title: The AMÉLIE project: failure mode, effects and criticality analysis: a model to evaluate the nurse medication administration process on the floor.
abstract: OBJECTIVE
  The objective of this article was to critically evaluate the causes of adverse drug events during the nurse medication administration process in paediatric care units in order to identify and prioritize interventions that need to be implemented.
  
  
  METHODS
  This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary committee composed of nurses, pharmacists, physicians and risk managers evaluated through consensus the process of administering medications at the Centre hospitalier universitaire de Sainte-Justine. By mapping the process, all the failure modes were identified and associated with at least one cause each. Using a summary grid, each failure mode was evaluated by rating frequency (from 1 to 9), likelihood of failure detection (from 0 to 100%) and severity (from 1 to 9) using adapted versions of already published scales.
  
  
  RESULTS
  A 10-member committee was set up, and it met eight times between January and April 2010. In the two specialized paediatric units selected (n = 38 beds), an average number of approximately 20 000 drug doses was administered monthly from about 400 non-proprietary names. Through consensus, the committee identified 16 processes and 53 failure modes. While frequency and severity were based on perceptions that could be objectivized with local data and scientific documentation, the likelihood of detection was mainly based on individual perception.
  
  
  CONCLUSIONS
  FMECA is a useful approach to improve the medication process.
authors.affiliation: CHU Sainte-Justine, Montréal, Quebec, Canada. christina.nguyen.hsj@ssss.gouv.qc.ca
authors.forename: Christina
authors.initials: C
authors.lastname: Nguyen
authors.forename: Justine
authors.initials: J
authors.lastname: Côté
authors.forename: Denis
authors.initials: D
authors.lastname: Lebel
authors.forename: Elaine
authors.initials: E
authors.lastname: Caron
authors.forename: Christine
authors.initials: C
authors.lastname: Genest
authors.forename: Monia
authors.initials: M
authors.lastname: Mallet
authors.forename: Véronique
authors.initials: V
authors.lastname: Phan
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bussières
mesh_terms: D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D010371:Pediatric Nursing; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D017751:Safety Management / Q000458:organization & administration*