FailureModesandEffectsAnalysis(FMEA)Tool

CopyofOncology/Chemotherapy
TheRichlandHospital,Inc.
RichlandCenter,Wisconsin,UnitedStates
HospitalCommunity

Aim:ReducetheRPNfortheOncologyReferral/Chemotherapyprocessin6months
ProcessData
Date:07/02/2004
Step

Description

PatientreferredforOncologyConsult

FailureMode

Causes

Effects

Patientworkupincomplete
forthetypeofcancerbeing
seenfor

Lackofknowledgeof
referringphysician.

Patientdoesn'tgetgood
informationonthefirstvisit.
Needstoscheduledanextra
visit.
Delayspatienttreatment

Oncologistschedulechanges

Walkins
Getsadditionalpatients
scheduled
MDoncallinMadisonand
needstoleaveearly

Patientinconvenience
Timeisrequiredtochange
theschedulestaffresources

Step

Description

Chartspulledandprepped

Occ Det Sev RPN Actions

10

350 ArrangeaGrandRounds
Program
Developreferraltemplates

40

FailureMode

Causes

Effects

Allchartsnotavailablefor
Oncologyclinic

Schedulenotcomplete
Walkins
Referralsdaybeforeclinic

Patientinformationnot
availableforphysiciantouse

4 WorkwithMedicalRecords
toeducatestaff
Comparechartswith
scheduledaybefore
Comparechartswithnew
scheduledayof

Allrequiredpatient
Referringphysiciandidn't
informationnotinchartwhen dictatenoteyet.
patientseenbyOncologist
Referringphysiciandidn't
writeanorderforreferral.
MedicalRecordsdidn'tlocate
allrecenthospitalvisits
Referencelab(sendouts)not
backyet
Specimen(path)reports
someplaceelse
MedicalRecord

Patientdoesn'tgetagood
firstvisitOncologistdoesnot
haveallinformationheneeds
toassesspatientand
determinecourseofaction

16 WorkwithMedicalRecords
toeducate.
Includeallitemsorderedon
schedulein"comments"
section.
Startpull/prepprocess2
dayspriortoclinicscheduled
Allstaffprep/reviewrecords
consistently

Computersgodown

SchedulesandRMCrecords
notavailable.

10

Hardwarefailure
Softwarefailure
Electricalstorm/failure

Step

Description

Oncologistwritesordersforchemo

Occ Det Sev RPN Actions

FailureMode

Causes

Effects

Ordersareincomplete

Oncologistinahurry
Nursedoesn'treviewbefore
heleaves
MDassumesRNknowswhat
hewantsintheblanks

Can'tgivechemowithout
completeorders
Delaystoclarifyitemswith
Pharmacy
Longdistancephonecalls
Relianceonfillinginblanks
bytelephoneorder
AddstimetotheOPDstaff
day

OrdersIllegible(numbers)

Poorpenmanship
(Oncologist)
Inahurry
Alloftheblanksutilize
handwritingandmostarefor
numbers(amounts)ofmeds,
fluids,etc.

Medicationerrors
Patientplacedonwrong
cycle/schedule
Delaysintherapytoclarify

10

10

100

Occ Det Sev RPN Actions

150 Reviseorderstobemore
userfriendly

300 WorkwithOncologisttoslow
down
Stresslegibilityofnumbers
Reducenumberofblanksto
aminimum
Putallordersastemplates
onEHRwithdropdownlists

PatientarrivesinOPDfor
chemowithnonotification

Patientnotcheckedoutof
Clinicproperly
Communicationbreakdown

Patientmaynotgetchemo
thatday
Outpatientnotreadyfor
patient(staff,resources,
room)
Pharmacymightnothave
medicationinstock

Lackofcoordinationofcare,
testing

Schedulermightnotknow
patient(consult)mightturn
intoachemo
Visitnotlistedonschedule
(dropinordayofvisit
referral)
Schedulinginhouseandout
ofhousetestingistrickey

Ifinformationmissing,
chemomayberescheduled
Delaytotrackdown
information
Physicianinterruptedfor
clarification

Step

Description

Patientmayneedprocedure(port,bonemarrow,etc.)

FailureMode

Causes

Ordernotwritten

Clinicprocedureroom
unfamiliarterritory

Effects
Delay
Preopcarenotcoordinated
H&Pnotdone
Instructionsnotgiven

Proceduremayneedanurse Clinicdelays
whodoesn'thavetimeona
busyclinicday
Hospitalnursesunfamiliar
withRMClayout

Step

Description

Orderswrittenforfuturelabs,chemocycles,etc.

FailureMode

Causes

Effects

Staffdon'tuseconsistently

Sometimesthey're
incomplete
Makecopiesoforiginaland
makechangestothemfor
futurecycles,testing

Can'ttellwhichisthevalid
order
Nursingpracticingbeyond
scopeofpractice
Medicationerrors

Step

Description

OncologypatientssenttoOPDforchemo,education,etc.

2 MeetingbetweenOPDand
Clinicstaffonthatpod

125

Occ Det Sev RPN Actions

2

2 Useshortform
Schedulethrough2Bprocess

8 Alwaysusethesameroom
atRMC
Taketimetoorienttoroom,
equipment
Learntoruntheprocedure
room
Adjuststaffingforsome
flexibility
SeekassistancefromRMC
MA's,reception

Occ Det Sev RPN Actions

3

75 Developneworderform
Enforceneedforneworder
eachtimeno"recycling"to
savetime

FailureMode

Causes

Effects

Roomavailability

Onlyhave10rooms
AlsohaveDayCaresurgery
patients
Chemopatientmayneed
roomforanextendedtime

Poorcustomerservice

84

OPDstaffnotavailablefor
chemooreducation

Patient'scyclerequires
weekendcares
Busyshift
Staffunawarepatientwas
sentoverfromclinic

Poorcustomerservice
Staffmayhaveovertimeif
theycomeinonweekends

90

Medicationerror

Requireddoublechecknot
doneinroom
Failuretouseall5R'sof
medicationadministration

Injurytopatient
Patientdeath

10

10

200

ChemoexposureinUnit

Setupdoesn'tinclude
needlelesssystemwhen
arrivesinunitfrom
Pharmacy

RN'shavetochangeneedles
insideaplasticbag
Potentialforsharpsinjury
Initialchemoprepareanear
afoodprepareainunit

10

250 IncludePharmacyina
discussion/plansession

Injuryinareawhile
giving/receivingservice

Inconsistencyinwaystaff
doesportdraws,chemo
administration,handlingof
productsandtubing,etc.

Potentialforinjuryishigh

10

160

Dieticiannotavailablefor
assessment/consult

Dietaryreferralnotmade

Patientnutritionalneedsnot
met

175

Step

Description

Patientsscheduledforfuturevisits,followup

FailureMode

Causes

Effects

Patientfailstofollowupwith
provider

Inconsistentcommunication
withpatient

Patientcomplications
Patientunsatisfiedwithcare

Occ Det Sev RPN Actions

Occ Det Sev RPN Actions

3

10

30 Noresultstobegivenover
thephone

Nomechanismforassuring
followthrough
Patientsarebeinggivenlab
resultsoverphoneby
nursingstaff

Recommendseeing
physician
Patientsremindedtheycan
receiveacopyoftheir
resultswitharequestto
MedicalRecords

CalculatedTotals
TotalRiskPriorityNumberfortheprocess
Occ: LikelihoodofOccurrence(110)
Det: LikelihoodofDetection(110)
NOTE: 1=VerylikelyitWILLbedetected

10=VerylikelyitWILLNOTbedetected

Sev: Severity(110)
RPN:RiskPriorityNumber(OccDetSev)

Annotation
None

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