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Current Pharmaceutical Biotechnology

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ISSN (Print): 1389-2010
ISSN (Online): 1873-4316

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Research Article

Proactive Risk Assessment through FMEA of Home Parenteral Nutrition Care Processes: A Survey Analysis

Author(s): Giulio Toccafondi, Giulia Dagliana, Vittorio Fineschi*, Paola Frati and Riccardo Tartaglia

Volume 22, Issue 3, 2021

Published on: 12 June, 2020

Page: [433 - 441] Pages: 9

DOI: 10.2174/1389201021666200612171943

Price: $65

Abstract

Background: Home Parenteral Nutrition (HPN) is a lifesaving clinical care process. However, undetected hazards and vulnerabilities in care transitions from hospital to community care may pose risk to patient’s safety. Avoidable complications and adverse events may hinder the benefits of treatment.

Objective: The analysis carried out aims at framing through Human Factors and Ergonomics (HF/E) the critical issues for patient safety related to clinical care practices for HPN in healthcare organization.

Methods: We present the results of a proactive risk assessment analysis based on the FMEA methodology (Failure Mode and Effects Analysis) carried out in three different areas of the regional health care system of Tuscany, Italy. The clinical risk management and patient safety unit assessed the risk perception of Healthcare Workers (HWs) in regard to patient safety and situational awareness throughout the HPN patient journey.

Results: The analysis revealed heterogeneity in the Risk Priority Index (RPI) expressed by HWs. A lower RPI is associated with a HPN process that deploys in continuity between hospital care and community care. A higher RPI is associated with a quality and safety improvement process that is still ongoing. We also observed HWs expressing low RPI in the areas of the region where HPN has a hospital- focused approach and has limited adherence to patient safety requirements. Low RPI for HPN process may relate both to extensively deployed continuity of care and to jeopardized awareness on HPN phases and coordination. The analysis carried out enabled the definition of a common HPN workflow used as reference schema allowing for the definition of a set of recommendations for improving the quality and safety of the care processes. Moreover, the outcome of the proactive risk assessment laid the groundwork for the advancement of the patient safety regional requirements.

Conclusion: The analysis had the role of promoting the contextualization of the culture of quality and safety within the HPN process resulting in an improved awareness of the criticalities and the role of nutrition units throughout the care process.

Keywords: Home parenteral nutrition, human factors, ergonomics approach, proactive risks assessment analysis, clinical care practices, adverse events.

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[1]
Correia, M.I.; Waitzberg, D.L. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin. Nutr., 2003, 22(3), 235-239.
[http://dx.doi.org/10.1016/S0261-5614(02)00215-7 ] [PMID: 12765661]
[2]
Norman, K.; Pichard, C.; Lochs, H.; Pirlich, M. Prognostic impact of disease-related malnutrition. Clin. Nutr., 2008, 27(1), 5-15.
[http://dx.doi.org/10.1016/j.clnu.2007.10.007] [PMID: 18061312]
[3]
Leistra, E. van Bokhorst-de van der Schueren, M.A.; Visser, M.; van der Hout, A.; Langius, J.A.; Kruizenga, H.M. Systematic screening for undernutrition in hospitals: predictive factors for success. Clin. Nutr., 2014, 33(3), 495-501.
[http://dx.doi.org/10.1016/j.clnu.2013.07.005] [PMID: 23891161]
[4]
Soop, M.; Fryksmark, U.; Köster, M.; Haglund, B. The incidence of adverse events in Swedish hospitals: A retrospective medical record review study. Int. J. Qual. Health Care, 2009, 21(4), 285-291.
[http://dx.doi.org/10.1093/intqhc/mzp025] [PMID: 19556405]
[5]
Albolino, S.; Tartaglia, R.; Bellandi, T.; Bianchini, E.; Fabbro, G.; Forni, S.; Cernuschi, G.; Biggeri, A. Variability of adverse events in the public health-care service of the Tuscany region. Intern. Emerg. Med., 2017, 12(7), 1033-1042.
[http://dx.doi.org/10.1007/s11739-017-1698-5] [PMID: 28646442]
[6]
Vincent, C.; Neale, G.; Woloshynowych, M. Adverse events in British hospitals: Preliminary retrospective record review. BMJ, 2001, 322(7285), 517-519.
[http://dx.doi.org/10.1136/bmj.322.7285.517] [PMID: 11230064]
[7]
Taylor-Adams, S.; Vincent, C. Systems analysis of clinical incidents: The London protocol. Clin. Risk, 2004, 10(6), 1-21.
[http://dx.doi.org/10.1258/1356262042368255]
[8]
Vincent, C.; Amalberti, R. Safety in healthcare is a moving target. BMJ Qual. Saf., 2015, 24(9), 539-540.
[http://dx.doi.org/10.1136/bmjqs-2015-004403] [PMID: 26150547]
[9]
Caccialanza, R.; Klersy, C.; Marinelli, M.; Cameletti, B.; Chiara, B.; Montagna, E.; Zugnoni, M.; Rava, M.L.; Curti, C.; Calvi, M.; Dionigi, P. A 4-year survey of the activity of a malnutrition task force in an Italian research hospital. Nutrition, 2010, 26(5), 575-578.
[http://dx.doi.org/10.1016/j.nut.2009.09.025] [PMID: 20036514]
[10]
Pronovost, P.; Needham, D.; Berenholtz, S.; Sinopoli, D.; Chu, H.; Cosgrove, S.; Sexton, B.; Hyzy, R.; Welsh, R.; Roth, G.; Bander, J.; Kepros, J.; Goeschel, C. An intervention to decrease catheter-related bloodstream infections in the ICU. N. Engl. J. Med., 2006, 355(26), 2725-2732.
[http://dx.doi.org/10.1056/NEJMoa061115] [PMID: 17192537]
[11]
Gandhi, T.K.; Peterson, J.F.; Forster, A.J.; Bates, D.W.; Murff, H.J. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann. Intern. Med., 2013, 138(3), 161-167.
[PMID: 23922061]
[12]
Jack, B.W.; Chetty, V.K.; Anthony, D.; Greenwald, J.L.; Sanchez, G.M.; Johnson, A.E.; Forsythe, S.R.; O’Donnell, J.K.; Paasche-Orlow, M.K.; Manasseh, C.; Martin, S.; Culpepper, L. A reengineered hospital discharge program to decrease rehospitalization: A randomized trial. Ann. Intern. Med., 2009, 150(3), 178-187.
[http://dx.doi.org/10.7326/0003-4819-150-3-200902030-00007] [PMID: 19189907]
[13]
Haggerty, J.L.; Reid, R.J.; Freeman, G.K.; Starfield, B.H.; Adair, C.E.; McKendry, R. Continuity of care: A multidisciplinary review. BMJ, 2003, 327(7425), 1219-1221.
[http://dx.doi.org/10.1136/bmj.327.7425.1219] [PMID: 14630762]
[14]
Hesselink, G.; Zegers, M.; Vernooij-Dassen, M.; Barach, P.; Kalkman, C.; Flink, M.; Öhlen, G.; Olsson, M.; Bergenbrant, S.; Orrego, C.; Suñol, R.; Toccafondi, G.; Venneri, F.; Dudzik-Urbaniak, E.; Kutryba, B.; Schoonhoven, L.; Wollersheim, H. European HANDOVER Research Collaborative. Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC Health Serv. Res., 2014, 14(1), 389.
[http://dx.doi.org/10.1186/1472-6963-14-389] [PMID: 25218406]
[15]
Tomasello, M. The Origins of Human Communication Title; MIT Press: Cambridge, 2008.
[http://dx.doi.org/10.7551/mitpress/7551.001.0001]
[16]
Sujan, M.A.; Embrey, D.; Huang, H. On the application of human reliability analysis in healthcare: Opportunities and challenges Reliab. Eng. Syst. Saf., 2020, 194, 0-1.
[17]
Institute for Healthcare Improvement. QI Essentials Toolkit: Failure Modes and Effects Analysis (FMEA); Tool, 2017.
[18]
Dean Franklin, B.; Shebl, N.A.; Barber, N. Failure mode and effects analysis: Too little for too much? BMJ Qual. Saf., 2012, 21(7), 607-611.
[http://dx.doi.org/10.1136/bmjqs-2011-000723] [PMID: 22447819]
[19]
Shebl, N.A.; Franklin, B.D.; Barber, N. Failure mode and effects analysis outputs: Are they valid? BMC Health Serv. Res., 2012, 12(1), 150.
[http://dx.doi.org/10.1186/1472-6963-12-150] [PMID: 22682433]
[20]
Potts, H.W.; Anderson, J.E.; Colligan, L.; Leach, P.; Davis, S.; Berman, J. Assessing the validity of prospective hazard analysis methods: A comparison of two techniques. BMC Health Serv. Res., 2014, 14(41), 41.
[http://dx.doi.org/10.1186/1472-6963-14-41] [PMID: 24467813]
[21]
Rizzo, A.; Pasquini, A.; Di Nucci, P.; Bagnara, S. SHELFS: Managing critical issues through experience feedback. Hum. Factors Ergon. Manuf. Serv. Ind., 2000, 10(1), 83-98.
[http://dx.doi.org/10.1002/(SICI)1520-6564(200024)10:1<83::AIDHFM5>3.0.CO;2-D]
[22]
Arenas Villafranca, J.J.; Gómez Sánchez, A.; Nieto Guindo, M.; Faus Felipe, V. Using failure mode and effects analysis to improve the safety of neonatal parenteral nutrition. Am. J. Health Syst. Pharm., 2014, 71(14), 1210-1218.
[http://dx.doi.org/10.2146/ajhp130640] [PMID: 24973381]
[23]
Lago, P.; Bizzarri, G.; Scalzotto, F.; Parpaiola, A.; Amigoni, A.; Putoto, G.; Perilongo, G. Use of FMEA analysis to reduce risk of errors in prescribing and administering drugs in paediatric wards: a quality improvement report. BMJ Open, 2012, 2(6), 1-9.
[http://dx.doi.org/10.1136/bmjopen-2012-001249] [PMID: 23253870]
[24]
Albolino, S.; Bellandi, T.; Cappelletti, S.; Di Paolo, M.; Fineschi, V.; Frati, P.; Offidani, C.; Tanzini, M.; Tartaglia, R.; Turillazzi, E. New rules on patient’s safety and professional liability for the Italian Health Service. Curr. Pharm. Biotechnol., 2019, 20(8), 615-624.
[http://dx.doi.org/10.2174/1389201020666190408094016 ] [PMID: 30961486]
[25]
Jain, K. Use of Failure Mode Effect Analysis (FMEA) to improve medication management process. Int. J. Health Care Qual. Assur., 2017, 30(2), 175-186.
[http://dx.doi.org/10.1108/IJHCQA-09-2015-0113] [PMID: 28256927]
[26]
Guenter, P.; Ayers, P.; Boullata, J.I.; Gura, K.M.; Holcombe, B.; Sacks, G.S. Parenteral nutrition errors and potential errors reported over the past 10 years. Nutr. Clin. Pract., 2017, 32(6), 826-830.
[http://dx.doi.org/10.1177/0884533617715868] [PMID: 28662372]
[27]
Kumpf, V.J. Challenges and obstacles of long-term home parenteral nutrition. Nutr. Clin. Pract., 2019, 34(2), 196-203.
[http://dx.doi.org/10.1002/ncp.10258] [PMID: 30714635]
[28]
La Russa, R.; Fineschi, V.; Di Sanzo, M.; Gatto, V.; Santurro, A.; Martini, G.; Scopetti, M.; Frati, P. Personalized medicine and adverse drug reactions: The experience of an Italian teaching hospital. Curr. Pharm. Biotechnol., 2017, 18(3), 274-281.
[http://dx.doi.org/10.2174/1389201018666170207124835 ] [PMID: 28176638]
[29]
Santurro, A.; Vullo, A.M.; Borro, M.; Gentile, G.; La Russa, R.; Simmaco, M.; Frati, P.; Fineschi, V. Personalized medicine applied to forensic sciences: New advances and perspectives for a tailored forensic approach. Curr. Pharm. Biotechnol., 2017, 18(3), 263-273.

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