Application of FMEA model and 6S management method in reducing dispensing errors in PIVAS of children’s hospitals
- VernacularTitle:FMEA模型和6S管理方法在降低儿童专科医院PIVAS调剂差错中的应用
- Author:
Linfeng HE
1
;
Yaya YANG
1
;
Yunzhu LIN
1
;
Chunsong YANG
1
;
Lingli ZHANG
2
Author Information
1. Dept. of Pharmacy/ Evidence-based Pharmacy Center，West China Second Hospital，Sichuan University，Chengdu 610041，China;Key Laboratory of Birth Defects and Related Diseases of Women and Children，Sichuan University，Ministry of Education，Chengdu 610041，China
2. Dept. of Pharmacy/ Evidence-based Pharmacy Center，West China Second Hospital，Sichuan University，Chengdu 610041，China
- Publication Type:Journal Article
- Keywords:
pharmacy intravenous admixture service;
dispensing errors;
risk evaluation;
failure mode and effect analysis;
6S
- From:
China Pharmacy
2024;35(2):237-241
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.
