医疗失效模式与效应分析对肿瘤放疗患者医院感染的预防作用  

Effect of Health Failure Mode and Effects Analysis on prevention of hospital infection of patients treated with radiation therapy

作　　者：朱伟[1] 陆美芹[1] 倪杰[1] 倪峰[1] 陈蕾[1] ZHU Wei;LU Meiqin;NI Jie;NI Feng;CHEN Lei(Department of Radiotherapy,Nantong Tumor Hospital,Nantong 226361,China)

机构地区：[1]南通市肿瘤医院放疗科,江苏南通226361

出　　处：《医药高职教育与现代护理》2019年第2期114-117,共4页Medical Higher Vocational Education and Modern Nursing

基　　金：南通市科技局指导性项目(HS149014)

摘　　要：目的探讨医疗失效模式及效应分析(health failure mode and effect analysis,HFMEA)对肿瘤放疗患者医院感染的预防作用。方法选择2014年1月至2015年12月在南通市肿瘤医院放疗科一、二、三病区住院放疗的4 217例患者,应用医疗失效模式与效应分析(HFMEA)的管理方法,即组建项目团队,根据医院肿瘤患者放疗的流程,采用头脑风暴法列出患者发生医院感染的可能原因,找出潜在失效模式,根据每一失效模式的严重程度(S)、发生的可能性(O)和不易探测度(D)3个因子计算事先风险数值(RPN),对排在前4位的失效模式制定并实施一系列干预控制措施。并选择2012年1月至2013年12月未实施HFMEA管理前的3 968例患者作为对照。比较实施HFMEA管理前后4个失效模式的RPN值、医务人员手卫生依从性和患者医院感染率。结果四个失效模式为"手卫生依从性""放疗患者自身因素""疑似医院感染病例识别""侵入性操作规范性",事先风险数值(RPN)较实施HFMEA管理前有明显下降,分别减少了85.12%、80.71%、78.13%、56.25%;实施HFMEA管理前医生、护士、放技人员手卫生依从性分别为79.8%、82.1%、73.3%,实施后依次为90.2%、92.2%、87.0%,实施前后比较差异均有统计学意义(P<0.01);实施HFMEA管理前患者医院感染率为2.07%,明显高于实施后的0.97%,差异有统计学意义(P<0.01)。结论开展医疗失效模式与效应分析在肿瘤放疗患者医院感染管理中的应用可以提高医务人员的手卫生依从性,有效降低肿瘤放疗患者的医院感染发生率。Objective The aim of this study is to explore Health Failure Mode and Effects Analysis(HFMEA)on prevention of hospital infection of patients treated with radiation therapy,which provides the reference for reducing the incidence of hospital infection.Methods Patients who were hospitalized for radiotherapy in the first,second and third wards of our hospital were enrolled.From January 2014 to December 2015,4 217 patients(project team)who were treated with HFMEA were observed.The possible causes of infection were listed by the method of brainstorming.Through the potential failure mode,to calculate the prior risk value(RPN)according to the severity(S),probability of occurrence(O)and non-detectability(D)of each failure mode was calculated.A series of intervention control measures was implemented in the first four failure modes.From January 2012 to December 2013 before the HFMEA,3 968 patients were treated as control group.The RPN values of the four failure modes before and after the implementation,the medical staff s hand hygiene compliance and the hospital infection rate were compared.Results RPN of four failure modes reduced significantly.Hand hygiene compliance,personal factor of radiation oncology patients,identification of suspected hospital infection and the normative nature of invasive operation were reduced by 85.12%,80.71%,78.13%and 56.25%,respectively.Hand hygiene compliance of doctors,nurses and radiological technicians were 79.8%、82.1%and 73.3%before intervention which reached 90.2%,92.2%and 87.0%after intervention.These were significant difference(P<0.01).The hospital infection rate of patients reduced significantly from 2.07%to 0.97%(P<0.01).Conclusions Hospital infection rate of patients treated with radiation therapy can be reduced through the application of HFMEA which improves the compliance of hand hygiene for medical staffs.

关 键 词：医疗失效模式及效应分析 肿瘤放疗患者 医院感染 控制 

分 类 号：R473.73[医药卫生—护理学]