RISK MANAGEMENT IN THE CLINICAL LABORATOIRES - USE OF THE FAILURE MODES AND EFFECTS ANALYSIS (FMEA)
Abstract
Introduction: Risk Management Process consists of a series of steps that, when undertaken in sequence, enable continual improvement in decision making. Failure Modes and Effects Analysis (FMEA) is systematic method of identifying and preventing product and process problems before they occur.
Objective: To present FMEA as a tool for risk managing and improvement in a public clinical laboratory.
Methods: We studied the failure modes that might occur in the total testing process (TTP) . Each failure mode was ranked on estimated frequency of occurrence (O), detection (D) and severity (S), each on a scale of 1–4. Failure risks were calculated by Risk Priority Numbers (RPNs) = O × D × S.
Results: We used FMEA, including technical risks as well as risks related to human failure in assessment of analytical procedures. FMEA was applied in two stages: at the beginning of the project and after the implementation of the proposed measures. The analytical method was broken down into process steps and we identified possible failure modes for each step. Failure modes with the highest RPN scores were subjected to corrective actions.
Conclusion: We recommend risk analysis as an addition to the usual analytical validation, as the FMEA proved to be a reliable tool for detection of previously unidentified risks.
Key words: FMEA, risk management, clinical laboratory
References
1. International Organization of Standardization. ISO/TS 15189: 2012 Medical Laboratories-Requirements for Quality and Competence
2. International Organization of Standardization. ISO/TS 22367: Medical Laboratories—Reduction of Error through Risk Management and Continual Improvement
3. Clinical and Laboratory Standards Institute. EP18-A2: Risk Management Techniques to Identify and Control Laboratory Error Sources; Approved Guideline, 2nd ed. CLSI document EP18-A2. Wayne, PA: Clinical and Laboratory Standards Institute, 2009.
4. Clinical and Laboratory Standards Institute EP23-A: Laboratory Quality Control on Risk Management; Approved Guideline, CLSI document EP23-A. Wayne, PA: Clinical and Laboratory Standards Institute, 2011.
5. Plebani M. The Detection and Prevention of Errors in Laboratory Medicine. Ann Clin Biochem 2010; 47 (Pt 2): 101-10. https://doi.org/10.1258/acb.2009.009222
6. Plebani M, Astion M, Barth J, et al. Harmonization of Quality Indicators in Laboratory Medicine. A Preliminary Consensus. Clin Chem Lab Med 2014; 52(7): 951-8. https://doi.org/10.1515/cclm-2014-0142
7. Plebani M. Errors in Laboratory Medicine and Patient Safety: The Road Ahead. Clin Chem Lab Med 2007; 45(6):700-7. https://doi.org/10.1515/CCLM.2007.170
8. Plebani, M, Ceriotti F, Messeri G, et al. Laboratory Network of Excellence: Enhancing Patient Safety and Service Effectiveness. Clin Chem Lab Med 2006; 44 (2): 150-60. https://doi.org/10.1515/CCLM.2006.028
9. Szecsi PB, Odum L. Error Tracking in a Clinical Biochemistry Laboratory. Clin Chem Lab Med 2009; 47(10): 1253-57. https://doi.org/10.1515/CCLM.2009.272
10. An introduction to FMEA: using failure mode and effects analysis AQ9 to meet JCAHO’s proactive risk assessment requirement. Health Devices 2002;31:223–6.
11. International Organization of Standardization. ISO 9001:2015 Quality Management Systems-Requirements
12. Passey RD. Foresight begins with FMEA: delivering accurate risk assessments. Med Device Technol 1999;10 (2): 88–92.
13. Kieffer RG. Validation and the human element. PDA J Pharm Sci Technol 1998;52(2): 52–4.
14. Grissinger M, Rich D. JCAHO: meeting the standards for patient safety. Joint Commission on Accreditation of Healthcare Organizations. J Am Pharm Assoc (Wash) 2002; 42(5 suppl 1):S54–5.
15.Hawkins, R. Managing the Pre- and Post-Analytical Phases of the Total Testing Process. Ann Lab Med 2012; 32(1): 5-16. https://doi.org/10.3343/alm.2012.32.1.5
16. Lippi G, Guidi G. Risk Management in Pre-Analytical Phase of Laboratory Testing. Clin Chem Lab Med 2007; 45 (6): 720-7. https://doi.org/10.1515/CCLM.2007.167
17. Plebani M. Quality Indicators to Detect Pre-Analytical Errors in Laboratory Testing. Clin Biochem Rev 2012; 33(3): 85-8.
18. Clinical and Laboratory Standards Institute. GP32-A: Management of Nonconforming Laboratory Events; Approved Guideline. CLSI document GP32-A. Wayne, PA: Clinical and Laboratory Standards Institute, 2007
19. Ricos C, Biosca C, Ibarz M, et al. Quality Indicators and Specifications for Strategic and Support Processes in Laboratory Medicine. Clin Chem Lab Med 2008; 46(8): 1189-94. https://doi.org/10.1515/CCLM.2008.225
20. Ruiz R, Llopis M, Biosca C, et al. Indicators and Quality Specifications for Strategic and Support Processes Related to the Clinical Laboratory. Four Years’ Experience. Clinical Clin Chem Lab Med 2010; 48(7): 1015-9. https://doi.org/10.1515/CCLM.2010.229
21.Plebani M. Errors in Clinical Laboratories or Errors in Laboratory Medicine? Clin Chem Lab Med 2006; 44(6): 750-9. https://doi.org/10.1515/CCLM.2006.123