title: Proactive risk assessment of blood transfusion process, in pediatric emergency, using the Health Care Failure Mode and Effects Analysis (HFMEA).
abstract: BACKGROUND
  Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology.
  
  
  METHODS
  This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts' panel views via the interview and focus group discussion sessions.
  
  
  RESULTS
  The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ ("Theory of Inventive Problem Solving.")
  
  
  CONCLUSIONS
  The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency.
authors.affiliation: Research Center for Health Services Management, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. rdehnavi@gmail.com.
authors.forename: Reza
authors.initials: R
authors.lastname: Dehnavieh
authors.forename: Hossein
authors.initials: H
authors.lastname: Ebrahimipour
authors.forename: Yasamin
authors.initials: Y
authors.lastname: Molavi-Taleghani
authors.forename: Ali
authors.initials: A
authors.lastname: Vafaee-Najar
authors.forename: Somayeh
authors.initials: S
authors.lastname: Noori Hekmat
authors.forename: Hamid
authors.initials: H
authors.lastname: Esmailzdeh
mesh_terms: D001803:Blood Transfusion / Q000592:standards*; D003430:Cross-Sectional Studies; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D007492:Iran; D019300:Medical Errors / Q000517:prevention & control*; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D017751:Safety Management; D065227:Transfusion Reaction