After the change process has been developed a failure mode and effects analysis (FMEA) would need to be done. This analysis is done in order to project the likelihood that the process improvement plan will not fail. The interdisciplinary team for this entire process will consist of an emergency room physician, an RN, an LPN, a clinical quality consultant, an HR representative and an a patient safety advocate.
The process for conducting an FMEA is straightforward. A sturdy analysis can be obtained from interface matrices, boundary diagrams, and parameter diagrams. A lot of breakdowns are due to noise factors and shared interfaces with other parts or systems. In order to begin it is necessary to describe the system as a whole and its function. A good understanding simplifies further analysis. This way a person can see which uses of the system are desirable and which are not. It is imperative to consider both intentional and unintentional uses. Unintentional uses are a form of hostile environment (Crow, 2002).
The second thing to be done is the creation of a block diagram of the system. This diagram gives a general idea of the major components or process steps and how they are related. These are called logical relationships around which the FMEA can be developed. It is useful to create a coding system in order to identify the different system elements. The block diagram should always be included with the FMEA. Previous to starting the actual FMEA, a worksheet needs to be created. This should contain the significant information about the system, such as the revision date or the names of the components. Included on this worksheet should be all the items or functions of the subject listed in a logical manner, based on the block diagram (Crow, 2002).
There are three basic steps of a FMEA. The first is that of Severity. In this step it is necessary to determine all failure modes based on the functional requirements and their effects. It is essential to note that a failure mode in one component can lead to a failure mode in another component. So each failure mode should be written down in technical terms and for function. After this the ultimate effect of each failure mode needs to be considered. A failure consequence is defined as the result of a failure mode on the function of the system as perceived by the user. In this way it is opportune to write these effects down in terms of what the user might see or experience (Crow, 2002). Putting this into perspective to the situation with Mr. B, there was a failure to follow proper procedures in regards to the conscious sedation policy. There was also a failure in communication between the LPN and Nurse J. along with a failure of communication between the staff in the emergency room and the backup staff that was in place to assist.
The second step is that of Occurrence. In this step it is essential to look at the cause of a failure and how many times it occurs. This can be done by looking at like products or processes and the failures that have been documented for them. A failure cause is seen as a design weakness. All the possible causes for a failure mode should be identified and documented. Again this should be in technical terms (Crow, 2002). In this case back incident reports would need to be looked at to determine the amount of times that these types of failures have occurred in the past.
The third step is that of Detection. When suitable actions are determined, it is necessary to test their efficiency. Also design verification is required. The proper inspection methods need to be chosen. One should put into place testing, analysis, monitoring and other techniques that can be or have been used on similar systems to detect failures. From these controls it can be seen how likely it is for a failure to be identified or detected (Crow, 2002). Testing of the new processes and procedures that have been put into place in the hospital will need to be done with simulations being conducted in order to make sure that the proper procedures are realized and carried out. Situations like the one with Mr. B could be recreated and acted through to make sure that all the proper steps were being done. This is the phase that can help identify gaps that are in the plan and whether these gaps are likely to cause failure of the entire plan. Gaps that are identified would then be fixed in order to prevent the implemented plan from failing.
Quality has become a chief focus within health care, especially in the areas of regulatory quality, quality assurance, quality improvement and patient safety. As this focus gets bigger, nurses' involvement in quality improvement activities is likely to expand. Nurses today have many roles beyond just patient care. In addition to taking care of the needs of patients and serving as part of the health care team, nurses also play a key role in meeting the Joint Commission's National Patient Safety Goals. These goals are usually are in such areas as medication safety, communication and patient safety. This role allows nurses to add to quality improvement. When nurses' efforts go beyond providing care and they in fact improve the quality of care for example, by participating in improvement projects and patient safety initiatives, they experience more joy in their work (Nurses Play Key Role in Improving Quality of Patient Care, 2010). This allows for them to always feel as if they are contributing and possible not get into a complacent mode in their work where things start getting overlooked and not carried out according to procedure.
In this case the key role that nurses would play in this hospital would be that of improving patient safety goals including communication and patient safety. They would need to be involved from the beginning in all processes that were undertaken in order to improve communication and patient safety. Optimizing a nursing staff's time at the bedside is the key to better patient safety. As the main caregivers in hospitals, nurses are in the best position to improve quality and patient safety. However, they are often pulled away from the bedside to conduct tasks that have nothing to do with actually taking care of patients. The No. 1 driver of patient safety is communication (Runy, 2008). All of these things are definite issues that should be worked on at the hospital in question.
Since nurses spend so much time with the patients taking care of them it only makes sense that these are the people that you need involved in any patient safety initiative. They are the ones who are on the front line and witness a lot of time when there are not only safety issues but breakdowns in communication as well. Priorities within the nursing staff need to be established and best practices need to be defined and shared with everyone. What works needs to be identified and documented and what doesn't needs to be discarded. Nursing goals need to focus around providing the best possible care to the patients in their charge, at all times. The best way to ensure this is to always be focusing on quality improvement and patient safety. Both of these areas are works in progress and should always be at the top of the priority list for all medical providers.
Crow, Kenneth. (2002). Failure Modes and Effects Analysis (FMEA). Retrieved March 25,
2010, from Web site: http://www.npd-solutions.com/fmea.html
Lewin's freeze phases. (2010). Retrieved March 25, 2010, from Changing Minds Web site: