title: Safety Management of a Clinical Process Using Failure Mode and Effect Analysis: Continuous Renal Replacement Therapies in Intensive Care Unit Patients.
abstract: The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p < 0.05); less patients suffered circuit coagulation with inability to return the blood to the patient (25 patients [46.3%] vs. 16 patients [22.2%]; p < 0.05); 54 patients (100%) versus 5 (6.94%) did not get phosphorus levels monitoring (p < 0.05); in 14 patients (25.9%) versus 0 (0%), the CRRT prescription did not appear on medical orders. As a measure of improvement, we adopt a dynamic dosage management. After the process FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.
authors.affiliation: From the *Intensive Care Department, University Hospital 12 de Octubre, Madrid, Spain; and †Intensive Care Department, University Hospital de Álava, Vitoria, Spain.
authors.forename: Jose Angel
authors.initials: JA
authors.lastname: Sanchez-Izquierdo-Riera
authors.forename: Esteban
authors.initials: E
authors.lastname: Molano-Alvarez
authors.forename: Ignacio
authors.initials: I
authors.lastname: Saez-de la Fuente
authors.forename: Javier
authors.initials: J
authors.lastname: Maynar-Moliner
authors.forename: Helena
authors.initials: H
authors.lastname: Marín-Mateos
authors.forename: Silvia
authors.initials: S
authors.lastname: Chacón-Alves
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D000067495:Healthcare Failure Mode and Effect Analysis; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D017751:Safety Management