应用医疗失效模式与效应分析预防压疮的实践  

Application of Healthcare Failure Mode and Effect Analysis in the prevention of pressure ulcer

作　　者：冯丹[1] 康宜琴 季丽萍[3] 

机构地区：[1]如皋市人民医院ICU,江苏省南通市226500 [2]如皋市人民医院手术室,江苏省南通市226500 [3]如皋市人民医院护理部,江苏省南通市226500

出　　处：《中国护理管理》2014年第5期531-533,共3页Chinese Nursing Management

摘　　要：目的:探讨医疗失效模式与效应分析技术(HFMEA)应用于预防压疮的实践效果。方法:选定2012年我院住院治疗患者中入院时未发生压疮、自住院起连续卧床7d以上需要他人协助翻身的成年患者7980例为研究对象,应用HFMEA技术,通过组建HFMEA项目团队,绘制压疮的发生因果关系鱼骨图,找出潜在失效模式,进行风险分析,制定改进方案,实施与监测新流程,应用PDCA循环法,定期验证改进措施是否有效,并及时修订,调整。将收集到的数据与对照组进行比较分析。结果:两组危急值的变化比较,实验组明显低于对照组;压疮发生率实验组为0.125%,对照组为0.310%(P<0.05)。结论:HFMEA技术的应用能够对于压疮发生的潜在失效模式进行根本原因分析及流程改进,减少压疮发生率,并具有较好的可行性。Objective：To explore the effects of implementing Healthcare Failure Mode and Effect Analysis （HFMEA） technology on the prevention of pressure ulcer. Method：Totally 7980 patients with intact skin when admitted to hospital in 2012, who had been bedridden for more than 7 days, were selected as experimental group. The HFMEA project team was set up. Then they analyzed the causal relationship of pressure ulcer using ifsh bone diagram, identiifed potential failure mode, formulated the improvement plan, implemented the new work process, evaluated the effects, revised and modiifed the process accordingly through PDCA cycle. All data collected was compared with the patients in controlled group, who were hospitalized in 2011. Results： The critical value in the experimental group was statistically lower than the control group. The incidence of pressure ulcer was lower than the control group （0.125%vs 0.310%, P〈0.05）. Conclusion：Application of HFMEA technology could reduce pressure ulcer rate, and had good feasibility.

关 键 词：医疗失效模式与效应分析 压疮 预防 护理安全 

分 类 号：R47[医药卫生—护理学]