Failure mode and effects analysis of the universal anaesthesia machine in two tertiary care hospitals in Sierra Leone.
BACKGROUND
Anaesthesia care in developed countries involves sophisticated technology and experienced providers. However, advanced machines may be inoperable or fail frequently when placed into the austere medical environment of a developing country. Failure mode and effects analysis (FMEA) is a method for engaging local staff in identifying real or potential breakdowns in processes or work systems and to develop strategies to mitigate risks.


METHODS
Nurse anaesthetists from the two tertiary care hospitals in Freetown, Sierra Leone, participated in three sessions moderated by a human factors specialist and an anaesthesiologist. Sessions were audio recorded, and group discussion graphically mapped by the session facilitator for analysis and commentary. These sessions sought to identify potential barriers to implementing an anaesthesia machine designed for austere medical environments-the universal anaesthesia machine (UAM)--and also engaging local nurse anaesthetists in identifying potential solutions to these barriers.


RESULTS
Participating Sierra Leonean clinicians identified five main categories of failure modes (resource availability, environmental issues, staff knowledge and attitudes, and workload and staffing issues) and four categories of mitigation strategies (resource management plans, engaging and educating stakeholders, peer support for new machine use, and collectively advocating for needed resources).


CONCLUSIONS
We identified factors that may limit the impact of a UAM and devised likely effective strategies for mitigating those risks.
Armstrong Institute of Patient Safety and Quality, JHUSOM, Baltimore, MD, USA Anaesthesia and Critical Care Medicine, Johns Hopkins School of Medicine (JHUSOM), Baltimore, MD, USA.
M A
MA
Rosen
Anaesthesia and Critical Care Medicine, Johns Hopkins School of Medicine (JHUSOM), Baltimore, MD, USA.
J B
JB
Sampson
Anaesthesia and Critical Care Medicine, Johns Hopkins School of Medicine (JHUSOM), Baltimore, MD, USA Value Institute, Christiana Care Health System, Newark, DE, USA.
E V
EV
Jackson
Anaesthesia and Critical Care Medicine, Johns Hopkins School of Medicine (JHUSOM), Baltimore, MD, USA.
R
R
Koka
Anaesthesia and Critical Care Medicine, Johns Hopkins School of Medicine (JHUSOM), Baltimore, MD, USA.
A M
AM
Chima
Anaesthesia and Critical Care Medicine, Johns Hopkins School of Medicine (JHUSOM), Baltimore, MD, USA.
O U
OU
Ogbuagu
Anaesthesia and Critical Care Medicine, Johns Hopkins School of Medicine (JHUSOM), Baltimore, MD, USA.
M K
MK
Marx
Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.
M
M
Koroma
Anaesthesia and Critical Care Medicine, Johns Hopkins School of Medicine (JHUSOM), Baltimore, MD, USA blee31@jhmi.edu.
B H
BH
Lee
D000776:Anesthesiology / Q000295:instrumentation*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003906:Developing Countries; D019544:Equipment Failure Analysis / Q000379:methods*; D006804:Ergonomics / Q000379:methods*; D006801:Humans; D009726:Nurses; D010564:Personnel, Hospital; D018570:Risk Assessment / Q000379:methods; D012807:Sierra Leone; D062606:Tertiary Care Centers; D016526:Workload
Sierra Leone; austere anaesthesia; failure mode and effects analysis, FMEA; quality improvement