Mistake proofing laboratory monitoring for alemtuzumab treated patients with multiple sclerosis Barclay, Krista Marie
Background: The outpatient laboratory monitoring process involves the coordination of multiple systems in healthcare and this complexity makes it prone to failures. As laboratory monitoring becomes a part of the standard of care for certain conditions such as Multiple Sclerosis, healthcare providers rely on these systems to prevent delays in identification, diagnosis and treatment of serious adverse events. Purpose: Using mistake-proofing methodology, this project was designed to identify, prioritize and generate solutions to the risks of laboratory monitoring with alemtuzumab; Alemtuzumab is an immune modulating agent used in multiple sclerosis, which has a demanding monitoring schedule and the potential for life threatening secondary conditions in the four years after treatment. Methods: The tools used for this analysis were process mapping, failure modes and effects analysis (FMEA), risk prioritization, targeted questioning and solution prioritization. Results: Adapting tools from other risk-prone systems may provide a framework for conceptualizing risk, but these tools need to be adapted to reflect the principles, outcomes and values of healthcare. These tools, however, can support the development of recommendations in the use of the mistake proofing method and health care initiatives to address the risks in laboratory monitoring for patients with multiple sclerosis, treated with alemtuzumab. Conclusions: Patient engagement, clinic flexibility in supporting patients and involvement of registered nurses are important to decreasing risks in laboratory monitoring of those treated with alemtuzumab.
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