<p> FMECA Reporting of Critical Values Worksheet</p><p>Step 1: Result Available on Instrument Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Instrument down Delay in testing Tech not available to Delay in verify result. reporting result</p><p>Step 2: Tech Verifies Result Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Tech not available to Delay in verify result. reporting result.</p><p>Step 3: Tech Calls Result Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Call wrong floor Delay in reporting results Wrong result given Wrong treatment administered Wrong patient name Wrong given. patient will be treated. No answer on floor Delay in reporting results. Call not made in a Delay in timely manner reporting results Step 4: Unit Acknowledgement of Result Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Heard the wrong Wrong result result. gets communicated Two patients with Wrong patient the same name. gets treatment & right patient gets no treatment. Person answering Result never the phone is not gets related to the unit communicated Person doesn’t Don’t react to understand what the result in timely lab value means. manner. Result does not get Forget the documented. result, no follow-up Person doesn’t know No follow-up the critical result not “protocol” communicated to MD</p><p>Step 5: Result Documented and Read Back Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Wrong information Wrong written down treatment Result is not read Wrong result back. documented Result written on No follow-up temporary paper.</p><p>Step 6: Identify Responsible Clinician Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Can’t determine who Delay in to call in a timely treatment way.</p><p>Step 7: Report and Document Result to Responsible Clinician Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Wrong value is Wrong reported treatment Delay in Reporting Delay in treatment Report value on the Wrong wrong patient. patient treated Step 8: Clinician Makes Treatment Decision Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Wrong decision made Pour patient outcome Delay in making Delay in treatment decision treatment Don’t know the entire Wrong clinical story. treatment</p><p>Step 9: Clinician Gives Order Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Not given to the Delay in patients RN treatment RN does not know Cannot the entire medical give history. clinical context RN does not write Wrong down the order treatment accurately. given No read back Wrong transcript</p><p>Step 10: Action Taken on Clinical Orders Potential Failure Potential Probability Severity of Detection Criticality Rank Modes Effect(s) Effect Rating Difficult to obtain Delay in medical record writing order. Omnicell down. Delay in treatment Can’t find another Delay in RN treatment Patient’s RN does not Delay in know about the treatment clinician’s order. </p>