Use and effectiveness of the Failure Modes and Effects Analysis (FMEA) for identification of potential errors and failures in the process of root canal treatment

Authors

  • Mohsen Yazdanian
  • Mostafa Alam
  • Esmail Rafiee
  • Elahe Tahmasebi
  • Arash Ghaffarpasand
  • Kamyar Abbasi
  • Mohammadkarim Bahadori

DOI:

https://doi.org/10.5195/d3000.2022.238

Keywords:

Dentistry, Endodontics, Failure Modes and Effects Analysis, Risk Priority Number, Patient Safety, Human Errors

Abstract

Background and Aim: Root canal treatment (RCT) has high technical sensitivity, and many human procedural errors can compromise the success of treatment and well-being of patients. The failure modes and effects analysis (FMEA) is a risk assessment and management tool that ensures the safety of patient care by a systematic approach to failures. This study aimed to identify the potential errors and failures in the process of RCT using the FMEA.

Materials and Methods: This descriptive study evaluated the failure modes and their effects qualitatively and quantitatively using the FMEA methodology. For this purpose, a FMEA team was first established and the steps of RCT were described in a flowchart. Next, the potential errors and failures in each step were identified, and each failure mode was scored from 1 to 10, based on the severity of impact, likelihood of occurrence, and likelihood of detection. The three scores were multiplied to obtain the risk priority number (RPN). Corrective measures and preventive strategies were suggested for high-risk failure modes (RPN≥250).

Results: The FMEA identified 19 steps and 48 potential failures in the process of RCT. The maximum RPN in the process of RCT was assigned to file fracture in the root canal (RPN=324), apical extrusion of irrigating solution (RPN=320), and inappropriate or no rubber dam isolation (RPN=315).

Conclusion: The FMEA has high efficacy for detection and prioritization of improvable points in a complex dental procedure in a busy department such as the endodontics department.

References

Verklan MT, Walden M, Forest S. Core curriculum for neonatal intensive care nursing e-book: Elsevier Health Sciences; 2020.

Yamalik N, Perea Pérez B. Patient safety and dentistry: what do we need to know? Fundamentals of patient safety, the safety culture and implementation of patient safety measures in dental practice. International dental journal. 2012;62(4):189-96. PMID: 23017000.

Zanin AA, Herrera LM, Melani RF. Civil liability: characterization of the demand for lawsuits against dentists. Braz Oral Res. 2016 Aug 18;30(1). PMID: 27556556.

Thusu S, Panesar S, Bedi R. Patient safety in dentistry - state of play as revealed by a national database of errors. Br Dent J. 2012 Aug;213(3):E3. PMID: 22878337.

.5 Wetterneck TB, Skibinski KA, Roberts TL, et al. Using failure mode and effects analysis to plan implementation of smart i.v. pump technology. Am J Health Syst Pharm 2006;63(16):1528–1538. PMID: 16896081.

Bailey E, Tickle M, Campbell S. Patient safety in primary care dentistry: where are we now? British dental journal. 2014;217(7):339-44. PMID: 25303580.

Chiozza ML, Ponzetti C. FMEA: a model for reducing medical errors. Clinica chimica acta. 2009;404(1):75-8. PMID: 19298799.

de Wet C, O’Donnell C, Bowie P. Developing a preliminary ‘never event’list for general practice using consensus-building methods. Br J Gen Pract. 2014;64(620):e159-e67. PMID: 24567655.

van Galen LS, Struik PW, Driesen BE, Merten H, Ludikhuize J, van der Spoel JI, et al. Delayed recognition of deterioration of patients in general wards is mostly caused by human related monitoring failures: a root cause analysis of unplanned ICU admissions. PloS one. 2016;11(8).. PMID: 27537689.

Mikulak RJ, McDermott R, Beauregard M. The basics of FMEA: CRC Press; 2017.

Ramoni RB, Walji MF, White J, Stewart D, Vaderhobli R, Simmons D, et al. From good to better: toward a patient safety initiative in dentistry. The Journal of the American Dental Association. 2012;143(9):956-60. PMID: 22942131.

Pemberton M. Developing patient safety in dentistry. British dental journal. 2014;217(7):335-7. PMID: 25303579.

Black I, Bowie P. Patient safety in dentistry: development of a candidate'never event'list for primary care. British Dental Journal. 2017;222(10):782-8. PMID: 28546608.

Brunton P. Summary of: Patient safety in dentistry–state of play as revealed by a national database of errors. British dental journal. 2012;213(3):126-7. PMID: 22878313.

Renton T, Sabbah W. Review of never and serious events related to dentistry 2005–2014. British dental journal. 2016;221(2):71-9. PMID: 27444598.

Kalenderian E, Walji MF, Tavares A, Ramoni RB. An adverse event trigger tool in dentistry: a new methodology for measuring harm in the dental office. The Journal of the American Dental Association. 2013;144(7):808-14. PMID: 23813262.

Walji MF, Yansane A, Hebballi NB, Ibarra-Noriega AM, Kookal KK, Tungare S, Kent K, McPharlin R, Delattre V, Obadan-Udoh E, Tokede O, White J, Kalenderian E. Finding Dental Harm to Patients through Electronic Health Record-Based Triggers. JDR Clin Trans Res. 2020 Jul;5(3):271-277. PMID: 31821766.

Madarati AA. Why dentists don’t use rubber dam during endodontics and how to promote its usage? BMC oral health. 2016;16(1):24. PMID: 26916426.

Parashos P, Messer HH. Rotary NiTi instrument fracture and its consequences. J Endod. 2006 Nov;32(11):1031-43. PMID: 17055902.

Kalenderian E, Obadan-Udoh E, Yansane A, Kent K, Hebballi NB, Delattre V, et al. Feasibility of electronic health record–based triggers in detecting dental adverse events. Applied clinical informatics. 2018;9(3):646. PMID: 30134473.

Tanalp J, Güngör T. Apical extrusion of debris: a literature review of an inherent occurrence during root canal treatment. Int Endod J. 2014 Mar;47(3):211-21. PMID: 23711187.

Nahmias Y, Serota KS, Watson Jr W. Predictable Endodontic Success: Part II-Microstructural Replication. Oral Health. 2003;93(12):36-41. PMID: 12442825.

Tzanetakis GN, Kontakiotis EG, Maurikou DV, Marzelou MP. Prevalence and management of instrument fracture in the postgraduate endodontic program at the Dental School of Athens: a five-year retrospective clinical study. Journal of Endodontics. 2008;34(6):675-8. PMID: 18498887.

Friedman S. Expected outcomes in the prevention and treatment of apical periodontitis. Essential endodontology: prevention and treatment of apical periodontitis. 2008:408-69. PMID: 21689541

Spili P, Parashos P, Messer HH. The impact of instrument fracture on outcome of endodontic treatment. J Endod. 2005;31(12):845-50. PMID: 16306815.

Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod. 1979 Mar;5(3):83-90. PMID: 296248.

Strindberg LZ. The dependence of the results of pulp therapy on certain factors-an analytical study based on radiographic and clinical follow-up examination. Acta Odontol Scand. 1956;14:1-175. PMID: 2084204.

McGuigan M, Louca C, Duncan H. The impact of fractured endodontic instruments on treatment outcome. British dental journal. 2013;214(6):285-9. PMID: 23518972.

Guivarc'h M, Ordioni U, Ahmed HM, Cohen S, Catherine JH, Bukiet F. Sodium Hypochlorite Accident: A Systematic Review. J Endod. 2017 Jan;43(1):16-24. PMID: 27986099.

Hatton J, Walsh S, Wilson A. Management of the sodium hypochlorite accident: a rare but significant complication of root canal treatment. BMJ Case Rep. 2015 Mar 25;2015:bcr2014207480. PMID: 25809429.

Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M. Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. Int Endod J. 2004 Apr;37(4):272-80. PMID: 15056354.

de Sermeño RF, da Silva LA, Herrera H, Herrera H, Silva RA, Leonardo MR. Tissue damage after sodium hypochlorite extrusion during root canal treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jul;108(1):e46-9. PMID: 19442541.

Markose G, Cotter CJ, Hislop WS. Facial atrophy following accidental subcutaneous extrusion of sodium hypochlorite. British Dental Journal. 2009;206(5):263-4. PMID: 19287421.

Pelka M, Petschelt A. Permanent mimic musculature and nerve damage caused by sodium hypochlorite: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2008;106(3):e80-e3. PMID: 18602848.

Mehra P, Clancy C, Wu J. Formation of a facial hematoma during endodontic therapy. J Am Dent Assoc. 2000 Jan;131(1):67-71. PMID: 10649874.

Chaudhry H, Wildan TM, Popat S, Anand R, Dhariwal D. Before you reach for the bleach. British Dental Journal. 2011;210(4):157-60. PMID: 21350524.

Al-Sebaei MO, Halabi OA, El-Hakim IE. Sodium hypochlorite accident resulting in life-threatening airway obstruction during root canal treatment: a case report. Clin Cosmet Investig Dent. 2015 Mar 4;7:41-4. PMID: 25767406.

Elderton R. A modern approach to the use of rubber dam--1. The Dental practitioner and dental record. 1971;21(6):187. PMID: 5278933.

Palmer NO, Ahmed M, Grieveson B. An investigation of current endodontic practice and training needs in primary care in the north west of England. Br Dent J. 2009 Jun 13;206(11):E22; discussion 584-5. PMID: 19478812.

Hill EE, Rubel BS. Do dental educators need to improve their approach to teaching rubber dam use? J Dent Educ. 2008 Oct;72(10):1177-81. PMID: 18923098.

Ahmad I. Rubber dam usage for endodontic treatment: a review. International endodontic journal. 2009;42(11):963-72. PMID: 19825034.

Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018 Dec;51(12):1367-1388. PMID: 29777616.

European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006 Dec;39(12):921-30. PMID: 17180780.

Gilbert GH, Litaker MS, Pihlstrom DJ, Amundson CW, Gordan VV; DPBRN Collaborative Group. Rubber dam use during routine operative dentistry procedures: findings from the Dental PBRN. Oper Dent. 2010 Sep-Oct;35(5):491-9. PMID: 20945739.

American Academy on Pediatric Dentistry Clinical Affairs Committee-Pulp Therapy subcommittee; American Academy on Pediatric Dentistry Council on Clinical Affairs. Guideline on pulp therapy for primary and young permanent teeth. Pediatr Dent. 2008-2009;30(7 Suppl):170-4. PMID: 19216417.

Ghasemi M, Khoshakhlagh AH, Mahmudi S, Fesharaki MG. Identification and assessment of medical errors in the triage area of an educational hospital using the SHERPA technique in Iran. Int J Occup Saf Ergon. 2015;21(3):382-90. PMID: 26327157.

.47 Jäggi M, Magni E, Eggmann F, ElAyouti A, Connert T, Weiger R. Apical Pressure Generated Using Conventional Syringe Irrigation in Immature Teeth—An In Vitro Study. Materials. 2021; 14(10):2580. PMID: 34063549

.48 Silva WO, Vianna Silva Macedo RP, Nevares G, Val Rodrigues RC, Grossi Heleno JF, Braga Pintor AV, Almeida BM. Recommendations for Managing Endodontic Emergencies during Coronavirus Disease 2019 Outbreak. J Endod. 2021 Jan;47(1):3-10. PMID: 33045270.

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Published

2022-08-12

Issue

Section

Development of Craniofacial Structures