Failure mode and effect analysis (FMEA) for Paediatric Intubation - - PowerPoint PPT Presentation

Beverley Ludick

Third QPEM Conference 11-13th of January 2019

Failure mode and effect analysis (FMEA) for Paediatric Intubation

A technique to evaluate high risk procedures

I do not have any relevant financial relationship with commercial interest to disclose.

Disclosure

Learning objectives

Apply Failure Mode Analysis in prehospital emergency setting with pediatric intubation as an example

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)?

What is 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 use Failure modes and effect analysis (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

Why should I be involved in FMEA?

Processes in:

• Medication safety
• Different Care processes
• Hospital-acquired conditions e.g.

VAP, surgical site infections, wrong site surgery, patient falls etc.

• Infection control

Using FMEA in Healthcare

• Medication administration
• Surgery
• Transfusions
• Resuscitation
• Emergency Endotracheal 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
• f adult and paediatric patients meeting base criteria for intubation (non cardiac arrest, GCS <8)
• Total adults meeting criteria = 4.57 per 1000 dispatches
• 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

Audit revealed a clinical need to warrant further investigation

Here comes the fun stuff……

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%])

• r 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
• Develop a SOP for Airway Management Skills Competencies

In Process

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

errors and adverse drug events

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