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Using Healthcare Failure Mode and Effect Analysis to Reduce Intravenous Chemotherapy Errors in Chinese Hospitalized Patients

Li, Gui MD; Xu, Bo MD; He, Rui-xian MD; Zhang, Shu-xiang MD

doi: 10.1097/NCC.0000000000000348

Background: Intravenous chemotherapy administration is a high-risk process; attention must be paid to preventing errors that might occur during the administration of chemotherapy.

Objective: The aim of this study is to investigate whether the healthcare failure mode and effect analysis (HFMEA) is a valid proactive method to apply to chemotherapy administration in the Chinese oncology inpatient setting.

Methods: A multidisciplinary team created a flow diagram of the chemotherapy administration process and potential failure modes were identified and evaluated using a hazard-scoring matrix. Using a decision tree, failure mode recommendations were made. Chemotherapy error rates before and after the HFMEA were compared.

Results: A total of 5 failure modes were identified with high hazard scores, and 15 recommendations were made. After the intervention, the chemotherapy error rate decreased significantly from 2.05% to 0.17%.

Conclusions: The complexity of intravenous chemotherapy makes it vulnerable to error, and with serious consequences. Multiple errors can occur during ordering, preparing, compounding, dispensing, and administering the chemotherapy. The process of HFMEA helped reduce the chemotherapy error rate in Chinese hospitalized patients.

Implications for Practice: Clinicians in oncology can take effective measures to avoid chemotherapy errors using the HFMEA.

Author Affiliations: Department of Medical Oncology, Cancer Hospital of Chinese Academy of Medical Sciences (Mrs Li, He, and Zhang); and Nursing Department, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China (Mrs Xu).

This study was supported by the Beijing Hope Run Special Fund.

The authors have no conflicts of interest to disclose.

Correspondence: Gui Li, MD, Department of Medical Oncology, Cancer Hospital of Chinese Academy of Medical Sciences, No. 17 South Panjiayuannanli Avenue, Chaoyang District, Beijing 100021, PR China (

Accepted for publication December 3, 2015.

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