, effects and criticality analysis (FMECA) was carried out before the relocation in order to anticipate any failure modes likely to affect the pharmacy's missions or patient safety during the move.
METHODS
The FMECA was performed by a multidisciplinary team (pharmacists and logisticians) which analysed the complete upcoming process of relocating the pharmacy and its implications. Criticality indices (CIs) were defined based on the matrix developed by Williams , which sets a maximum score of 810. Every potential failure mode identified was analysed, and mitigation measures were proposed for each one.
RESULTS
The analysis identified 86 potential failures. The mean initial CI calculated for the entire pharmacy relocation was 177 (min 4-max 567), but this was estimated to be reduced to 39 (-78%) after mitigation measures were identified. Within the whole pharmacy, the failures with the highest CIs were identified in the Logistics unit. Among these, the time necessary to transfer the pharmacy's drugs from their traditional alphabetical storage location to their new location using robotic, chaotic storage principles was identified as the riskiest potential failure. Indeed, the rapid availability of emergency medicines would have to be guaranteed at all times.
CONCLUSIONS
The present study highlighted the relevance of using an FMECA-type evaluation to anticipate the impact of a hospital pharmacy relocation. This tool enabled pharmacy professionals to structure their potential relocation problems and reflect on mitigation measures in order to provide concerted, realistically applicable solutions before the move.
目的
医院药房搬迁的经验鲜有记载，但充分准备对于确保药房运作顺畅和患者安全至关重要。2019 年秋季，由四个单元（物流、制剂、临床药学和养老院供应）组成的沃州东部医院药房在短短几天内搬迁到了新医院。在此背景下，搬迁前进行了失效模式、影响和关键性分析（FMECA），以预测可能影响药房任务或患者安全的任何失效模式。
方法
由药剂师和物流人员组成的多学科团队对即将进行的药房搬迁及其影响进行了 FMECA。关键性指数（CI）是根据 Williams 开发的矩阵定义的，最高得分为 810。识别出的每一种潜在失效模式都进行了分析，并为每一种模式提出了缓解措施。
结果
分析确定了 86 种潜在失效模式。整个药房搬迁的初始平均 CI 计算值为 177（最小值 4-最大值 567），但预计在确定缓解措施后将降至 39（-78%）。在整个药房中，物流单元的失效模式具有最高的 CI。在这些失效模式中，使用机器人、混乱存储原理将药房的药物从传统的字母存储位置转移到新位置所需的时间被确定为最危险的潜在失效模式。事实上，必须始终保证急救药品的快速供应。
结论
本研究强调了使用 FMECA 型评估来预测医院药房搬迁影响的相关性。该工具使药剂师能够对潜在的搬迁问题进行结构化，并思考缓解措施，以便在搬迁前提供协调、实际可行的解决方案。
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