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An FMEA will be performed on postoperative infections. Data is available by surgery type on the frequency, severity, and detectability of these infections.

An FMEA will be performed on postoperative infections. Data is available by surgery type on the frequency, severity, and detectability of these infections.

Summary

PROBLEMS

1. An FMEA will be performed on postoperative infections. Data is available by surgery type on the frequency, severity, and detectability of these infections. The director of quality improvement wants you to prepare a priority list giving the order in which the various sur- geries should be examined, to produce the greatest potential benefit for the organization. Severity is ranked from most severe (4) to least severe (1), and detectability is ranked from difficult to detect (4) to easy to detect (1). Calculate a frequency ranking from very high (5) to very low (1) based on the number of infections and cases shown in the following and the RPNs for each type of surgery. Which surgery should be examined first? Which surgery should be examined last? What is the maximum possible risk score for this analysis?

Surgery Types

Number of Infections

Number of Cases

Frequency

Severity of Infections

Detectability

Risk Priority Number

Thoracic 5

Neuro 1

Orthopedic 50

Plastic 32

Oral 25

General 100

200 3 3

100 4 3

2,000 2 2

800 1 2

500 1 1

5,000 2 1

2. Instead of the ordinal ranking of frequency, 1 to 5, used in problem 10.1, the director of quality improvement has collected data on the number of cases for each type of surgery and the num- ber of patients that contracted a postoperative infection. The director wants you to recalculate the RPN using the actual incidence rates of infection. Infection severity and detectability are ranked the same as in problem 10.1. Compare your new RPNs with those calculated in 10.1. How does the use of the incidence rate change the improvement work list? Which surgery should be examined last? What is the maximum possible risk score for this analysis?

Surgery Types

Number of Cases

Number of Infections

Rate of Infection

Severity of Infections

Detectability

Risk Priority Number

Thoracic 200

Neuro 100

Orthopedic 2,000

Plastic 800

Oral 500

General 5,000

5 3 3

1 4 3

50 2 2

32 1 2

25 1 1

100 2 1

Chapter : Failure Mode and Effects Analysis

3. Assume that in problem 10.2 strict adherence to antibiotic administration one hour prior to thoracic surgery has reduced the rate of infection to 1.0% and severity to 2.0. How did this improvement affect the priority list? Which surgery should be the primary target for improvement?

4. A hospital is setting its quality improvement agenda for the upcoming year and will per- form an FMEA in one area. The hospital has rated sentinel events for severity, probability, and detectability on the following scale: very high, high, moderate, low, very low. Calculate the risk priority number for each type of event. Which sentinel event should be the focus of the hospital’s FMEA effort?

Event

Severity

Probability

Detectability

Hospital-acquired High Moderate Infection

Medication Error Moderate High

Patient Fall Low High

Pressure Ulcer Low High

Treatment Delay Low High

High

Moderate

Very high

Very high

High

References

Apkon M, Leonard J, Probst L, DeLizio L, and Vitale R, 2004, Design of a Safer Approach to Intravenous Drug Infusions: Failure Mode Effects Analysis, Quality and Safety in Health Care 13 (4): 265–271.

Camp RC and DeToro IJ, 1999, Benchmarking, in Juran’s Quality Handbook, 5th ed., edited by JM Juran and AB Godfrey, McGraw-Hill, New York, NY, 12.1–12.20.

Cleary P and Edgman-Levitan S, 1997, Health Care Quality: Incorporating Consumer Perspectives, JAMA 278 (19): 1608–1612.

Cohen H, 2007, Protecting Patients from Harm: Reduce the Risk of High-Alert Drugs, Nursing (September 2007): 49–54.

Coronary Drug Project Research Group, 1980, Influence of Adherence to Treatment and Response of Cholesterol on Mortality in the Coronary Drug Project, New England Journal of Medicine 303 (18): 1038–1041.

Curran TA and Ladd A, 2000, SAP R/3 Business Blueprint, Prentice Hall PTR, Upper Saddle River, NJ.

DeToro IJ, 1995, Business Process Benchmarking Workshop, The Quality Network Inc., Rochester, NY.

Duwe B, Fuchs B, and Hansen-Flaschen, J, 2005, Failure Mode and Effects Analysis Application to Critical Care Medicine, Critical Care Clinics 21 (1): 21–30.

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