失效模式和效应分析模式在儿科门急诊静脉留置针风险管理中的应用  

Application of failure mode and effect analysis mode in risk management of venous indwelling needle in pediatric emergency department

作　　者：王娟[1] 闻亚军 梅云霞 周琴 

机构地区：[1]南京医科大学第一附属医院妇幼分院门急诊,210036 [2]南京医科大学第一附属医院妇幼分院护理部,210036

出　　处：《中华现代护理杂志》2012年第32期3873-3875,共3页Chinese Journal of Modern Nursing

摘　　要：目的探讨失效模式和效应分析（FMEA）模式在儿科门急诊静脉留置针中应用的效果。方法2011年1—12月将小儿门急诊输液使用留置针患者240例纳入研究。将2011年1-6月实施FMEA模式前的使用留置针的120例患儿作为对照组，将2011年7-12月应用FMEA模式后的120例患儿作为观察组，应用FMEA分析方法，对门急诊小儿静脉留置针使用过程中可能出现的失效模式、原因、结果进行查找，计算出RPN值，针对影响家庭留置的高危因素，实施相应的整改措施。比较两组静脉留置针输液患儿导管堵塞、外渗、意外拔针／脱管、穿刺点感染的RPN值和留置天数。结果实施FMEA后，观察组在意外拔管（48．00±9．13）、导管堵塞（72．00±27．96）及外渗（140．00±18．39）等安全质量方面的RPN值均较对照组[（96．00±12．47），（288．00±37．40），（168．00±31．24）]明显下降，两组比较，差异有统计学意义（t值分别为8．79，13．08，2．22；P〈0．05）。观察组的静脉留置针留置时间（2．02d）较对照组（3．95d）明显缩短，两组比较，差异有统计学意义（t=5．39，P〈0．01）。结论FMEA模式的应用有利于提升门急诊患儿静脉留置针风险管理，保障输液安全，减少并发症，延长留置时间，值得在儿科门急诊推广。] Objective To explore the application effect of Failure Mode and Effect Analysis （FMEA） Mode in venous indwelling needle in pediatric emergency department. Methods 240 cases of patients with venous indwelling needle in pediatric emergency department from January to December 2011 were enrolled in the research. 120 cases from January to June who used indwelling needle before FMEA were the control group, and 120 cases from July to December who used indwelling needle after FMEA were the observation group. FMEA was used to search the possible failure modes, causes and results, and calculate the RPN values. Reform measures were implemented according to the high risk factors of the lien family influence. Two groups＇ catheter obstruction, extravasation, accidental withdrawal/removal of needles, RPN values, and retention time were compared. Results After FMEA, the RPN values in terms of safety and quality including accidental withdrawal of needles, catheter obstruction and extravasation were Obviously lower in the observation group （48.00 ± 9.13, 72.00 ±27.96, 140.00 ± 18.39, respectively） than in the control group （96.00 ±12.47, 288. 00 ± 37.40, 168.00 ± 31.24, respectively）, and the differences were statistically significant （t = 8.79, 13.08, 2.22, respectively; P 〈 0.05 ）. Retention time in the observation group （2.02 d） was also shorter than that in the control group （3.95 d）, and the difference was statistically significant （t = 5.39, P 〈0. 01 ）. Conclusions The application of FMEA mode is conducive to improve the risk management of venous indwelling needle in pediatric emergency department, ensure the infusion safety, reduce complications and prolong retention time, thus is worth promoting in the pediatric emergency department.

关 键 词：儿科 门急诊 失效模式和效应分析模式 留置针 

分 类 号：R473.72[医药卫生—护理学]