title: Failure mode and effect analysis: improving intensive care unit risk management processes.
abstract: Purpose Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran. Design/methodology/approach This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services - their frequency and severity - were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation. Findings Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures. Practical implications Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function. Originality/value Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.
authors.affiliation: Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences , Yazd, Iran.
authors.forename: Roohollah
authors.initials: R
authors.lastname: Askari
authors.affiliation: Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences , Yazd, Iran.
authors.forename: Milad
authors.initials: M
authors.lastname: Shafii
authors.affiliation: Department of Health Management, School of Health, Qazvin University of Medical Sciences , Qazvin, Iran.
authors.forename: Sima
authors.initials: S
authors.lastname: Rafiei
authors.affiliation: Abarkouh Paramedical School, Shahid Sadoughi University of Medical Sciences , Yazd, Iran.
authors.forename: Mohammad Sadegh
authors.initials: MS
authors.lastname: Abolhassani
authors.affiliation: Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences , Yazd, Iran.
authors.forename: Elaheh
authors.initials: E
authors.lastname: Salarikhah
mesh_terms: D000067495:Healthcare Failure Mode and Effect Analysis / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D007492:Iran; D019300:Medical Errors / Q000517:prevention & control; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012308:Risk Management / Q000458:organization & administration*
keywords: Effectiveness; FMEA; Intensive care unit; Risk management