Improving the safety patient and quality of care of the totally implantable venous access device process in oncology: An experience in a developing country tertiary university hospital

Abstract

Background

The totally implantable venous access device, named also the implantable chamber, is one of the most medical devices used in the oncological therapies. However, the process of implementing such devices provide several failure modes which decrease the quality of care and the enhance the risk of patient complications. For this reason, it is essential to develop an effective risk management plan enable to detect and reduce different associated risks in order to improve the quality and the safety processes in the totally implantable venous access device implementation activity.

Methods

The process of identification and assessment of risks is ensured using an adapted Failure Modes and Effects Analysis (FMEA) to the context of developing countries (application field is a Moroccan oncology university centre). Finally, the prioritization of corrective actions is calculated based on a proposed parameter (named the Priority Level) which takes into consideration developing countries constraints.

Results

The study of the totally implantable venous access device process leads to identify a large number of potential failures (n=72) which are divided in 3 classes (19 % intolerable, 51 % to be monitored; and 29 % of intolerable). Moreover, the adapted approach of FMEA proves high optimization of the project in terms of time and resources. An action program mapping is developed in order based on the Rik Priority Number and the Priority Level.

Conclusion

The implantable chamber poses a major challenge to any practitioner in oncology. This study constitutes the first experience in risk management of implantable chambers under developing countries constraints while highlighting all the failures to be prevented during their handling.