Author/Authors :
Asefzadeh، Saeed نويسنده Qazvin Research Center for Social Determinants of Health, Qazvin University of Medical Sciences, Qazvin , , Yarmohammadian، Mohammad H. نويسنده Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan , , Nikpey، Ahmad نويسنده School of Health, Qazvin University of Medical Sciences, Qazvin , , Atighechian، Golrokh نويسنده Health in disaster and Emergencies, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran ,
Abstract :
Background: Clinical risk management focuses on improving the
quality and safety of health care services by identifying the circumstances
and opportunities that put patients at risk of harm and acting to prevent
or control those risks. The goal of this study is to identify and assess
the failure modes in the ICU of Qazvin’s Social Security Hospital (Razi
Hospital) through Failure Mode and Effect Analysis (FMEA).
Methods: This was a qualitative-quantitative research by Focus
Discussion Group (FDG) performed in Qazvin Province, Iran during
2011. The study population included all individuals and owners who
are familiar with the process in ICU. Sampling method was purposeful
and the FDG group members were selected by the researcher. The
research instrument was standard worksheet that has been used by
several researchers. Data was analyzed by FMEA technique.
Results: Forty eight clinical errors and failure modes identified,
results showed that the highest risk probability number (RPN) was
in respiratory care “Ventilator’s alarm malfunction (no alarm)”
with the score 288, and the lowest was in gastrointestinal “not
washing the NG-Tube” with the score 8.
Conclusions: Many of the identified errors can be prevented by
group members. Clinical risk assessment and management is the
key to delivery of effective health care.
