Multisite Risk Assessment to Reduce MTX-Use Errors in Childhood Malignancy
ZHU Chen1, LIANG Gang1, LI Ying2, JIANG Ni3, FANG Hong-mei1, GUAN Yan1, WANG Xiao-ling2*
1. Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; 2. Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China; 3. Dalian Children′s Hospital of Dalian Medical University, Dalian 116012, China
Abstract：OBJECTIVE Medication errors (ME) more frequently affect pediatric patients than adults. Chemotherapeutic drug MEs seems more serious and less detected, among which, the most commonly involved chemotherapeutic agent was methotrexate (MTX). To engage multidisciplinary teams of childhood malignancy in a multisite study using proactive risk assessment methods to identify how MTX errors occur and propose risk reduction strategies. METHODS We recruited doctors, nurses, pharmacists and parents from three children′s hospitals in the northeast and southeast China to participate in failure mode and effects analyses (FMEA). An FMEA is a systematic team-based proactive risk assessment approach in understanding ways a process can fail and develop prevention strategies. Steps included diagram the process, collect failure modes/risks and prioritize failure modes, and propose risk reduction strategies. We focused on MTX-use process in and out of hospitals. RESULTS A multidisciplinary medication safety team was formed of total 66 members. They developed a four-stage flow diagram with four main phases, based on which, 56 potential risks were recognized and 17 were classified as higher risks by the hazard-scoring matrix. The highest priority failure modes in hospital included wrong solvents, wrong frequency label and lake of monitoring; furthermore, errors involving excessive intake of oral MTX after discharge were worth extra attention. Meanwhile, remediation strategies were developed, consisting of constrained and recommended strategies. CONCLUSION FMEA is a useful tool to identify the risk of MTX MEs and several years later, with the concerted efforts of all the healthcare staff and technicians, we wish to see a reduction in the potential for errors being made and an improvement of children safety.
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