title: Using failure mode and effects analysis to improve the safety of neonatal parenteral nutrition.
abstract: OBJECTIVE
  Failure mode and effects analysis (FMEA) was used to identify potential errors and to enable the implementation of measures to improve the safety of neonatal parenteral nutrition (PN).
  
  
  METHODS
  FMEA was used to analyze the preparation and dispensing of neonatal PN from the perspective of the pharmacy service in a general hospital. A process diagram was drafted, illustrating the different phases of the neonatal PN process. Next, the failures that could occur in each of these phases were compiled and cataloged, and a questionnaire was developed in which respondents were asked to rate the following aspects of each error: incidence, detectability, and severity. The highest scoring failures were considered high risk and identified as priority areas for improvements to be made.
  
  
  RESULTS
  The evaluation process detected a total of 82 possible failures. Among the phases with the highest number of possible errors were transcription of the medical order, formulation of the PN, and preparation of material for the formulation. After the classification of these 82 possible failures and of their relative importance, a checklist was developed to achieve greater control in the error-detection process. FMEA demonstrated that use of the checklist reduced the level of risk and improved the detectability of errors.
  
  
  CONCLUSIONS
  FMEA was useful for detecting medication errors in the PN preparation process and enabling corrective measures to be taken. A checklist was developed to reduce errors in the most critical aspects of the process.
authors: Jose Javier Arenas Villafranca is Hospital Pharmacy Resident; Araceli Gómez Sánchez is Pharmacist; Miriam Nieto Guindo, BCPS, is Pharmacist; and Vicente Faus Felipe, Pharm.D., is Director of Pharmacy, Pharmacy Service, Costa del Sol Hospital, Marbella (Málaga), Spain. jjavier.arenas@gmail.com.
authors: Jose Javier
authors: JJ
authors: Arenas Villafranca
authors: Jose Javier Arenas Villafranca is Hospital Pharmacy Resident; Araceli Gómez Sánchez is Pharmacist; Miriam Nieto Guindo, BCPS, is Pharmacist; and Vicente Faus Felipe, Pharm.D., is Director of Pharmacy, Pharmacy Service, Costa del Sol Hospital, Marbella (Málaga), Spain.
authors: Araceli
authors: A
authors: Gómez Sánchez
authors: Jose Javier Arenas Villafranca is Hospital Pharmacy Resident; Araceli Gómez Sánchez is Pharmacist; Miriam Nieto Guindo, BCPS, is Pharmacist; and Vicente Faus Felipe, Pharm.D., is Director of Pharmacy, Pharmacy Service, Costa del Sol Hospital, Marbella (Málaga), Spain.
authors: Miriam
authors: M
authors: Nieto Guindo
authors: Jose Javier Arenas Villafranca is Hospital Pharmacy Resident; Araceli Gómez Sánchez is Pharmacist; Miriam Nieto Guindo, BCPS, is Pharmacist; and Vicente Faus Felipe, Pharm.D., is Director of Pharmacy, Pharmacy Service, Costa del Sol Hospital, Marbella (Málaga), Spain.
authors: Vicente
authors: V
authors: Faus Felipe
mesh_terms: D057189:Checklist; D006769:Hospitals, General; D006801:Humans; D007231:Infant, Newborn; D008508:Medication Errors / Q000517:prevention & control*; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D010607:Pharmacy Service, Hospital / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012308:Risk Management / Q000379:methods; D011795:Surveys and Questionnaires