基于失效模式与效应分析法在腹膜透析相关感染风险管理中的应用研究  

Application of failure mode and effects analysis in risk management of peritoneal dialysis-related infections

作　　者：凌佩瑶[1] 高桂英[1] 邹芸[1] 徐圆圆 朱丽丽 江淑芳[2] 张丽伟[2] 狄佳[2] LING Peiyao;GAO Guiying;ZOU Yun;XU Yuanyuan;ZHU Lili;JIANG Shufang;ZHANG Liwei;DI Jia(Department of Nephrology,the First People's Hospital of Changzhou,Changzhou Jiangsu,213003)

机构地区：[1]常州市第一人民医院肾内科,江苏常州213003 [2]常州市第一人民医院感染管理办公室,江苏常州213003

出　　处：《中国感染与化疗杂志》2022年第4期402-407,共6页Chinese Journal of Infection and Chemotherapy

基　　金：江苏省现代医院管理研究中心基金资助项目(JSY-3-2019-098);常州市卫健委青年人才科技基金资助项目(QN202019)。

摘　　要：目的探讨失效模式与效应分析(failure mode and effect analysis,FMEA)在终末期肾脏病患者腹膜透析相关感染防控风险管理中的应用,为临床防控腹膜透析相关感染提供依据。方法应用FMEA风险管理工具,对终末期肾脏病患者腹膜透析相关感染进行风险评估,借助根本原因分析(root cause analysis,RCA)查找失效模式的具体原因,优先对高风险项目进行整改,比较风险管理前后的效果。结果根据计算风险优先系数(risk priority number,RPN)值对前五项高风险失效模式进行RCA并实施针对性干预措施,实施FMEA模式后各项失效模式的RPN值明显下降;腹膜透析相关感染率由1.92%降低为1.30%,随访依从性由75.24%提高至89.77%,操作规范性由82.94%提高至93.33%,差异有统计学意义(P<0.01);培训参与率由77.50%提高至88.10%,差异无统计学意义(P>0.05)。结论应用FMEA模式评估腹膜透析相关感染风险因素并实施改进方案,能有效降低腹膜透析相关感染的发生,有助于改善腹膜透析患者的预后。Objective To explore the application of Failure Mode and Effects Analysis(FMEA)in the risk management of peritoneal dialysis-related infections in patients with end-stage renal disease.Methods FMEA combined with Root Cause Analysis(RCA)were used to identify the specific causes of peritoneal dialysis-related infections in patients with end-stage renal disease.The high-risk factors were intervened and rectified firstly and the effects of risk management were evaluated.Results RCA was performed for the first five high-risk failure modes according to risk priority number(RPN)score and targeted intervention measures were implemented.The RPN score of each failure mode decreased significantly after the interventions were implemented.The incidence of peritoneal dialysis-related infections decreased from 1.92%to 1.30%.The follow-up compliance increased from 75.24%to 89.77%.The standard operation increased from 82.94%to 93.33%(P<0.01).The training participation rate increased from 77.50%to 88.10%(P>0.05).Conclusions FMEA model is useful for evaluating and rectifying the risk factors of peritoneal dialysis-related infections,which can effectively reduce the incidence and improve the outcome of peritoneal dialysis-related infections.

关 键 词：失效模式与效应分析 根本原因分析 腹膜透析 感染 风险管理 

分 类 号：R692.5[医药卫生—泌尿科学]