The Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols

El Healthcare Failure Mode and Effect Analysis como herramienta de evaluación de protocolos asistenciales

ABSTRACT

Objectives:

to identify, classify, and analyze modes of failure in the medication process.

Methods:

evaluative research that used the Healthcare Failure Mode and Effect Analysis (HFMEA) in a service of bone marrow transplant from June to September 2018, with the participation of 35 health workers.

Results:

207 modes of failure were identified and classified as mistakes in verification (14%), scheduling (25.6%), administration (29%), dilution (16.4%), prescription (2.4%), and identification (12.6%). The analysis of risk showed a moderate (51.7%) and high (30.9%) need of intervention, leading to the creation of an internal quality assurance group and of continued education activities.

Conclusions:

the Healthcare Failure Mode and Effect Analysis showed itself to be a tool to actively identify, classify, and analyze failures in the process of medication, contributing for the proposal of actions aimed at patient safety.

Descriptors:
Medication Errors; Healthcare Failure Mode and Effect Analysis; Patient Safety; Protocol; Nursing