故障模式与影响分析在连续性肾脏替代治疗非计划性下机中的应用  

Utility of failure mode and effect analysis to improve safety in patients with continuous renal replacement therapies

作　　者：郝桂华[1] 胡敏[1] 黄洁[2] 赵丽[4] 陆伟[2] 侯黎莉 Hao Guihua;Hu Min;Huang Jie;Zhao Li;Lu Wei;Hou Lili(Nursing Department of the Ninth People＇s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院普外科重症监护病房,200011 [2]上海交通大学医学院附属第九人民医院血透室,200011 [3]上海交通大学医学院附属第九人民医院护理部,200011 [4]上海交通大学医学院附属仁济医院血透室

出　　处：《中国实用护理杂志》2018年第26期2027-2031,共5页Chinese Journal of Practical Nursing

基　　金：上海交通大学医学院护理科研项目（Jyh1710）

摘　　要：目的识别连续性肾脏替代治疗（CRRT）过程中潜在的非计划性下机风险，为科学有效的实施CRRT提供依据。方法运用故障模式与影响分析（FMEA）工具，对CRRT的实施流程进行分析，通过计算事先风险指数（RPN）值查找每个流程中潜在的高危因素，并对RPN〉125的关键环节制定并实施改进方案。结果导致CRRT非计划性下机的故障模式有28个，其中8个故障模式RPN〉125。通过制定并实施改进防范措施，RPN值均降至125以下。FMEA实施前后非计划性下机发生率由10．86％（24／221）降至5．81％（14／241），差异有统计学意义（χ2=3．896，P〈0．05）。结论运用FMEA对CRRT进行风险管理，有助于优化CRRT实施流程，提高患者的血液净化效果，降低治疗花费，有利于护理工作质量的持续改进。Objective To identify the potential risks in patients receiving continuous renal replacement therapies （CRRT）. Methods The concept of failure mode and effect analysis （FMEA） was used to analyze the management of CRRT, to find out the potential failure risks in all of the steps, risk priority numbers （RPNs） of each failure mode were calculated and countermeasures were implemented. Results Twenty-eight failure modes were analyzed, of which 8 modes RPN〉125. After improvement of the nursing process in patients with CRRT, the RPN was lowered. The incidence of unplanned end of the CRRT was decreased from 10.86% （24/221） to 5.81% （14/241）（χ2=3.896, P〈0.05）. Conclusions Application of FMEA in risk management for CRRT can help to standardize the workflow and guarantee the safety of patients during CRRT, and is beneficial to continuous improvement of nursing.

关 键 词：患者安全 故障模式与效应分析 连续性肾脏替代治疗 风险管理 

分 类 号：R473.6[医药卫生—护理学]