失效模式与效应分析法在神经外科手术压疮预防中的应用  

Application of FMEA in Prevention of Pressure Ulcer in Neurosurgery

作　　者：周萍[1] 何巧芳[1] 张益辉[1] 王海琴[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,广东广州510280

出　　处：《护理学报》2012年第8期43-46,共4页Journal of Nursing（China）

基　　金：广东省医学科研基金(A2011383)

摘　　要：目的应用失效模式与效应分析(failure mode and effects analysis,FMEA)法预防神经外科手术患者压疮,以降低压疮发生的风险。方法成立预防神经外科手术患者压疮FMEA小组,进行失效模式与风险原因分析,其失效模式有术前访视时评估不足,入手术室前、术前、术中无压疮预防性措施,术后对受压皮肤护理不当,提出相应的改善措施:从患者术前访视及最初进入手术室开始就将其术前诊断、拟行手术及手术部位等常规项目查对与导致压疮的危险因素查对交接相结合;要求手术医生与巡回护士一起根据手术需要并结合患者个体情况妥善摆放体位,科学地安放头架、体位垫,在体表骨性突出的重点部位合理放置防压疮垫;手术过程中巡回护士随时观察患者体位有无移动,定时对登记记录的重点部位进行查看和记录,手术结束时仔细检查患者全身皮肤和软组织情况,体位恢复和过床后请手术室专科护理组长和神经外科手术医生协同查对并签字确认。结果经过1年的工作实践,各项失效模式的风险指数评分均降到了100分以下。结论应用FMEA法查找神经外科手术患者压疮预防的潜在失效原因,能使可能影响手术压疮的风险因素得到分级、量化,使制定的改进措施更加有针对性,从而降低压疮发生的风险。Objective To explore the effect of failure mode and effects analysis（FMEA） on the prevention of pressure ulcer in neurosurgery.Methods A panel was established with FMEA for lowering the risk of pressure ulcer in neurosurgery.Failure mode involved insufficient evaluation for preoperative visit,no prevention measures before entering into the operation room,before and during the operation,inappropriate nursing of pressure skin after the operation.Corresponding measures were provided after the analysis as followed.Conventional examination items were combining with risk factors of pressure ulcer before the operation while during the preparation of operation,measures such as preventive cushion,appropriate body position were taken.During the preparation,circuit nurses monitored and recorded the body position regularly and after the operation,patients＇ whole skin and soft tissue were examined carefully.Results Scores of all risk indexes of failure mode were lower than 100 after one year＇s practice.Conclusion The application of FMEA in finding out potential failure reasons for pressure ulcer in neurosurgery is beneficial to the scaling and quantification of risk factors of pressure ulcer and eventually lowering the risk of pressure ulcer.

关 键 词：失效模式与效应分析 神经外科 手术体位 压疮 

分 类 号：C931.3[经济管理—管理学] R473.6[医药卫生—护理学]