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Application of Risk Management Methodology in Improving the Performance of Point-of-Care Testing

EL-Wakil, Sahar MD

doi: 10.1097/POC.0000000000000021
Original Articles

Risk management methodology is a specific problem-solving methodology for quality improvement projects that focus on safety or prevention.

Health care failure mode and effect analysis (HFMEA) is a systematic method of identifying and preventing process problems before they occur.

Point-of-care testing (POCT) is defined as the performance of diagnostic testing occurring at or near the site of patient. A POCT operator is responsible for all stages in the specimen workflow path.

The aim of this work was to describe the application of HFMEA and the subsequent process changes made to reducing errors at the POCT system.

A multidisciplinary team mapped out the steps involved in processing blood glucose level using a POCT glucometer. The team identified failure modes; each of these failure modes was listed with its consequence. Severity of failure and likelihood of failure as well as a risk priority number were then calculated for each failure mode.

Critical values reporting failure mode got the highest score, and it has been selected for action. Corrective actions were initiated and reviewed.

The team tracked the process overtime to check whether changes being made to the process were leading to improvement. After 3 months, there was improvement in reporting critical values by POCT operators as well as a 50% reduction of criticality for that selected failure mode.

We concluded that HFMEA can be applied to point-of-care services to identify and address possible weaknesses within the system.

From the Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Reprints: Sahar EL-Wakil, MD, Department of Clinical Pathology, Faculty of Medicine, Cairo University, Kaser Alaini St, Cairo, Egypt. E-mail:

The author declares no conflict of interest.

© 2014 by Lippincott Williams & Wilkins