FMEA: Failure of Automatic Doors in ER and Pharmacy

Session Description
On a busy 36 beds Emergency room that is attached to a 1A Veterans Affairs facility, the use of Failure Mode Effects and Analysis (FMEA) in mapping out effects of power outages and surges to Electronic Main Frame for Badge Readers that disrupts safe and effective operation of the Main Emergency Room and Pharmacy. Failure Modes were provided Actions and Outcome Measures to mitigate impacts to clinical and administrative operations, patient flow, emergency scenarios, and routine operations of space occupants.

Results/Discussion
100% replacements of outdated Badge Reader Main Frames, 36/36 rechargeable batteries assessed and dated for future scheduled replacements, and implementation of Standards to Guide; Engineering, Police Department, Nursing, Medical, and Pharmacy Team members approaches during Badge Reader Failure Modes. Practices are sustained during Monthly Power Transfer and generator Testing.

Problem:
Badge Reader Failures impacts normal, urgent and emergent operations and clinical processes in the Emergency Room and Pharmacy. The impact hampers movement of materials/supplies, nursing staff, Pharmacy team members, Police Department, and Medical Providers to and from Pharmacy and the Main Emergency Room.

Measurement:
A Chartered Failure Mode Effects and Analysis (FMEA) was completed in 45 days to map out processes to highlight areas of vulnerabilities to identify Failure Modes. Failure Modes were further dissected by the FMEA Team with Severity and Probability Scores to assign the Hazzard index using the Hazzard Matrix.

Analysis:
The Hazzard Analyses and Critical Control Point (HACCP) was used to analyze criticality, absence of control measures, and lack of detectability of each Failure Mode. Failure Modes were treated with three to four questions that guided FMEA team to either proceed or not with Actions and Outcome Measures.

Implementation:
FMEA Team recommended replacement of Main Frames to a much updated technologies that is equipped with Power-Battery cycle back-up, routine Monthly Generator and Power transfer Testing, design and implemented Standard Operating Procedures in maintaining and replacements of obsolete Badge Reader Main Frames and their respective re-chargeable batteries.

Speakers
Patient Safety Clinician at South Texas Veterans Health Care System
Patient Safety Clinician – South Texas Veterans Health Care System

Speaker Type: Poster Presentations On-Demand

Event Details