Introduction
Medical errors have been defined as adverse events that
can impact the health and well-being of patients in the healthcare environment.
The causes of medical errors can be multiple including equipment failures, poor
staff training, poor communication processes, flawed healthcare structural
processes, and others (Wachter, 2012). Medication
errors are found to be prevalent in the pediatric inpatient setting. The
potential for medication related patient injury is high in pediatric patients
because they are unable to communicate regarding the side effects of improper
medication administered. Pediatric patients need to be given dosage based on
their weights which is an extensive process that involves calculations (Shekelle et al, 2013). In addition, the stock
solutions have to be diluted in order to achieve success. A small dosage error
for adult patients can have adverse impact in small children. Specifically,
care must be undertaken for children that are undergoing chemotherapy for
cancer treatment. The Health Care Failure Mode and Effect Analysis
(HFMEA) tool uses five steps in order to analyze the healthcare process. The
use of hazard scoring matrix and flow diagrams helps to achieve the critical
objectives. Additionally, the hazards can be identified based on their severity
by the tool. The recommend modes of action can be identified through the use of
this tool. The aim of this paper is to analyze the prescription process for chemotherapy
patients in the pediatric oncology ward of a national medical center.
Setting
The research has been conducted at a medical center that comprises
of a university hospital, children’s hospital, and medical facility. The
medical center has approximately 9,000 employees with the children’s hospital
located in a separate structure. The children’s hospital has a total of 143
beds with the oncology ward having 300 admissions in the year 2014. The age of
children admitted was between 0-19 years. There is a separate pharmacy for the
children’s hospital that evaluates the ordered medications. This is done in
order to identify the interactions and body surface area as well as the
uniformity with the chemotherapy schedule for each patient. The practitioners
that use the system are provided complete information regarding the medication.
The registered pediatric oncologist uses a separate system to approve the
chemotherapy medications. After the approval process, the pharmacy department
will send the medication for the specific patient.
Composition of
HFMEA team
A number of practitioners belonging to multiple
disciplines were selected on the basis of HFMEA guidelines. There were nine
members while two advisors were included in the multidisciplinary team.
Additionally, a parent was involved because her child has been receiving
chemotherapy treatment for the past one year. The team was led by the
hospital’s patient safety coordinator. The other members were from the
pharmacy, pediatric oncology department, nursing department, and medical
department.
Process Description
Prescription
This process involves the prescription of medications
for the child patient that is admitted in the hospital. The treatment schedule
in the chart is selected with proper dose calculation and prescription entry
into the system by the resident in the pediatric oncology department. The
prescription is printed out with the supportive care orders documented by the
resident. The prescription print out is sent to the nursing department. An
oncologist must authorize the prescription. After that, the prescription print
out is processed and checked by the nurses.
Processing Pharmacy
The prescription is matched with the treatment schedule
for the patient. The preparation protocol mode is initiated which is evaluated
by the pharmacist. The authorization from the oncologist is processed while the
department strives to ensure that the medication is prepared. The medication is
properly labeled and presented in a tube so that it can be checked by the
pharmacist before being finally handed over to the nursing department.
Administration
The administration department collects the medication
from the pharmacy department and stores it in the refrigerator. The
prescription is checked with the print out and handed over to the nurses. The
nurses connect the medication tube to the patient while striving to adjust the
medication pump in the patient. The pump is started so that the medication can
be administered to the patient. When this process is finished than the pump is
flushed out while the nurses mark that the medication has been administered to
the patient.
Failure Modes
One of the primary hazards that
have been identified is related to the chemotherapy treatment schedule that is
depicted through charts. This occurs because of the fact that pediatric
oncologist did not provide timely updates on the chart. Another hazard is related to improper dosage
by the resident in the pediatric oncology department. The possible causes for
this hazard are the increased number of hours for residents. Alternatively, the
use of pagers in the department can also distract the resident when they are
preparing the dosage for chemotherapy. Other
hazards identified in the analysis have been the failure of the nursing staff
and pharmacy department to check the changes in prescription of medication that
is used for chemotherapy for young patients. The causes can be failure of the
department to check out the prescription as well as the resident failing to
inform the nurses. Another hazard identified has been old dose delivered by the
pharmacy once authorized medication has been changed for the patients. Finally,
another hazard that was identified was extravasation of peripheral venous
access which is a rare process. This means that residents or nurses are unaware
of the risks of peripheral venous access.
Recommended
Actions
A standardized chemotherapy chart scheduled has been
recommended because the standard procedure for changes can help to implement
high levels of uniformity and consistency with respect to provision of care to
the oncology patients (Keers et al, 2013). Moreover,
standardized processes help to ensure that practitioners can work in an
integrated manner in order to respond to problems. The information can be
accessed which helps to achieve efficiency and effectiveness. Another important
recommendation is to reduce the work hours that can play an instrumental role
in mitigating medical errors. New doctors that join a team are at higher risks
of making prescription errors.
The recommendation is therefore to place minimum
number of residents in the pediatric oncology ward. The use of pagers was
prohibited because it can cause distraction in the ward. Additionally, the
residents are provided with maximum concentration for prescribing chemotherapy
in a separate room in order to reduce the chances of errors. Another recommendation is to implement an
electronically controlled administration system that would help to provide
sound information to the healthcare workforce. This is because the changes in
prescriptions that have been authorized go disregarded by the nursing staff (Keers et al, 2013).
The pharmacy
department would be notified by telephone about changes in medications. This is
because the pharmacy department might deliver the incorrect chemotherapy once
change has been implemented in an authorized order. This is done in order to
prevent medication errors so that patient safety can be promoted in an
efficient and effective manner. Vincristine should be a administered by a
peripheral intravenous access by a trained pediatric oncologist in order to
ensure efficiency. Nurses and residents do not have knowledge about the risk of
extravasation of the heart when peripheral intravenous access is used for the
purposes of treating the patients.
Discussion
Prescription errors are a critical issue in the
healthcare environment as they can prolong the hospitalization stays for
patients. In other cases, prescription errors might be fatal for the patient.
Specifically, the prescription errors can increase costs for the patient as
well as the hospital. HFMEA is an appropriate tool for diagnosing problems and
hazards that are encountered in the healthcare environment (Ghaferi &
Dimick, 2015).
In addition, it can be used for analyzing the
prescription process in a pediatric oncology ward. The case discusses the
administration of chemotherapy which is vincristine. The analysis suggests that
there are multiple hazards that can cause medication errors and jeopardize
patient safety. Prescription errors can be multifaceted in nature because of
the analysis that has been undertaken in this paper. The analysis using the
HFMEA tool is important since it helps to identify the multiple hazards and the
possible solutions to resolve them. It provides accurate and reliable
information to the management so that they can make critical decisions that can
lead to high levels of efficiency and effectiveness. The recommendations target
the specific failure modes by using proactive and dynamic strategies in order
mitigate the chances of errors related to prescription in the oncology ward (Duwe
et al, 2005). The HFMEA was conducted through a multidisciplinary team which
helps to achieve the critical objectives of analyzing hazards in the healthcare
environment. In addition, a parent was part of the team because they can
provide valuable feedback about the entire process. Specifically, the success
of HFMEA occurs when the hospital management is involved in the entire process.
The analysis suggests that administrative and technological processes need to
be implemented in order to reduce prescription errors. Moreover, the staff must
be appropriately trained so that they can work in providing continuity of care
for the patients. The staff must be aware about the implications of
prescription errors. Communication processes need to be strengthened so that prescription
errors can be mitigated. The flow and exchange of information should be done in
a consistent manner in order to reduce the chances of errors. Technology can be
used to create quality and efficient healthcare services in the oncology
department. It can be used for storing patient information and medication
information which is vital for the success of the medical center (Shebl et al,
2012).
Conclusion
HFMEA is an appropriate tool that
has been used to study the medication errors that can occur in the pediatric
oncology ward of a national medical center. Medication errors need to be
combated through the presence of a patient safety culture. The staff must work
in a coordinated manner with each other so that they are able to successfully
develop proactive and dynamic strategies in responding to problems occurring in
the environment. Proper research and analysis is important for the healthcare
team so that they can identify the source of medication errors. The HFMEA tool
used for the oncology department found that there are several sources of
medication errors in the hospital environment. A proactive and integrated
strategy is needed in order to combat the problem. This can be done through the
use of clear and precise goals. Another recommendation
is to implement an electronically controlled administration system that would
help to provide sound information to the healthcare workforce. This is because
the changes in prescriptions that have been authorized go disregarded by the
nursing staff. The pharmacy department
would be notified by telephone about changes in medications. This is because
the pharmacy department might deliver the incorrect chemotherapy once change
has been implemented in an authorized order. This is done in order to prevent
medication errors so that patient safety can be promoted in an efficient and
effective manner.
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