Patient Involvement in Evaluation of Safety in Oral Antineoplastic Treatment: A Failure Mode and Effects Analysis in Patients and Health Care Professionals

Abstract

Objectives: To identify risks associated with delivery of treatment with oral antineoplastic agents in an outpatient setting and to evaluate additional value and feasibility of engaging patients in a proactive risk analysis. Methods: We conducted 2 separate but parallel failure mode and effects analyses (FMEAs) among patients and health care professionals (HCPs) at a clinical oncology department in Denmark. Comparative analyses were performed using the FMEA process maps and risk priority numbers (RPNs) as main outcome measures. The FMEAs were augmented by semistructured interviews with HCPs and patients on acceptability and feasibility of FMEAs analyzed using systematic text condensation. Results: Patients and HCPs found failures in information regarding treatment (cause, aim, and plan) to be of high risk. Also, HCPs found failures in checking for potential interactions to be of high risk. HCPs focused on the in-hospitals procedures, whereas patients identified risks related to both the hospital and the home setting. Both HCPs and patients found participation in the FMEA process meaningful but found the use of RPNs difficult. Conclusions: Patient engagement in proactive risk analysis using FMEA is acceptable, meaningful, and feasible, with patients providing a different perspective on the risks associated with oral antineoplastic treatment compared with HCPs.

Process Mapping in Healthcare: A Systematic Review

“…Online versions of published articles or online supplements [64,84,98,104,125,[133][134][135][136][137] could provide more detailed process maps as these are often di cult to display in printed versions of journals.…”

“…For example, in ICP projects the use of PM to understand systems helped to improve coordination of care across different settings and networks [79,81,95], while in FMEA projects it helped to identify potential systems failures. [64,94,[96][97][98][98][99][100][101][102][103][104] (ii) Inform scope, design, development and evaluation of interventions The identi cation of actual constraints and opportunities within local systems helped assessment of problem areas and development of improvement solutions grounded in research evidence and local knowledge. [68,72,74,80,86,90,[105][106][107] The use of PM before the implementation of information systems (IS) to help project members with diverse backgrounds achieve a shared understanding of the system has been reported as crucial for solving design challenges.…”

Betegek a betegbiztonságról

“…A szerepvállalás alapja a beteg, aki a saját testének, tüneteinek és állapotának szakértője [17], és megjelenhet az aktív cselekvésben (pl. önmenedzsmentben) [18,19] vagy akár az információnyújtásban is [20].…”

“…A gyógyszerelésből adódó hibák megelőzésében a betegeknek kiemelt szerepe van (pl. a teamek közötti információátadás támogatásában, a felírási hibák észlelésében, hiányzó gyógyszerek azonosításában) [19,20]. Olyan információik lehetnek, amelyekre az orvosoknak nincs rálátása az adott pillanatban (pl.…”

“…Olyan információik lehetnek, amelyekre az orvosoknak nincs rálátása az adott pillanatban (pl. gyógyszerallergia, amely nem szerepel a beteg kórlapján) [20]. A betegek felelősségvállalása saját gyógyszerelésük iránt fokozott stresszt okozhat számukra, ugyanakkor magasabb szintű betegbiztonsághoz is vezethet [20,47].…”