Failure mode and effect analysis (FMEA) for Paediatric Intubation A technique to evaluate high risk procedures Third QPEM Conference 11-13 th of January 2019 Beverley Ludick
Disclosure I do not have any relevant financial relationship with commercial interest to disclose.
Learning objectives Apply Failure Mode Analysis in prehospital emergency setting with pediatric intubation as an example
What is Failure modes and effect analysis (FMEA)? A team-based systematic and proactive approach aimed at identifying: • ways that a process can fail; • why it might fail; • the effects or repercussions of that failure; and • How the process can be made safer The goal is to eliminate or minimize the risk of process failures
What is Failure modes and effect analysis (FMEA)?
Why use Failure modes and effect analysis (FMEA)? • Prevent tragedy (PROACTIVE), instead of responding to it (REACTIVE) • It does not require previous “near-miss” events (PROACTIVE) • Makes a system more FAIL-PROOF • Annual requirement to do a prospective risk analysis as part of our JCI accreditation
Why should I be involved in FMEA? • Practitioners have an ethical obligation to “first do no harm” • Practitioners in the system already know the specific points of vulnerabilities and failure points • They are the best people to be involved in proactively eliminating or minimising the risk of process failures
Using FMEA in Healthcare Processes in: • Medication safety • Medication administration • Different Care processes • Surgery • Hospital-acquired conditions e.g. • Transfusions VAP, surgical site infections, wrong • Resuscitation site surgery, patient falls etc. • Emergency Endotracheal Intubation • Infection control
HMC Ambulance Service use of FMEA process in the implementation of prehospital paediatric intubation • Howard I, Castle N, Al Shaikh LAS. Application of a Healthcare Failure Modes and Effects Analysis to Identify and Mitigate Potential Risks in the Implementation of a National Prehospital Pediatric Rapid Sequence Intubation Program. Journal of Patient Safety. 2017; doi: 10.1097/PTS.0000000000000454. [Epub ahead of print] • Prior to 2017, RSI for adult patients only, recommendations made to include pediatric patients (<14 yrs). • Basic needs analysis conducted and a retrospective audit (March 2015 to April 2016) to compare rates of adult and paediatric patients meeting base criteria for intubation (non cardiac arrest, GCS <8) Here comes the fun Audit revealed a clinical • Total adults meeting criteria = 4.57 per 1000 dispatches need to warrant further stuff…… investigation • Total paediatric patients meeting criteria = 3.02 per 1000 dispatches • Initial process and sub process map drafted for a standard paediatirc RSI
HMC Ambulance Service use of FMEA process in the implementation of prehospital paediatric intubation 44 sub processes across 9 major • processes were described This highlights the perceived • complexities associated with prehospital paediatric RSI This is further emphasised by 104 • separate potential failure points being identified, the majority of which were classified as either Major (n=39 [37.5%]) or catastrophic (n=35 [33.7%]) However, these were deemed to occur • infrequently, uncommon category (n=56 [53.9%]) These results highlight the importance of • such an analysis and provide additional understanding of the controversies regarding the procedure
HMC Ambulance Service use of FMEA process in the implementation of prehospital paediatric intubation Major Recommendations after FMEA • Develop a specific Paediatric RSI clinical practice guideline • Further develop a tailor-made Paediatric Airway Management CPD event In Process • Develop a SOP for Airway Management Skills Competencies
Conclusion • FMEA is a simple yet comprehensive methodology that can be used for risk analysis of complex procedures within the prehospital emergency care setting and hospital setting. • Application of the FMEA methodology provided guidance for the consensus identification of hazards and failure points associated with prehospital pediatric RSI and appropriate actions to mitigate the risks thereof. • Future applications: System focused barriers to the reporting of medication WATCH THIS SPACE errors and adverse drug events
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