Hospital initiative achieves 65% RPN reduction
Hospital initiative achieves 65% RPN reduction
While most quality managers are still learning what failure mode and effect analysis (FMEA) is, a few adventurous souls have initiated FMEA projects at their facilities — with encouraging results. At Atlantic Health System (AHS)/Overlook Hospital in Summit, NJ, for example, one of two groups seeking to improve the blood specimen labeling process achieved a 65% reduction in the RPN, or risk priority number.
"This was a problem we had been working on since October of 2000," recalls Tina Maund, MS, RN, director of performance improvement for AHS/Overlook. "After using all of the usual PI [process improvement] initiatives and root-cause analyses, we did not see the level of improvement we wanted," she explains.
Last April, the decision was reached to address the problem using FMEA. In June, a "Safety Summit" was held to kick off the process. The goal was to come up with a safer blood specimen labeling process, resulting in 100% correctly labeled specimens. "We reviewed the process maps that had been created and made some revisions based on the input of the participants," says Maund. "We also reviewed the previous work done with cause-and-effect analysis, and all process changes and results to date."
Then, the participants broke into two groups — one to concentrate solely on the routine process using lab-generated labels, the other on the process where lab-generated labels are not available, she says. "In addition to calculating RPNs for the overall processes, we identified three or four areas in each process for which we wanted to calculate RPNs — for instance, patient identification," Maund explains.
The team members assigned the severity, occurrence, and detection ratings that ultimately would determine the RPNs. "We actually asked people to write down their ratings," says Maund. "We went through each group and calculated an average rating based on individual responses. This was an interesting exercise, because we found that the variation in ratings was very narrow." In selecting team members, says Maund, she focused on people who were active, frontline participants in the process. FMEA teams must include "process designers" and "process experts."
"Process designers are usually people in management, or clinical staff like nurse specialists," Maund explains. "These are people who are not exclusively hands-on. Process experts, on the other hand, are people who actually have consistent, and usually daily, hands-on experience with the process," she adds.
The teams conducted their FMEAs, then reviewed the results. "This part of the process was excellent," says Maund. "We were able to see immediately for the overall process and key process steps what the RPN was; this was very powerful. Ideally, all of our RPNs would be below 150, and in fact, we had none below 150. That was when the message of how critical it was to redesign the process really came across to the group."
The teams then selected priority areas for improvement. Assignments were made to redesign specific process components that had the highest RPNs. "We made key changes in two weeks; it had to be a rapid-cycle improvement process," Maund says.
The results were very impressive in terms of the process that does not use lab labels. "We did a very specific intervention; our goal was to achieve at least a 50% reduction in RPN for the overall process, and we achieved about a 65% reduction," Maund observes. "In terms of individual steps within the process, all RPNs are now below 150." In the other group, some improvement was achieved, but not at the desired level. "We’re still working on it," says Maund. "We will continue to use FMEA as a very effective tool in driving and evaluating the needed improvements."
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