基于医疗失效模式与效应分析优化重型颅脑损伤患者肠内营养输注流程的研究  

Optimization of enteral nutrition infusion process for patients with severe craniocerebral injury based on Health Failure Mode and Effect Analysis

作　　者：余强[1] 刘巧梅 赵丽萍[3] 罗征[1] 徐灿[1] YU Qiang;LIU Qiaomei;ZHAO Liping;LUO Zheng;XU Can(Neurosurgery Department,The Second Xiangya Hospital of Central South University,Changsha,410011,China)

机构地区：[1]中南大学湘雅二医院神经外科,长沙市410011 [2]中南大学湘雅二医院消化内镜中心,长沙市410011 [3]中南大学湘雅二医院护理部,长沙市410011

出　　处：《中国护理管理》2021年第7期1102-1107,共6页Chinese Nursing Management

基　　金：中南大学湘雅二医院2018年护理科研立项项目(2018-YHL-20)。

摘　　要：目的:运用医疗失效模式与效应分析(Health Failure Mode and Effect Analysis,HFMEA)优化重型颅脑损伤患者肠内营养输注流程并分析其应用效果。方法:选取2016年7月至2018年1月收治的实施常规肠内营养输注流程的重型颅脑损伤患者131例作为对照组,另选取2018年2月至2019年8月收治的实施HFMEA模式优化肠内营养输注流程的重型颅脑损伤患者145例作为观察组。比较两组患者的危险值(Risk Priority Number,RPN)、喂养不耐受症状及营养指标。结果:流程优化后观察组RPN值、喂养不耐受发生率较对照组明显下降,差异具有统计学意义(P<0.05)。观察组第4天、第7天和第10天血清总蛋白、白蛋白、转铁蛋白、前白蛋白和总淋巴细胞计数均高于对照组,差异有统计学意义(P<0.05)。结论:应用HFMEA能有效筛查影响重型颅脑损伤患者肠内营养输注的失效风险,并构建针对性优化流程,联合多科室医疗资源,有效减少了患者喂养不耐受发生率,提高了肠内营养输注效果和护理质量,整体改善了患者的营养状况和临床结局。Objective:To optimize the procedure of enteral nutrition infusion for patients with severe craniocerebral injury using Health Failure Mode and Effect Analysis(HFMEA)and explore its clinical effects.Methods:A total of 131 patients with severe craniocerebral injury admitted from July 2016 to January 2018 receiving conventional enteral nutrition infusion were selected as the control group,and 145 patients with the same diseases admitted from February 2018 to August 2019 receiving HFMEA-based enteral nutrition infusion were recruited as the observation group.The risk priority number(RPN),feeding intolerance symptoms and nutritional indicators of the two groups were compared.Results:After the process optimization,the RPN value and the incidence of feeding intolerance in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Serum total protein,albumin,transferrin,prealbumin and total lymphocyte counts of the observation group were higher than those of the control group on the 4th,7th and 10th day,and the differences were statistically significant(P<0.05).Conclusion:With the help of HFMEA,nurses can effectively screen the failure risks of enteral nutrition infusion in patients with severe head injury,build a targeted optimization process and cooperate with medical staff of multiple departments to significantly reduce the incidence of feeding intolerance and optimize both enteral nutrition infusion and nursing quality to improve their nutritional status and clinical outcome as a whole.

关 键 词：医疗失效模式与效应分析 重型颅脑损伤 肠内营养 流程优化 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]