Involving Intensive Care Unit Nurses in a Proactive Risk Assessment of the Medication Management Process

Abstract

Background Vulnerabilities in the medication management process can lead to serious patient harm. In intensive care units (ICUs), nurses represent the last line of defense against medication errors. Proactive risk assessment (PRA) offers methods for determining how processes can break down and how people involved in such processes can contribute to or recover from a breakdown. Such methods can also be used to identify ICU nurses’ contribution to the quality and safety of medication management. Methods A PRA method was conducted in a cardiovascular ICU to identify and evaluate failure modes in the nursing medication management process. The contributing factors to the failure modes and the recovery processes used by nurses were also characterized. Results A total of 54 failure modes were identified across the seven steps of the medication management process. For the 4 most critical failure modes, nurses listed 21 contributing factors and 21 recovery processes. Ways were identified to redesign the medication management process, one of which consists of dealing with work system factors that contribute to the most critical failure modes. Conclusions From a data-analysis viewpoint, the PRA method permits one to address a variety of objectives. Different scoring methods can be used to focus on either frequency or criticality of failure modes; one may also focus on a specific step of the process under study. Developing efforts towards eliminating or mitigating contributing factors would help reduce the criticality of the failure modes in terms of their likelihood and impact on patients and/or nurses. Developing systems to support the recovery processes used by nurses may be another approach to process redesign.

Sociotechnical systems approach to healthcare quality and patient safety

“…Therefore, our research can provide useful information on how to redesign work systems in order to improve care processes and patient outcomes. Our research has examined the following care processes: outpatient surgery information management [3, 11, 33], ICU nursing medication management [19], and the bedside rounds process in a pediatric hospital [7]. …”

The Nurses’ Understanding About Patient Safety and Medication Errors

“…Esse deve ser um processo contínuo e ininterrupto para a verificação e correção de possíveis falhas, a fim de estabelecer estratégias a serem seguidas, avaliar os riscos iminentes e verificar falhas que podem interferir no cuidado ao paciente, prevenindo assim a ocorrência de erros de medicação. 12,13 Não foi observada nas falas dos participantes a necessidade de criação de uma comissão multidisciplinar envolvida nos aspectos da segurança do paciente, visando à prevenção e à redução dos eventos adversos e de medicamentos e gestão de risco clínico. Essa comissão auxilia com formulações de estratégias para que as instituições tenham cuidado mais seguro e livre de erros.…”

Macroergonomics in Health Care Quality and Patient Safety

“…For instance, various methods such as FMEA have been developed to analyze vulnerabilities of high-risk processes. Macroergonomists have adapted these proactive risk assessment methods to analyze system vulnerabilities in IV medication administration (Wetterneck et al, 2006), medication management by ICU nurses (Faye et al, 2010) and patient transfer from operating room to ICU (Hundt et al, 2013). These adaptations are based on the SEIPS model (see Figure 1) (Carayon et al, 2006), rely on various data collection methods (e.g., observation, archival data analysis) to identify and characterize process vulnerabilities, and use a participatory process to ensure stakeholder representation in the analysis and redesign of the process (Carayon, Faye, Hundt, Karsh, & Wetterneck, 2011).…”

“…Usability can also be incorporated in a macroergonomic proactive risk assessment (Carayon, Faye, Hundt, Karsh, & Wetterneck, 2011; Faye et al, 2010). Since workflow assessment is one component in many common risk assessment methods, including Failure Mode and Effects Analysis (FMEA), it is logical to incorporate a technology’s design – and an evaluation of its usability – in the risk assessment (Wetterneck et al, 2006).…”