医疗失效模式与效应分析应用于血液透析患者感染控制的效果观察  

Application effect of health-care failure mode and effect analysis in infection control among hemodialysis patients

作　　者：徐骏[1] 吉小静[1] 戴欢欢[1] 常美[1] 

机构地区：[1]江苏省苏北人民医院血液净化中心,扬州225001

出　　处：《中华现代护理杂志》2017年第2期194-197,共4页Chinese Journal of Modern Nursing

基　　金：中国医院协会医院感染预防与控制能力建设项目（20121210）

摘　　要：目的 探讨医疗失效模式与效应分析（HFMEA）在血液透析患者感染控制中的应用效果.方法 2014年10月苏北人民医院血液透析室成立HFMEA管理小组,运用HFMEA评估血液透析患者易发生感染的失效环节,分析原因,提出整改措施并实施.比较实施前（对照组）和实施后（观察组）血液透析感染事件（血管通路感染、呼吸系统感染、泌尿系统感染、其他部位感染）发生情况、失效模式RPN值及患者满意度.结果 应用HFMEA后血液透析患者感染事件发生明显减少;易造成患者感染的失效模式RPN值由1470分下降到605分,总分下降了58.8%;患者满意度由（81.31±6.74）分提高到（91.70±5.02）分,差异有统计学意义（t=23.935,P〈0.01）.结论 HFMEA的运用可以预见血液透析相关操作过程中的失效环节,并通过RPN值使潜在隐患得到量化,进而确定重点改进项目,从而有效减少患者感染事件的发生和提高患者的满意度.Objective To explore the application effect of health-care failure mode and effect analysis （HFMEA） in infection control among hemodialysis patients.Methods In October 2014,Northern Jiangsu People′s Hospital hemodialysis unit established a management group for HFMEA. We assessed the susceptible failure of hemodialysis patients and analyzed the causes to propose corrective measures. We compared the control group and the intervention group in following aspects：the occurrence of infection （vascular access infection, respiratory infection,urinary system infection and other infections）,risk priority number （RPN） of HFMEA and patient′s satisfaction.Results The incidence rate of infection in hemodialysis patients was significantly decreased after the application of HFMEA mode. RPN value of failure mode easy to cause infection dropped to 605 points′s from 1470 points,and the total scores reduced by 58.8%;the patient′s satisfaction increased from （81.31±6.74） to （91.70±5.02）（t=23.935,P〈0.05）.Conclusions By using HFMEA mode,the failure can be forecasted in hemodialysis procedure and the potential danger can be quantized through RPN. In addition, the projects that need to be focusd on can be identified. So as to effectively reduce the incidence of infection in hemodialysis patients and improve patient′s satisfaction.

关 键 词：肾透析 感染 医疗失效模式与效应分析 

分 类 号：R473.5[医药卫生—护理学]