Applicability of Healthcare Failure Mode and Effects Analysis to healthcare epidemiology: Evaluation of the sterilization and use of surgical instruments
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作者:
Linkin, DR
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Linkin, DR
Sausman, C
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Sausman, C
Santos, L
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Santos, L
Lyons, C
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Lyons, C
Fox, C
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Fox, C
Aumiller, L
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Aumiller, L
Esterhai, J
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Esterhai, J
Pittman, B
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Pittman, B
Lautenbach, E
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机构:Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
Lautenbach, E
机构:
[1] Univ Penn, Div Infect Dis, Dept Med, Philadelphia, PA 19104 USA
[2] Univ Penn, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA
[3] Univ Penn, Ctr Educ & Res Therapeut, Philadelphia, PA 19104 USA
[4] Univ Penn, Dept Orthoped, Philadelphia, PA 19104 USA
[5] Univ Penn, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
Healthcare Failure Mode and Effects Analysis (HFMEA) is a methodology for correcting latent system errors before they lead to adverse events. We examined the utility of HFMEA in evaluating the sterilization and use of surgical instruments. First, a multidisciplinary team graphed the process in a flow diagram. A hazard analysis was then used to examine potential failure modes (i.e., ways in which a process can fail) and their causes and to score the severity and other factors for each failure mode cause. Actions were then planned to address the selected failure mode causes. Flow charts were created for 3 foci: sterilization process, reading of biologicals, and use of equipment. Information was gathered through interviews and a review of the literature. Multiple clinically significant system errors were identified, and actions to correct them were developed. The HFMEA methodology facilitated the detection of previously unrecognized system errors, demonstrating its potential utility in addressing healthcare epidemiology-related adverse events.
机构:
Health Management and Economics Research Center, School of Management and Medical Information, Isfahan University of Medical ScienceHealth Management and Economics Research Center, School of Management and Medical Information, Isfahan University of Medical Science
Fatemeh Rezaei
Hojat Sheikhbardsiri
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Department of Disaster and Emergency Medical Management Center, Kerman University of MedicalHealth Management and Economics Research Center, School of Management and Medical Information, Isfahan University of Medical Science