IDDF2024-ABS-0364 Failure mode, effects, and criticality analysis of home parenteral nutrition setup in a Saudi tertiary referral hospital

<h3>Background</h3> Home parenteral nutrition (HPN) is a life-sustaining therapy for patients with chronic intestinal failure. Ensuring the safe and efficient setup of HPN in a home environment is crucial to prevent complications and optimize patient outcomes. This study aimed to perform a comprehensive failure mode and effects analysis (FMEA) specifically tailored to the process of setting up HPN for patients transitioning from hospital care to home-based management. <h3>Methods</h3> We assembled a multidisciplinary task force team of gastroenterologists with an interest in nutrition, pharmacy, nursing, home health care, vascular access team, and quality improvement to perform an FMEA of HPN. We identified the steps involved in the HPN process, the potential failure modes, their causes and effects, and their severity, occurrence, and detectability ratings. We calculated the risk priority number (RPN) for each failure mode and proposed corrective actions to reduce the RPN. <h3>Results</h3> We identified 5 steps in the HPN process, 8 potential failure modes, and 28 causes and effects. The most common causes of failure were human error, transportation mishaps, communication breakdown, and patient non-adherence. The most severe effects of failure were anaphylaxis, infection, thrombosis, and loss of drug efficacy. The highest RPNs were associated with failure modes such as incorrect drug administration, delayed or missed infusion, adverse drug reaction, and drug contamination or degradation. We suggested several corrective actions to prevent or mitigate these failures, such as patient education, remote monitoring, standardized protocols, and quality checks. We found that HPN had lower RPNs than hospital-based infusion for some failure modes but higher RPNs for others. <h3>Conclusions</h3> Patient transition from hospital to HPN is a complex process that involves multiple steps and stakeholders. FMEA is a useful tool for identifying and prioritizing potential failures and their consequences in this process. HPN may have some advantages over hospital-based infusion in terms of convenience and cost, but it also requires careful planning, coordination, monitoring, and evaluation to ensure patient safety and quality of care.