47: Using Healthcare Failure Modes and Effects Analysis and in-situ simulation to identify latent safety threats in a new pediatric ECMO program

Introduction: Cannulation for veno-venous or veno-arterial extracorporeal membrane oxygenation (ECMO) in the pediatric intensive care unit (PICU) is a high acuity, low-frequency event which generates significant risk for the patient and considerable anxiety for interprofessional (IP) teams. Timely and successful ECMO cannulation requires complex care team coordination in order to minimize risk to the patient. In order to identify and minimize latent safety threats (LSTs), our team performed serial simulations using the Healthcare Failure Mode Effects Analysis (HFMEA) for evaluation. Methods: The IP team conducted a high fidelity in-situ simulation of ECMO cannulation within the PICU. Using HFMEA, IP stakeholders quantitatively scored LSTs that transpired on a 1-4 scale based on probability of occurrence and severity of impact, which generated a total Hazard Score (HS) with all HS >8 deemed major threats. Stakeholders determined remediation methods for LSTs identified, which were then retested via repeat simulation with consequent HFMEA evaluation. Results: A total of 25 LSTs were identified during the initial simulation, with the majority (88%) of LSTs scoring as minor threats (HS<9). The highest LSTs were related to personnel placement throughout the room or inadequate staffing, resulting in contamination of the sterile field or inability to perform successful ECMO cannulation. The second simulation demonstrated improvement with resolution of all previously identified LSTs and zero new LSTs with HS>8. Conclusion: In utilizing HFMEA to evaluate the success of ECMO simulations in the PICU, LSTs were proactively identified resulting in system-based changes to minimize risk to future patients.