La tecnica di analisi proattiva FMEA/FMECA per la gestione del rischio clinico in diagnostica di laboratorio

Autori

  • Elisa Porcu Ufficio Risk Management, Direzione Sanitaria, IRCCS Istituto Ortopedico Rizzoli, Bologna
  • Patrizio Di Denia Ufficio Risk Management Direzione Sanitaria, IRCCS Istituto Ortopedico Rizzoli, Bologna
  • Daniela Cavedagna Servizio di Assistenza Infermieristica, Tecnica e della Riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna
  • Maurizia Rolli Direzione Sanitaria, IRCCS Istituto Ortopedico Rizzoli, Bologna
  • Luca Bianciardi Direzione Sanitaria, IRCCS Istituto Ortopedico Rizzoli, Bologna

DOI:

https://doi.org/10.7175/pmeal.v9i3.1198

Parole chiave:

Patient safety, Clinical risk management, FMEA, FMECA, Risk analysis, Laboratory diagnostic process

Abstract

[FMEA/FMECA proactive analysis technique for clinical risk management in laboratory diagnostics]


At the IRCCS Rizzoli Orthopaedic Institute of Bologna the FMEA/FMECA technique has been used for several years in the laboratory diagnostics setting for the analysis of processes, the proactive identification of possible mistakes and the implementation of improvement actions.
In five laboratories of the Institute, current critical processes have been mapped to identify priority risks. Therefore, the intervention priorities have been defined, the improvement plans implemented and the efficacy in reducing the risks evaluated.
The results were assessed by calculating the index of improvement (IM), as the ratio between the value of the Risk Priority Number (RPN) obtained by an evaluation before (ex-ante) and after (ex-post) the improvement actions. In all analyzed diagnostic processes initial values RPN were reduced and all IM showed values > 1.
In addition, as result of risk analysis, 75 improvement actions were implemented, divided into: training/information (18,7%), organizational changes (53,3%), acquisition/maintenance of equipment and technologies (10,7%), revision and elaboration of procedures/protocols (16%), structural adjustments (1,3%).

The technique FMEA/FMECA has proven to be useful to identify critical and high-risk processes proactively and to implement improvement actions according to priorities.

Riferimenti bibliografici

Raab SS, Grzybicki DM, Janosky JE, et al. Clinical impact and frequency of anatomic pathology errors in cancer diagnoses. Cancer 2005; 104: 2205-13; http://dx.doi.org/10.1002/cncr.21431

McDermott RE, Mikulak RJ, Beauregard MR. The basic of FMEA, 2nd ed. New York: Productivity Press, Taylor and Francis Group, 2009.

Basini V, Cinotti R, Di Denia P, et al. FMEA - FMECA. Analisi dei modi di errore/guasto e dei loro effetti nelle organizzazioni sanitarie. Sussidi per la gestione del rischio 1. Dossier n. 75/2002 - Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna

Hergon E, Rouger P, Garnerin P. Preventing deficiencies in the transfusion process. Transfus Clin Biol 1994; 1: 455-65; http://dx.doi.org/10.1016/S1246-7820(06)80030-3

Marey A, Coupez B, Gruca L, et al. Impact of a quality approach for transfusion safety on prescription, circuit optimization, traceability. Transfus Clin Biol 1997; 4: 469-84; http://dx.doi.org/10.1016/S1246-7820(97)80065-1

Cohen MR, Senders J, Davis NM. Failure mode and effects analysis: a novel approach to avoiding dangerous medication errors and accidents. Hosp Pharm 1994; 29: 319-24; http://dx.doi.org/10.1097/00152193-199402000-00018

Francesconi F, Valmigli S, Francesconi R, et al. La mappatura dei rischi clinici in un pronto soccorso mediante l’applicazione del metodo FMEA/FMECA. Scenario 2014; 31: 25-33. Disponibile all’indirizzo http://www.aniarti.it/it/content/la-mappatura-dei-rischi-clinici-un-pronto-soccorso-mediante-lapplicazione-del-metodo (ultimo accesso luglio 2015)

De Rosier J, Stalhandske E, Bagian JP, et al. Using health care failure mode and effect analysis: the VA National Center for patient safety’s proactive risk analysis system. Jt Comm J Qual Improv 2002; 28: 248-67, 209

Duwe B, Fuchs BD, Hansen-Flaschen J. Failure mode and effects analysis application to critical care medicine. Crit Care Clin 2005; 21: 21-30; http://dx.doi.org/10.1016/j.ccc.2004.07.005

Roseti L, Serra M, Bassi A, et al. Failure mode and effects analysis to reduce risks of errors in the good manufacturing practice production of engineered cartilage for autologous chondrocyte implantation. Curr Pharm Anal 2015; 11: 1-12 http://dx.doi.org/10.2174/1573412911666150604233714

Joint Commission on Accreditation of Healthcare Organizations. Patient Safety Standards-Hospitals: Standard LD.5.2. Effective 7/1/2001

ISO/TS 22367: 2008. Medical Laboratories - Reduction of error through risk management and continual improvement. Disponibile all’indirizzo http://www.iso.org/iso/catalogue_detail.htm?csnumber=40918 (ultimo accesso luglio 2015)

Chiozza ML, Ponzetti C. FMEA : A model for reducing medical errors. Clin Chim Acta 2009; 404: 75-8; http://dx.doi.org/10.1016/j.cca.2009.03.015

European Medicines Agency, 31 January 2011. EMA/INS/GMP/79766/2011. Quality Risk Management (ICH Q9). Disponibile all’indirizzo http://www.rsihata.com/updateguidance/2011/WC500002873.pdf (ultimo accesso luglio 2015)

Regulation (EC) No 1394/2007 of the European Parliament and the Council on advanced therapy medicinal products and amending Directive 2001/83/EC and Regulation (EC) No 726/2004. Official Journal of the European Union L 324/121-37. 10/12/2007. Disponibile all’indirizzo http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2007:324:0121:0137:en:PDF (ultimo accesso luglio 2015)

Joint Working Group of the ISO Committee on Consumer Policy (COLPOLCO) and IEC Advisory Committee on Safety (ACOS), ISO/IEC Guide 51:2014. Safety aspects – Guidelines for their inclusion in standards. Disponibile all’indirizzo http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=53940 (ultimo accesso luglio 2015)

Caminati A, Di Denia P, Martini C, et al. 4.1. Applicazione della tecnica FMEA/FMECA per l’analisi proattiva dei rischi in ambito ostetrico/ginecologico. In: Cinotti R, Di Denia P, (a cura di). Gestione del rischio in Emilia-Romagna 1999-2007. Sussidi per la gestione del rischio 8. Dossier n. 146. Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna: 2007. pp. 107-17

Pubblicato

2015-08-31

Fascicolo

Sezione

Articolo