Use of failure mode and effect analysis (FMEA) to improve active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) at a university-affiliated medical center

Abstract

BACKGROUND: Failure mode effects analysis (FMEA) is a procedure that helps to identify each vulnerable step of a process to determine how these vulnerabilities affect the desired outcome. An FMEA ranks and prioritizes the possible causes of failures and facilitates the development of prevention strategies. As a result of a root cause analysis, our hospital's patient safety committee selected “Early Identification and Timely Isolation of Patients with MRSA” for FMEA. OBJECTIVES: To use FMEA to identify potential failures in the process of admission screening of high-risk patients thus delaying early identification and timely isolation of patients colonized or infected with MRSA. METHODS: Using the hospital's MRSA policy, a multidisciplinary team met to review the admission screening process of patients through all hospital admission sites: pre-admission testing (PAT) for same-day surgical patients, emergency department (ED), and admitting department. High-risk patients, as determined by a positive response to a screening questionnaire, have an automatic “screening alert” message printed on the nursing station printer of the receiving unit. The screening alert results in the entry of an order for a nares culture to rule out MRSA. Upon receiving a positive screening culture result, the patient is placed on contact precautions. RESULTS: The three highest-scoring potential failure modes identified were 1) staff compliance with standard precautions pending positive culture results; 2) delay in screening of patients admitted via the ED; and 3) no reliable process for communication of high-risk or positive MRSA history status by PAT staff to a surgeon, operating room, or infection control (IC) department. Additional potential failure modes included: ED physician-dependent orders for private rooms for isolation patients; delays in obtaining screening cultures for ED holding unit patients; unreliable and inconsistent communication between AD, nursing staff of admitting units, and IC staff; and a 2- to 3-day lag time from culture collection to results availability. CONCLUSIONS: The FMEA process was extremely useful for understanding and analyzing the complex process of screening high-risk admissions for multidrug-resistant pathogens. The process facilitated communication among the various departments that resulted in the identification of creative and sustainable solutions.