FMEA of the risk management of non-integral-dosage drug dispensing in PIVAS 

Objective: To eliminate the risks in the prescription examination, marking, dispensing, checking, and review of non-integral-dosage drugs in PIVAS. Method A project team was assembled, and the failure mode and effect analysis management method was used to identify the risks present in the four steps of the non-integral-dosage drug dispensing process in PIVAS drug management: prescription verification, mixed allocation and verification. The degrees of severity, incidence, and detectability were scored for each step, and the risk priority number (RPN) of each step was calculated. Corresponding measures for improvement were formulated for the steps with top RPN ranking, and the changes in the RPN values before and after the implementation of the measures were compared to observe the effect of the implementation. Results A total of 31 risk factors were tabulated in the management process of non-integral-dosage drugs, with the primary risks involving the dispensing process. Corresponding measures were provided for 8 risks containing high RPN values. After three months of optimization and improvement, the RPN values and incidences of internal difference were significantly reduced, with the improvement measures exhibiting a good risk control effect. In this project, a comprehensive conversion system of partial-dose drug dispensing was established, which could be directly converted into a volume of suction fluid for dispensing personnel according to doctor orders, avoiding manual secondary calculation. Meanwhile, the project team conducted a dissolution test of 23 types of drugs with non-integral dosage drugs and found that the solvent volume of 11 types of drugs increased after dissolution. The dosage conversion of partial dosage should be calculated according to the volume of the final solution to ensure the accuracy of the dosage. Conclusions Based on failure mode and effect analysis, the risk management of non-integral-dosage drugs was carried out in PIVAS, addressing the safety risks present in the dispensing of non-integral-dosage drugs, reducing errors in the dispensing of non-integral-dosage drugs, and ensuring safe and precise medication for patients.