Risk Assessment of Using Entonox for the Relief of Labor Pain: A Healthcare Failure Modes and Effects Analysis Approach.
BACKGROUND
In order to prevent medical errors, it is important to know why they occur and to identify their causes. Healthcare failure modes and effects analysis (HFMEA) is a type of qualitative descriptive that is used to evaluate the risk. The aim of this study was to assess the risks of using Entonox for labor pain by HFMEA.


METHODS
A mixed-methods design (qualitative action research and quantitative cross-sectional research) was used. The modes and effects of failures in the process of using Entonox were detected and analyzed during 2013-2014 at Hefdahe Shahrivar Hospital, Mashhad, Iran. Overall, 52 failure modes were identified, with 25 being recognized as high-risk modes.


RESULTS
The results revealed that 48.5% of these errors fall into the care process type, 22.05% belong to the communicative type, 19.1% fall into the administrative type, and 10.2% are of the knowledge and skills type. Strategies were presented in the forms of acceptance (3.2%), control (90.3%), and elimination (6.4%).


CONCLUSIONS
The following actions are suggested for improving the process of using Entonox: Close supervision by the midwife, precise recording of all the stages of the process in the woman's medical record, the necessity of the presence of the anesthesiologist at the woman's bedside during labor, confirming the indications for use of Entonox, and close monitoring to ensure the safety of the gas cylinder guards.
Ph.D. Student of Reproductive and Sexual Health, Department of Midwifery, Islamic Azad University, Mashhad Branch, Mashhad, Iran.
Tahereh Fathi
TF
Najafi
Ph.D. Student of Reproductive Health, Department of Midwifery, faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran.
Narjes
N
Bahri
Ph.D. of Health services Management, Associate Professor, Health Sciences Research Center, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Hosein
H
Ebrahimipour
Ph.D. of Health Services Management, Associate Professor, Department of Health and Management, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Ali Vafaee
AV
Najar
Ph.D. Student of Health Services Administration, Health Management and Economics Research Center, Department of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran.
Yasamin Molavi
YM
Taleghani
Entonox; healthcare failure modes and effects analysis; labor pain; risk assessment