title: Opportunities for quality improvement in cystic fibrosis newborn screening.
abstract: BACKGROUND
  With the rapid implementation of cystic fibrosis (CF) newborn screening (NBS), quality improvement (QI) has become essential to identify and prevent errors. Using Process Failure Modes and Effects Analysis (PFMEA), we adapted this method to determine if it could be applied to discover and rank high priority QI opportunities.
  
  
  METHODS
  Site visits to three programmes were conducted, and PFMEA exercises were accomplished in Colorado, Massachusetts and Wisconsin with 23 experienced professionals. During each of these comprehensive sessions, participants identified and ranked potential failures based on severity, occurrence and detection to calculate risk priority number (RPN) values.
  
  
  RESULTS
  A total of 96 failure modes were generated and ranked in a list of the 20 riskiest problems that show no significant discordances by site, although there were differences by profession of the rater, particularly nurses.
  
  
  CONCLUSIONS
  Our results illustrate that the PFMEA method applies well to CF NBS and that steps requiring communication and information transfer are perceived to be the highest risks. The number of identified failures makes and their potential impact demonstrate considerable overall risk and a need for ongoing QI.
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA.
authors.forename: Molly K
authors.initials: MK
authors.lastname: Groose
authors.forename: Richard
authors.initials: R
authors.lastname: Reynolds
authors.forename: Zhanhai
authors.initials: Z
authors.lastname: Li
authors.forename: Philip M
authors.initials: PM
authors.lastname: Farrell
mesh_terms: D003120:Colorado; D003550:Cystic Fibrosis / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D008404:Massachusetts; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D015997:Neonatal Screening / Q000379:methods*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D014922:Wisconsin
references.citation: J Cyst Fibros. 2009 May;8(3):153-73
references.pmid: 19246252
references.citation: MMWR Recomm Rep. 2004 Oct 15;53(RR-13):1-36
references.pmid: 15483524
references.citation: Arch Pediatr Adolesc Med. 2008 Mar;162(3):199-204
references.pmid: 18316655
references.citation: J Pediatr. 2005 Sep;147(3 Suppl):S73-7
references.pmid: 16202788
references.citation: Arch Pediatr Adolesc Med. 2008 Mar;162(3):280-1
references.pmid: 18316667
references.citation: Pediatrics. 2007 Feb;119(2):e495-518
references.pmid: 17272609
references.citation: J Pediatr. 2005 Sep;147(3 Suppl):S2-5
references.pmid: 16202776
references.citation: Adv Pediatr. 2000;47:79-115
references.pmid: 10959441