Applying System-Theoretic Accident Model Process view to patient safety for treatment with oral chemotherapy and anti-cancer drugs

Abstract

Although the use of anti-neoplastic chemotherapy provides benefit to patients with both malignant and non-malignant diseases, the use of these agents can be at times associated with safety concerns for both patients and the healthcare workers that administer the medication. In order to mitigate the risks or hazards that are identified there are several potential tools to consider. The tool considered for this thesis will be applying a System Theoretic Accident Model and Processes (STAMP). STAMP is used to investigate the safety of complex systems involving humans, organizations, computers, and other equipment. STAMP has the advantage of facilitating the understanding of highly complicated environments where traditional safety techniques become too costly and cumbersome and hence less efficient. "In the traditional causality models, accidents are considered to be caused by chains of failure events, each failure directly causing the next one in the chain" (Leveson, Engineering a Safer World, 2011). This view is rather different from the perspective taken by STAMP. In STAMP, accidents arise from complex processes involving, not just component failures and faults, but also system design errors, unintended component interactions, human errors, management oversight inadequacies, and more (Leveson, 2011). This thesis presents the "control structure" component of STPA as derived from inputs from healthcare workers particular to the Dana-Farber Cancer Institute. The suggested control structure will ultimately lay the groundwork for future work on a detailed Systems-Theoretic Process Analysis (STPA) and generate specific recommendations to help address the identified risks and hazards in addressing patient safety issues.