Nurses Risk Management: Failure Mode and Effects Analysis

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Table of Contents

Introduction
Risk Management Importance
Failure Mode and Effects Analysis Essence
FMEA Worth in the Context of Risk Management
FMEA’s Possibility to Prevent Sentinel Events
Joint Commission’s Requirements
Staff Concerns
Conclusion
References

Introduction

Nowadays, healthcare risk managers are in demand due to the necessity to develop safe plans of work, ensure effective patient care, adjust nursing activities, and minimize any possible risks. It is not enough to identify the sources of risk and develop an assessment. It is also necessary to develop a risk management plan and involve all medical staff in this process. Failure mode and effects analysis (FMEA) is a tool to be offered to hospital workers as a means to identify and analyze possible causes of failures (Brixey, Brixey, Saba, & McCormick, 2015). However, not many workers agree with the idea that FMEA is the best solution for their hospital. A risk manager has to investigate the main pros and cons of FMEA in the context of risk management in hospitals, clarify its impact and the possibility to prevent sentinel events, and reflect on the Joint Commission’s requirements to comprehend if staff concerns should be taken into consideration.

Risk Management Importance

Risk management is a process that cannot be neglected by nurses, managers, and other medical staff. It includes the analysis of the exposure to possible occupational risks and the explanations of the risk sources. Risk management aims at identifying, predicting, reducing, and even avoiding the number of risk sources in regards to patients, visitors, and workers in hospitals (Alexander & Kavaler, 2012). As a rule, there are four main steps in the risk management process. They include the identification of the risk sources, the assessment of probabilities and potentials, the development of risk treatment techniques, and the creation of a risk management plan. Still, some organizations also underline the importance of monitoring the results (Alexander & Kavaler, 2012).

This type of management is important for all stakeholders of such fields as healthcare and nursing because it could influence the development of financial concerns, liability risks, health problems, and emotional challenges. Therefore, if there is a chance to minimize or reduce risk outcomes, it should be used in regard to the needs and expectations of patients and the staff.

Failure Mode and Effects Analysis Essence

James Reason, an expert in human factors, mentioned that people faced a number of difficulties when they had to anticipate failures in the healthcare environment and underlined that the failure mode and effects analysis (FMEA) developed in the 1950s could become a good antidote to human optimism (Oster & Braaten, 2016). FMEA is defined as a widely used technique to identify and underline failure modes in the existing systems and processes before they actually occur in order to eliminate them or, at least, minimize the risks which are associated with them (Liu, Liu, & Liu, 2013).

The peculiar feature of this tool is the possibility to be used in different spheres. For example, FMEA was used in the US Apollo space program in order to find out the alternative to the two existing mottoes concerning the mission’s completion (Autry, Goldsby, Bell, & Hill, 2013). With time, this tool was applied in various spheres. There are many risks in different units of healthcare and nursing including ED care, medication administration, blood transfusion, radiology procedures, handoff communication, etc. (Oster & Braaten, 2016). Each unit has its particular risks and failures, and the chosen tool should help to eliminate them.

FMEA Worth in the Context of Risk Management

In the context of risk management, FMEA could be used to improve healthcare organizations’ processes in a variety of ways. For example, it is possible to evaluate the existing child security system and clarify if people may successfully interact with the technological processes (Oster & Braaten, 2016). The existence of complex forms of surgery is another aspect of risk management, and FMEA may be used to define the approaches in post-operative management in regards to a new surgical population. Besides, it is necessary to underline the quality-improvement tools such as the creation of a multidisciplinary team to recognize the needs of all stakeholders, the development of process maps, the introduction of a good plan, and the implementation of the ideas (Franklin, Shebl, & Barber, 2012). FMEA helps to improve the sterilization process considerably in order to remove infections on instruments and promote the required test. Such precautions may be neglected by the medical staff and lead to unpredictable outcomes. FMEA is the solution that could be offered.

FMEA’s Possibility to Prevent Sentinel Events

The Joint Commission defines a sentinel event as any event that is not related to a normal course of illness that could result in contemporary or severe harm or even death (Oster & Braaten, 2016). FMEA includes a number of proactive risk assessment activities with the help of which it is possible to recognize and identify the conditions under which sentinel events occur in healthcare organizations. The root causes of sentinel events are human factors, poor leadership, and communication, inappropriate assessment or physical environment, wrong operative care, or medication use. FMEA is a chance for medical workers to understand what they could do wrong and if it is possible to avoid negative outcomes. Medical workers should be ready to not only identify the threats in their activities but also analyze the possible outcomes and try to gain control over their development. Even if a failure occurs, it is important to take the steps, diminish its effects, and improve the situation. In brief, the reduction of infections and the attention to each decision made by a medical worker are the goals of FMEA in the context of sentinel event management.

Joint Commission’s Requirements

The Joint Commission endorsed FMEA as an evidence-based tool due to its effectiveness in identifying threats and failures, flexibility, and adaptability (Oster & Braaten, 2016). This method of evaluation is frequently used by many healthcare organizations because it is defined as a chance to improve the quality of patients’ care. The Joint Commission develops a number of requirements on FMEA in order to make sure that the processes are properly developed. First of all, it is necessary to choose a critical process that occurs annually in a hospital and is characterized by sentinel events or other patient safety risk factors. Second, the identification of leaders, who could observe the process of program implementation, takes place. Then, a root cause analysis of the process should be developed to understand why failures are possible. Finally, hospital workers have to cooperate in order to redesign processes and minimize the development of risks. The Joint Commission underlines that all medical workers have to participate in FMEA. The main goal of FMEA is to find out the answers to such a question as “What if?”. Medical workers, as well as patients and their families, have to understand that failures could occur because of different factors. Therefore, if there is no chance to avoid all of them, it is possible to take the steps and reduce this chance to any possible extent.

Staff Concerns

Taking into consideration all requirements and peculiar features of FMEA, it is possible to say that this technique is appropriate for healthcare organizations. FMEA helps to clarify the threats that patients and medical workers could be exposed to and identify the steps that could be taken to avoid the risks. However, some of the staff believe that FMEA is not good enough for their hospital because this tool was not actually designed to solve healthcare problems and threats. In other words, those people, who support the idea of using FMEA in hospitals, force it to work. However, the use of power or other attempts cannot lead to positive results but result in faulty analysis and increased risks. It is wrong to neglect the concerns of medical workers about the worth of FMEA in health care. Still, it is also an opportunity to investigate FMEA in the context of healthcare risk management and prove that new ideas could help to improve the current situation, prevent failures, and minimize risks.

Conclusion

In general, FMEA may have a number of positive and negative aspects in the context of risk management. However, risk management is a process that cannot be defined as a purely positive activity because of the possibility of unpredictable reactions and outcomes. Therefore, FMEA could be offered as a tool to analyze and control risks in healthcare organizations in case the staff and other stakeholders make the required preparations and improve their awareness of healthcare occupational and other details.

References

Alexander, R.S., & Kavaler, F. (2012). Risk management: An institutional imperative. In F. Kavaler, & R.S. Alexander (Ed.), Risk management in health care institutions (pp. 1-28). Burlington, MA: Jones & Bartlett Publishers.

Autry, C.W., Goldsby, T.J., Bell, J.E., & Hill, A.V. (2013). Managing the global supply chain. Upper Saddle River, NJ: FT Press.

Brixey, J.J., Brixey, J.E., Saba, V., & McCormick, K.A. (2015). Essentials of nursing informatics study guide. New York, NY: McGraw Hill Professional.

Franklin, B.D., Shebl, N.A., & Barber, N. (2012). Failure mode and effect analysis: Too little for too much? BMJ Quality & Safety, 21, 607-611.

Liu, H.C., Liu, L., & Liu, N. (2013). Risk evaluation approaches in failure mode and effects analysis: A literature review. Expert Systems and Applications, 40, 828-838.

Oster, C., & Braaten, J. (2016). High reliability organizations: A healthcare handbook for patient safety & quality. Indianapolis, IN: Sigma Theta Tau.

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