FMEA
gerontology
October 23, 2020Meteorology
October 23, 2020FMEA
The initials FMEA stands for Failure Mode Effects Analysis, which is a step-by-step analysis that is used for identifying the potential failures in a process, or a product (Stamatis, 2003). The term “failure modes” stands for the means or ways in which a process, or the thing that is under analysis might fail. The failures can be potential or actual, and they refer to the effects or errors that affect the service user. On the other hand, the “effects analysis” refers to the study of the consequences of the errors identified. In relation to the procedures in health sciences, failure modes and effects analysis incorporates the study of the current knowledge, as well as, the knowledge being developed. This essay purposes to analyze the procedure of preparing a 55-year old male for prostate surgery using the FMEA tool. The procedure is first described using the high-level flow chart of events, then the errors ad failures associated with the steps are discussed in a tabular representation in line with the FMEA tool.
Preparation of a 55-year male for prostate surgery:
FMEA of the process of preparing a 55-year old male for prostate surgery:
| PROCESSSTEP | POTENTIALFAILURE MODE | POTENTIALEFFECT | severity of effect | Probability of failure
|
Detection of failure | Criticality score |
| Explain the procedure to the patient (Williams &Wilkins, 2002) | The nurse fails to explain procedure to patient | Patient goes to theatre with fear and anxiety | 3 | 2 | 3 | 70 |
| Verify that the client has given consent for the operation. | The nurse fails to verify the patient’s consent | Patient s operated without consent | 5 | 3 | 1 | 90 |
| Ensure all investigations are done | The nurse fails to ensure that investigations are done | Patient may get complications intra- or post-operatively | 5 | 4 | 1 | 80 |
| Teach the patient deep breathing exercise (Smeltzer et al., 2010) | The nurse fails to teach the patient breathing exercises | Patient’s circulation is compromised while bedridden | 4 | 4 | 3 | 60 |
| Perform head to toe examination and take history | The nurse fails to examine the patient | The patient gets complications | 4 | 3 | 3 | 50 |
| Give the prescribed medications to the patient | The nurse fails to give medication to the patient | Patient experiences pain and other effects | 3 | 3 | 2 | 50 |
| Encourage client to void and empty bladder | The nurse fails to tell the patient to empty bladder | The patient experiences a lot of pressure and pain | 3 | 3 | 3 | 40 |
| Verify identification by checking the identification badge | Nurse fails to verify patients identity | A wrong patient may be operated | 5 | 5 | 2 | 90 |
| Orient client’s family to the hospital environment | The nurse fails to orient the family to the hospital environment | The family is not able to provide adequate anxiety relief to the client | 3 | 3 | 3 | 40 |
| Place call bell within reach and encourage client to call in case of eventuality | Nurse forgets to place the bell within patient’s reach | Patient experiences and emergency and is not able to call for help | 4 | 4 | 3 | 60 |
| Encourage the family members to stay with the client | The nurse fails to counsel the family members | Family members are not able to provide adequate care to the client | 3 | 3 | 2 | 40 |
| Gently, transfer the patient to the stretcher | The nurse transfers the client roughly | Client experiences pain | 2 | 2 | 1 | 20 |
| Complete the patient notes. Check that preoperative checklist is signed | The nurse fails to check the pre-operative check-list | Client may experience complications because some variables may be compromised | 4 | 4 | 1 | 60 |
| Accompany the patient to the operating room with the notes | The nurse fails to carry the notes with her/himself | No notes handed over to the operating team | 4 | 4 | 1 | 50 |
| Make sure blood is ready, in case of transfusion, and ensure the client has an infusion site ready | The nurse fails to order for blood before operation | Patient complicates during surgery | 5 | 4 | 1 | 90 |
| Assure the patient while handing over | The nurse fails to assure the patient | Patient develops anxiety | 3 | 3 | 3 | 30 |
Rating key:
Severity rating scale:
- No effect 4. Significant/long-term effect
- Minimal effect 5. Catastrophic effect
- Moderate/short-term effect
Probability rating scale:
- Highly unlikely/never happened before
- Low/relatively few failures
- Moderate/occasional failures
- High/repeated failures
- Very high/failure almost inevitable
Detection rating scale:
- Almost certain to be detected
- High likelihood of being detected and corrected
- Moderate likelihood of being detected and corrected
- Low likelihood of being detected and corrected
- Remote likelihood of being detected and corrected
| CRITICAL FAILURE | ROOT CAUSES | REDUCING FAILURE | MEASURES OF SUCCESS |
| The nurse fails to explain procedure to patient | Negligence | The administration should take disciplinary action | Rates of negligence on this step |
| The nurse fails to verify the patient’s consent | Negligence | Disciplinary action | Percentage of the cases |
| The nurse fails to ensure that investigations are done | Failure by the hospital to institute policy | Hospital to emphasize on following procedure | Percentages of investigations that are not done |
| The nurse fails to teach the patient breathing exercises | Inadequacy of patient preparation knowledge | Continuous education to reinforce knowledge | Rates of cases in the theatre |
| The nurse fails to examine the patient | negligence | Stern disciplinary action | Rates of cases |
| The nurse fails to give medication to the patient | negligence | Stern disciplinary action | Rates of failure cases |
| The nurse fails to tell the patient to empty bladder | Lack of knowledge on its importance | Encourage nurses to keep learning new knowledge | Percentage of failure cases |
| Nurse fails to verify patients identity | negligence | Stern disciplinary action | Percentage rates of such cases |
| The nurse fails to orient the family to the hospital environment | Inadequate knowledge on the issue | Encourage continuous education | Percentage rates of such cases |
| Nurse forgets to place the bell within patient’s reach | Negligence | Stern disciplinary action | Rates of such cases |
| The nurse fails to counsel the family members | Lack of emphasis on counselling family members | Emphasize on the role of the family members in preoperative care | Percentage rates of such cases |
| The nurse transfers the client roughly | Negligence: patients should be handled with care | Stern disciplinary action | Percentage rates of such cases |
| The nurse fails to check the pre-operative check-list | Negligence | The nurse should be given a warning | Percentage rates of such cases |
| The nurse fails to carry the notes with her/himself | Negligence | Give a warning to the nurse | Percentage rates of such actions |
| The nurse fails to order for blood before operation | Negligence | Take a disciplinary action against the nurse | Percentage rates of such cases |
| The nurse fails to assure the patient | Lack of knowledge on the importance of allaying anxiety | Encourage continuous medical education | Percentage rates of such cases |
Conclusion:
The above two tables and the high-level flow chart have been used to analyze the procedure of preparing a 55-year old male patient for prostate surgery. The FMEA tool has identified the errors that are likely, their potential effects, the consequences, the root causes, and, as well, the measures that can be taken to reduce the errors.
References
Smeltzer, C. S., Bare, B., Hinkle, L. J., & Cheever, H. K. (2010). Brunner and Suddarth’s textbook of medical-surgical nursing, volume 1. New York, NY: Lippincott Williams and Wilkins.
Stamatis, D. H. (2003). Failure Mode and Effects Analysis: fmea from theory to execution. Milwaukee, WI: ASQ Quality Press.
Williams, L. &Wilkins. (2002). Illustrated manual of nursing practice. New York, NY: Author.
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