Application of Healthcare Failure Mode and Effect Analysis in the Management of Patients With Intrathecal Morphine Pump Implantation.

Abstract

Background: Intrathecal morphine pump helps alleviate pain in the advanced stages of cancer, and thus, ensuring safe intrathecal morphine pump infusion is important. In this study, we investigated the effect of healthcare failure mode and effects analysis (HFMEA) in the management of patients with intrathecal morphine pump implantation.

Methods: We included 112 cancer patients with severe pain who met the inclusion criteria for intrathecal morphine pump implantation treatment in the pain department of our hospital from November 2021 to October 2022. We analyzed the severity, likelihood, and crisis of potential failure modes, causes, and results of intrathecal morphine pumps during this period, compiled the records, and formulated the appropriate improvement measures based on the results of the analysis. From November 2022 to October 2023, the HFMEA model was applied to 125 patients in the department, and the effectiveness of the model was evaluated by assessing the patients' VAS (visual analog scale) score, SAS (self-rating anxiety scale) score, SDS score, PSQI (Pittsburgh Sleep Quality Index) score and quality of life (QOL) (self-rating depression scale) score.

Results: The occurrence of adverse events (6 cases vs. 2 cases, p < .05), and the total incidence of adverse events (8.9% vs. 1.6%, X²= 6.600, p = .010) was significantly different before and after HFMEA was applied. For patients who received intrathecal morphine pump implantation, the VAS scores and the related pain indices were significantly lower after HFMEA than before. Additionally, the score of SAS (48.91 ± 6.03 vs. 47.02 ± 6.77), PSQI (37.30 ± 5.78 vs. 39.63 ± 5.64), and QOL (9.93 ± 3.04 vs. 8.98 ± 2.31) of patients improved significantly.

Conclusions: With the application of the HFMEA model, a multidisciplinary team assessed the risks associated with the use of intrathecal morphine pumps and prioritized measures to reduce them. By implementing the improvement measures, potential errors decreased significantly during the intrathecal morphine pump process. It allowed nursing managers to change the safety incidents related to drug administration using an intrathecal morphine pump from negative treatment after the event to active prevention before the event, greatly improved the level of drug use safety management, reflected the continuous improvement of nursing quality, and ensured nursing safety.