5PSQ-113 Risk assessment and management to improve parenteral nutrition safety

Background Parenteral nutrition has been classified as a high-alert medication. In recent years, quality organisations such as the Joint Commission require hospitals to conduct proactive risk assessments of high-risk processes. Purpose To describe the utilisation of Failure Modes, Effects and Criticality Analysis (FMECA) as a tool to evaluate the impact of the improvements implemented in the adult parenteral nutrition process. Material and methods As part of the departmental risk management strategy, a multidisciplinary team (two hospital pharmacists, two nurses, a technician and a safety specialist) were recruited for the analysis of the process. The team listed all the failure modes and the possible causes and effects. For each failure mode, the team assigned a score for likelihood of occurrence (1–10), severity (1–10) and likelihood of detection (1–10). Finally, the Risk Priority Number (RPN) was calculated by multiplying the three scores. Results The process in the year 2008 included: manual prescription, manual transcription to the compounding software, validation, preparation and check of the medication tray, compounding in the laminar airflow hood and visual inspection of the parenteral nutrition and the used products. In the year 2016 the process included: a computerised physician order entry (CPOE) software, an automated transcription interface from CPOE to the compounding software and a built-in gravimetric end product quality control. For the process in the year 2008, a total of 32 failure modes were listed and an overall RPN of 3518 points was calculated. Manual prescription (1,188), manual transcription of the fax-transmitted prescription (665) and compounding (542) reached the highest RPN. Fifteen high-risk failure modes (RPN >100 points) were listed. After the implementation of the improvements, in the year 2016 only three high-risk failure modes were found. The total number of failure modes decreased to 31 and an overall RPN of 1540 points was calculated. The highest RPN were found in the medication tray preparation (504) and compounding (394) subprocesses. The most noticeable improvements were obtained with the implementation of CPOE (111) and the transcription interface (17). Conclusion FMECA was considered a valuable tool for the detection of areas for improvement and helped monitoring the effectiveness of the improvements after their implementation. No conflict of interest