Using Failure Mode and Effects Analysis for safe administration of chemotherapy to hospitalized children with cancer

The administration of chemotherapy to hospitalized children with cancer is a complex and high-risk process. A team divided the process into three areas--prescribing, dispensing, and administration--and used Failure Mode and Effects Analysis (FMEA) to identify the elements of risk and implement appropriate strategies. For each area, potential failures within subprocesses were assigned risk priority numbers (RPNs), reflecting their frequency, severity, and detectability.

The team made prescribing and administration, the areas with the highest RPNs, the focus of most of its strategies, which were introduced and completed in 2002.

The potential prescribing error rate decreased from 23% to 14%; use of preprinted standard order sets increased from 22% to 45% in 2003 (one year after the FMEA was conducted) and 76% in 2005. Actual dispensing errors decreased from 3 to 1, and the actual administration errors from 4 to 3.

Computerized order entry systems would only affect prescribing, dispensing, and administering, which would still be done manually, resulting in potential for failure. The FMEA project will be an ongoing part of providing safe chemotherapy treatments.