运用HFMEA工具优化腰椎术后患者肌力下降急救流程及其效果评价  

Optimization of emergency process with the HFMEA tool and effects assessment among lumbar surgery patients with muscle weakness

作　　者：杨光宇[1] 张俊娟[1] 贾曼 张海鑫 刘佳[1] 王俊杰[2] Yang Guangyu;Zhang Junjuan;Jia Man;Zhang Haixin;Liu Jia;Wang Junji(Department of Orthopedics,He'nan Provincial People's Hospital,Zhengzhou 450003,China;Department of Nursing,He'nan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院骨科,郑州450003 [2]河南省人民医院护理部,郑州450003

出　　处：《中华现代护理杂志》2019年第21期2710-2714,共5页Chinese Journal of Modern Nursing

基　　金：河南省省级医学临床重点学科建设项目(2014095).

摘　　要：目的应用医疗失效模式与效应分析(HFMEA)管理工具对腰椎术后肌力下降患者的急救流程进行优化,旨在缩短急救时间,规范医护行为,提高及时救治率.方法根据HFMEA的理论基础,对腰椎术后患者从发生肌力下降到赴手术室行血肿清除术之间的急救流程进行优化.以流程优化前2016年6月-2017年5月行腰椎手术并于术后发生肌力下降患者6例为对照组,以流程优化后2017年6月-2018年5月行腰椎手术并于术后发生肌力下降患者7例为试验组,比较两组患者从发生肌力下降到得到有效救治所用时间的变化,比较护士对腰椎患者术后肌力下降6 h内发现率,以及护士对腰椎术后肌力评估的误判率.结果实施优化流程的干预方案后,患者从术后肌力下降到得到有效救治的耗时从(23.78±1.95)h下降至(5.37±0.78)h,护士对腰椎患者术后肌力下降6 h内发现率由33.3%提升至100.0%,护士对肌力评估误判率由12.2%下降为4.6%.结论应用HFMEA管理工具可优化腰椎患者术后肌力评估管理流程,规范医护人员行为,显著缩短肌力下降急救时间,提高肌力下降6h内发现率,保证患者安全.Objective To optimize the emergency process with the healthcare failure mode and effect analysis (HFMEA) tool among lumbar surgery patients with muscle weakness so as to shorten the first-aid time, standardize doctor-nurse behavior and improve the timely cure rate. Methods The emergency process from muscle weakness to hematoma evacuation in operating room was optimized based on the HFMEA. From June 2016 to May 2017, a total of 6 lumbar surgery patients with muscle weakness were in control group before optimization. From June 2017 to May 2018, a total of 7 lumbar surgery patients with muscle weakness were in experimental group after optimization. We compared the time from muscle weakness to effective cure of patients between two groups, and the detection rate for lumbar surgery patients with muscle weakness within 6 hours by nurses as well as the misjudgment probability for muscular strength assessment after lumbar surgery by nurses. Results After implementing optimal process, the time from muscle weakness to effective cure of patients decreased from (23.78±1.95) h to (5.37±0.78) h. The detection rate for lumbar surgery patients with muscle weakness within 6 hours by nurses increased from 33.3% to 100.0%. The misjudgment probability for muscular strength assessment after lumbar surgery by nurses decreased from 12.2% to 4.6%. Conclusions The application of HFMEA tool can optimize the muscular strength assessment management process for patients after lumbar surgery, standardize doctor-nurse behavior, shorten the first-aid time of muscle weakness and improve the detection rate for muscle weakness within 6 hours so as to guarantee the safety of patients.

关 键 词：肌力 脊髓神经运动功能 腰椎手术 医疗失效模式与效应分析 护理评估 

分 类 号：R473.6[医药卫生—护理学]