Pre-hospitalization process reengineering based on the failure mode and effect analysis combined with process analysis method / 中华医院管理杂志

The pre-hospitalization service is an important initiative for medical institutions to implement the national reform of the medical security system. In 2018, Zhejiang province proposed the " most run once reform", requiring the establishment of an admission preparation center to carry out pre-hospitalization services. In June 2021, a certain maternal and child health hospital conducted a process reengineering for the pre admission process of the admission preparation center by applying the combined process analysis and failure mode and effects analysis, high-risk points of the hospitalization process were screened, the job value and job functions of each sector were sorted out, and the sector for improvement sector was evaluated, to launch an independent information system, establish a one click automatic import of pre hospital medical orders function, and remove on-site billing physicians from various specialties for improvement measures. The steps of the process had been optimized, inlcuding issuing pre hospital medical orders, waiting for pre-hospitalization, pre-hospitalization, and so on. The completeness rate of pre hospital medical orders, average waiting days before hospitalization, and patient satisfaction scores of pre hospitalization centers had changed from 91%, 2.99 days, and 93.46 points before process reengineering to 92%, 2.44 days, and 95.80 points after reengineering, respectively. This practice had achieved dual improvements in pre admission service quality and efficiency, so as to provide a reference for China′s medical institutions to carry out safe and efficient pre admission services.

Research on clinical effectiveness of fuzzy failure mode and effects analysis combined with multi-dimensional management in orthopedic rehabilitation equipment management / 中国医学装备

Objective:To construct a fuzzy failure mode and effects analysis(FMEA)combined multi-dimensional management mode to improve the management quality of orthopedic rehabilitation treatment equipment.Methods:14 types of failure modes in 5 aspects and 25 common situations in 7 aspects of failure causes of orthopedic rehabilitation equipment were selected as risk control objects.Fuzzy algorithm was used to evaluate the risk severity,probability of occurrence,detectability and priority value,and multi-dimensional management countermeasures were developed from the aspects of daily inspection,quality detection,maintenance and emergency management.65 units of rehabilitation treatment equipment in clinical use in the hospital were selected and divided into control group(49 units)and observation group(54 units,including 38 units in the control group and 16 newly added units)according to different management methods.The control group adopted traditional FMEA priority value management method,and the observation group adopted fuzzy FMEA combined multi-dimensional management method.The equipment failure ratio,FMEA risk assessment value and medical equipment service quality were compared between the two groups.Results:The proportion of failures due to abnormal power-on self-test,poor treatment operation quality,malfunction shutdown,unqualified quality inspection and external damage of the orthopedic rehabilitation treatment equipment in the observation group were(0.76±0.89)%,(1.72±1.35)%,(1.07±1.22)%,(2.19±0.93)%and(0.13±0.26)%,respectively,which was lower than that of control group,the difference was statistically significant(Z=2.455,Z=2.833,Z=2.236,Z=3.637,Z=2.014;P<0.05).The severity,incidence,detectability and priority values of orthopedic rehabilitation equipment risk in the observation group were(3.34±1.57)points,(2.56±0.94)points,(3.63±1.20)points and(31.29±20.80)points,respectively,which were lower than that in the control group,the difference was statistically significant(Z=2.117,Z=2.665,Z=3.149,Z=3.466;P<0.05).The results of 50 randomly selected patients,37 related medical staff and 120 random inspection showed that the patient satisfaction,medical staff recognition and random inspection standardization of the equipment in the observation group were 88%(44/50),97.30%(36/37)and 96.67%(116/120),respectively,which were higher than those in the control group,the difference was statistically significant(x2=4.882,x2=6.198,x2=8.819;P<0.05).Conclusion:Fuzzy FMEA combined with multi-dimensional management mode can reduce the failure rate of orthopedic rehabilitation equipment,control the severity,occurrence probability and detectability of equipment risks,and improve the equipment operation safety and clinical service level.

Análisis causal integrado en la radiosinoviortesis y el tratamiento mielosupresor de la policitemia vera / Integrated causal analysis in radiosynoviorthesis and the myelosupressor treatment of polycythemia vera

Introducción: Con la matriz de riesgo se identifican las medidas de control relevantes. El análisis de modos y efectos de fallo posterga definir la efectividad de las medidas correctivas. El uso de uno solo de estos métodos limita el alcance al evaluar los riesgos y la toma de decisiones. Objetivos: Determinar la contribución individual de las causas básicas de fallo en el riesgo radiológico de la radiosinoviortesis y el tratamiento mielosupresor de la policitemia vera, a partir del modelo de la matriz y los reportes. Métodos: Se adaptó el análisis de la gestión de la calidad en radioterapia a las prácticas en estudio y la selección individual de las causas básicas más contribuyentes al riesgo radiológico. La base internacional de incidentes aportó las causas que completaron el listado de las derivadas de la aplicación del principio de Pareto. Resultados: Los subprocesos más contribuyentes al riesgo fueron, por orden de importancia, la administración del radiofármaco, su preparación y la prescripción clínica. Para estos se identificaron las etapas, modos de fallo y sus causas más importantes. Existieron causas que contribuyeron a varios modos de fallo. El incumplimiento de procedimientos, protocolos o prácticas, la falta de entrenamiento del personal y la fatiga del personal son las causas de los riesgos identificados. Conclusiones: Se caracterizó la efectividad de las medidas correctivas de las causas más contribuyentes, las que se adicionan a las derivadas de la matriz, en el plan de mejora en la radiosinoviortesis y el tratamiento mielosupresor de la policitemia vera en Cuba(AU)

Introduction: The risk matrix identifies the relevant control measures. Failure modes and effects analysis postpones defining the effectiveness of corrective measures. Using just one of these methods limits the scope when assessing risks and making decisions. Objectives: To determine the individual contribution of the basic causes of failure in the radiological risk of radiosynoviorthesis and the myelosupressor treatment of polycythemia vera, based on the matrix model and the reports. Methods: The analysis of quality management in radiotherapy was adapted to the practices under study and the individual selection of the basic causes most contributing to radiological risk. The international incident base provided the causes that completed the list of those derived from the application of the Pareto principle. Results: The sub-processes that contributed the most to risk were, in order of importance, the administration of the radiopharmaceutical, its preparation and the clinical prescription. For these, the most important, stages, failure modes and their causes were identified. There were causes that contributed to various failure modes. Non-compliance with procedures, protocols or practices, lack of staff training and staff fatigue are the causes of the identified risks. Conclusions: The effectiveness of the corrective measures of the most contributing causes, which are added to those derived from the matrix, was characterized in the improvement plan in radiosynoviorthesis and myelosupressor treatment of polycythemia vera in Cuba(AU)

Optimization of purification process of saponins in steamed Panax notoginseng by failure mode and effects analysis and central composite design-response surface methodology / 中草药

Objective: To optimize the purification technology of saponins in steamed Panax notoginseng with macroporous resin. Methods: The main factors affecting the purification process were screened by failure mode and effects analysis (FMEA). The purification method with macroporous resin was optimized by central combination design-response surface method (CCD-RSM) based on the recovery and purity of saponins. In this experiment, the concentration of sample solution, loading volume, washing volume, ethanol concentration, and ethanol elution volume were used to investigate the purification of saponins in steamed P. notoginseng. Results: The optimized purification process with macroporous resin was as follows: maximum recovery (82.81%) and purity (77.24%) of saponins were obtained with the concentration of saponin solution of 11.22 mg/mL, loading volume of 4.97 BV, washing volume of 2 BV, ethanol concentration of 70%, and ethanol elution volume of 3.31 BV. Conclusion: The optimized purification process based on FMEA and CCD-RSM is convenient and stable, with high recovery and purity of saponins, which has a certain practical value.

Reduction Error Rate of Homing the Withdrawn Drugs in PIVAS of Our Hospital by Using FMEA / 中国药房

OBJECTIVE:To reduce the error rate of homing the withdrawn drugs in pharmacy intravenous admixture service (PIVAS). METHODS:Using risk priority(RPN),the potential failure modes for links of homing the withdrawn drugs in PIVAS were evaluated by using failure mode and effects analysis (FMEA) method. Combining with the links of homing the withdrawn drugs,the reasons for errors were investigated,the feasible scheme to reduce error rates was proposed and the intervention effect was evaluated after 3 months. RESULTS:In the PIVAS links of homing the withdrawn drugs,8 high-risk failure modes had been found in total,such as poor double check system(RPN was 100),unfamiliarity of seemingly drugs(RPN was 36),a large num-ber of the withdrawn drugs(RPN was 20),etc. Thus,risk control measures had been formulated,including reinforcing the double check system,optimizing the management system of PIVAS and so on. After 3 months of intervention management,RPN of the first 3 items were reduced to 20,16,8;error rate of homing the withdrawn drugs was reduced from 1.98% to 0.62%(P<0.05). CONCLUSIONS:The application of FMEA management method in PIVAS of our hospital has reduced the error rate of homing the withdrawn drugs.

Reduction Error Rate of Homing the Withdrawn Drugs in PIVAS of Our Hospital by Using FMEA / 中国药房

OBJECTIVE:To reduce the error rate of homing the withdrawn drugs in pharmacy intravenous admixture service (PIVAS). METHODS:Using risk priority(RPN),the potential failure modes for links of homing the withdrawn drugs in PIVAS were evaluated by using failure mode and effects analysis (FMEA) method. Combining with the links of homing the withdrawn drugs,the reasons for errors were investigated,the feasible scheme to reduce error rates was proposed and the intervention effect was evaluated after 3 months. RESULTS:In the PIVAS links of homing the withdrawn drugs,8 high-risk failure modes had been found in total,such as poor double check system(RPN was 100),unfamiliarity of seemingly drugs(RPN was 36),a large num-ber of the withdrawn drugs(RPN was 20),etc. Thus,risk control measures had been formulated,including reinforcing the double check system,optimizing the management system of PIVAS and so on. After 3 months of intervention management,RPN of the first 3 items were reduced to 20,16,8;error rate of homing the withdrawn drugs was reduced from 1.98% to 0.62%(P<0.05). CONCLUSIONS:The application of FMEA management method in PIVAS of our hospital has reduced the error rate of homing the withdrawn drugs.

Process control of maintenance management for large medical equipment / 中国医学装备

Objective:To explore the process of maintenance management for large medical equipment, and the structure design and core connotation of the maintenance management software of them.Methods: Medical linear accelerator of Precise series of Elekta company was combined to achieve the objective. From the aim of designing normal operation rate to start, the failure mode and effects analysis (FMEA) was operated to analyze the maintenance strategies and maintenance manners which were established on the basis of PDCA(Plan, Do, Check, Action) cycle and the analysis mode of SWOT (Strength, Weakness, Opportunity, Threat), and it could achieve the aim of normal operation rate.Results: Through explored the connotation of maintenance management and the preliminary framework of the software of maintenance management, the detail and process of maintenance management that based on personalized accelerator of process control were established, and the element factors of software of maintenance management of accelerator also was established at the same time.Conclusion: The effective maintenance management of large medical equipment is based on informatization process management of process control, and the element factor of management software need personalized customization. On the other hand, failure mode and degradation mechanism of equipment were the basis for personalized customization, and the creation has practical value.

Safety and Curative Effect of Moxa Box Moxibustion Treatment with FMEA Methods / 世界科学技术-中医药现代化

This paper was aimed to study the safety of moxibustion with FMEA method.Failure mode and effects analysis (FMEA) were used in every aspect of the operation process of moxibustion.And the local skin temperature was measured in 80 patients treated with moxa box moxibustion.The results showed that the skin temperature reached the highest when the moxibustion was given for 15 min,which was in consistence with the patients' chief complaints and their tolerances.It indicated that moxibustion for 15 min was the best moxibustion amount.Meanwhile,inspection should be made to avoid burning.After the application of FMEA,the RPN of the inspection activities,the temperature and distance of moxibustion were significantly decreased (P ＜ 0.05).It was concluded that the application of FMEA management mode strengthened the risk management of moxibustion treatment,standardized treatment process,provided the basis for the temperature and distance of moxibustion,and ensured the safety and efficacy of treatment.

Application of health failure mode and effects analysis (HFMEA)in safety management of hospitalized patients medication / 中国基层医药

Objective To explore the effect of health failure mode and effects analysis(HFMEA)in reducing the risk of medication errors in of inpatients.Methods HFMEA was used to assess potential risk factors for medica-tion management process,in order to analyze the failure mode and the causes of potential risks.Effective precautionary measures were formulated and implemented.Results After the intervention.the incidence rate of errors in medication had been reduced from 5.21% to 1.77%,and the difference was statistically significant(χ2 =201.06,P <0.01). Conclusion HFMEA is effective in reducing the events of errors in medicine of inpatients.So as to guarantee the safety of the clinical medication of inpatients.

A Study on Failure Mode and Effect Analysis (FMEA) for Preoperative Risk Prevention / 간호행정학회지

PURPOSE: The purpose of this research was to provide patients with safe preoperative preparatory procedures by removing any risk factors from the preparatory procedures by using failure mode and effects analysis, which is a prospective risk-managing tool. METHODS: This was a research design in which before and after conditions of a single group were studied, Failure mode and effects analysis were applied for the preparatory procedures done before operations. RESULTS: The preparation omission rate before the operation decreased from 2.70% to 0.04%, and operation cancellation rate decreased from 0.48% to 0.08%. CONCLUSION: Failure mode and effects analysis which remove any risk factors for patients in advance of the operation is effective in preventing any negligent accidents.

Case Study on Improvement of Hospital Foodservice by Introduction of FMEA Techniques: Focus on Food Delivery Service Quality and Customer Satisfaction

In this study, we attempted to improve hospital food delivery service quality and customer satisfaction by using FMEA (Failure Mode and Effect Analysis), which is applied to the quality control of products in manufacturing plants. Subjective food delivery service quality improvement was judged based on a 5-point likert scale. Traditional FMEA uses an RPN (Risk priority number) to evaluate the risk level of a component or process. The RPN index was determined by calculating the product of severity, occurrence, and detection indexes. In our results, total RPN value (P<0.01) significantly decreased after FMEA introduction, whereas customer satisfaction (P<0.001) and food delivery service quality (P<0.001) significantly increased. Specifically, foodservice errors (P<0.01) and loss cost (P<0.01) were significantly improved by FMEA introduction. Taken together, we suggest that FMEA reduces critical activities and errors in foodservice delivery caused by simple priority selection.

Hemodialysis equipment fault management study based on FMEA / 中国医学装备

Objective:To study based FMEA hemodialysis device fault management. Methods:Using FMEA as a research tool, study hemodialysis equipment failure information. For the consequences of potential failure modes and failure to produce, analyze their severity, cause of the malfunction, the frequency of occurrence and detection, referring to the evaluation criteria for risk assessment. Results: By comparing effect, the report of equipment FMEA was obtained,summed hemodialysis equipment including machines in self-test, treatment and disinfection, such as different operating conditions common failure mode. Conclusion: For used in fault management of hemodialysis equipment, FMEA plays an important role in the equipment preventive maintenance.