Improving the safety of chemotherapy administration: an oncology nurse-led failure mode and effects analysis.
OBJECTIVE
To assess and improve the safety of hospital-based adult chemotherapy administration.


METHODS
Prospective, systems-focused clinical risk assessment.


METHODS
An adult inpatient and outpatient oncology unit in a large urban hospital in the United Kingdom.


METHODS
8-person nurse-led multidisciplinary team, which included managerial staff and patient safety researchers.


METHODS
Failure mode and effects analysis (FMEA), a prospective, systems-focused risk assessment methodology, was undertaken in biweekly team meetings and included mapping the chemotherapy administration process, identifying and numerically prioritizing potential errors (failure modes) for each process step, and generating remedial strategies to counteract them.


METHODS
The analysis aimed to identify chemotherapy administration failure modes and to generate remedial strategies to address them. User feedback on the FMEA process also was collected.


RESULTS
Several specific chemotherapy failure modes were identified, the majority of which had not previously been recognized, and several novel strategies to counteract them were generated. Many of the strategies were specific, environment-focused actions, which are simple, quick, and inexpensive to implement; however, more substantive, longer-term initiatives also were generated. User feedback generally was very positive, and the process of undertaking the analysis improved multidisciplinary teamwork and communication.


CONCLUSIONS
Although time and resource intensive, FMEA is a useful safety improvement tool.


CONCLUSIONS
Nurses should be aware of and informed about FMEA as a tool they can use in partnership with management and other disciplines to proactively and collectively improve the safety of high-risk oncology procedures such as chemotherapy administration.
Psychosocial Oncology and Clinical Practice Research Group, Faculty of Medicine and Health, University of Leeds, England. l.j.ashley@leeds.ac.uk
Laura
L
Ashley
Rachel
R
Dexter
Fay
F
Marshall
Brenda
B
McKenzie
Maggie
M
Ryan
Gerry
G
Armitage
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006786:Hospitals, Urban; D006801:Humans; D008508:Medication Errors / Q000451:nursing / Q000517:prevention & control*; D015404:Nursing Methodology Research; D009859:Oncology Nursing; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D017751:Safety Management / Q000458:organization & administration*; D006113:United Kingdom
D000970:Antineoplastic Agents