Improving the safety of chemotherapy process by a risks management tool

Abstract

Objectives: Chemotherapy compounding is a main step of chemotherapy cancer process. This step is formed by many parts. A multidisciplinary team is assembled to define critical points and failures linked to this process and proposed different actions to secure them and improve chemotherapy cancer process. Methodology: By a prospective analysis risks tool: the failure modes, effects, and criticality analysis (FMECA), anticancer drug process compounding was sequenced in many parts. During the brainstorming, different ideas expressed and were classified into an Ishikawa cause–effect diagram. The criticality indexes (CI) are calculated from occurrence, severity, and the detection probability. Results: The sum of CIs of 18 identified failure modes was CI=3607 for the decentralized system and CI=726 after the new organization of compounding process. The chemotherapy production step represents 37.17% (CI=1341) of all failures in the old process. The greatest risk reductions between the old and the new process concerned the risk of ‘Double check missing before delivery to the ward’ by a factor reduction of 28.0). Among the CIs remaining superior to 100, there was one failure: ‘Typing error during prescription’ (CI=144). Conclusion: Modification of the chemotherapy-compounding process by centralization, training program, and implementation of procedures resulted in an important risk reduction as shownby risk analysis.Our study illustrates the usefulness of risk analysismethods in the healthcare system. A systematic use of risk analysis is needed to improve the safety of high-risk activities in healthcare processes.