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The hazard Score was determined using the Error Scoring Matrix (the product of the two elements of the severity and probability of occurrence of the error) and was recorded in the HFMEA worksheet.
Study results of Dominici indicate that in order to evaluate the results of the application effect of HFMEA in the quality of patient care, creating multidisciplinary teams to identify and classify possible risks is important (25).
Department of Veterans Affairs (n.d.) HFMEA process was used to guide the project.
The team conducted a proactive HFMEA of the existing discharge process to create action plans directed at reducing high-risk failure modes.
HFMEA consists of a five-step process using a multidisciplinary team:
There are two primary differences between FMEA and HFMEA. HFMEA includes a hazard scoring matrix and decision tree that are not present in FMEA.
In completing HFMEA, it is important to identify the threats facing the project.
The three main components of the HFMEA risk assessment and their 10-point Likert scales are found in Figure 2.
* Healthcare Failure Modes and Effects Analysis (HFMEA) and Root Cause Analysis (RCA)
Two years posttraining, Year 1 trainees reported continued use of many of the skills/tools taught--especially RCA (76 percent), HFMEA (76 percent), human factors engineering (72 percent), and reporting adverse events and near misses (72 percent) (Table 2).
In consideration of these trends, along with the increasing frequency of adverse PCA events, the decision was made by the risk management department to select the "Reduction of PCA Oversedation Events for Post-operative Patients" as the HFMEA project for fiscal year 2008.
We described what we identified from our HFMEA analysis and what the implication to our center would be if we had an ABO mismatch error.
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