医疗失效模式与效应分析在预防手术室消极型结局护理中断事件中的应用  

Application of healthcare failure mode and effect analysis in preventing nursing interruption with negative outcome in operating room

作　　者：邹振亚 周晓阳 段红香 钱成成 郭存宝 茅金宝 Zou Zhenya;Zhou Xiaoyang;Duan Hongxiang;Qian Chengcheng;Guo Cunbao;Mao Jinbao(Department of Anesthesiology and Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院麻醉手术科一部,济南250021

出　　处：《中国实用护理杂志》2023年第14期1041-1047,共7页Chinese Journal of Practical Nursing

基　　金：山东省医药卫生科技发展计划项目(2019WS471)

摘　　要：目的探究医疗失效模式与效应分析(HFMEA)在降低手术室消极型结局护理中断事件发生率中的应用效果,以最大程度确保手术过程顺利进行。方法本研究为类实验研究。选取山东第一医科大学附属省立医院胃肠外科手术间为研究地点。依据手术顺序将2021年8月15—30日在胃肠外科手术间进行的38台手术设为对照组,实施常规医护合作模式流程;将2021年9月15—30日进行的42台手术设为干预组,实施HFMEA模式下手术室消极型结局护理中断事件管理流程。运用视频追踪法结合手术护理中断事件登记表对手术室消极型结局护理中断事件发生情况进行调研,比较2组手术室消极型护理中断事件发生的次数、持续时间、中断事件来源、险失事件发生率情况。结果对照组观察手术38台,消极型结局护理中断事件190次,未发生险失事件;干预组观察手术42台,消极型结局护理中断事件84次,未发生险失事件,2组比较差异有统计学意义(χ^(2)=-18.71,P<0.01)。对照组消极型结局中断事件持续时间为(5.26±1.02)min,与干预组的(2.06±0.08)min相比差异有统计学意义(t=-20.28,P<0.01)。干预组手术室消极型结局护理中断事件来源情况与对照组相比差异有统计学意义(χ^(2)=-12.71,P<0.01)。结论HFMEA模式可有效减少手术室消极型护理中断事件的发生次数,缩短中断事件的持续时间,最大程度地避免因护理中断事件造成的安全隐患,有利于保障患者生命安全。Objective To explore the effect of healthcare failure mode and effect analysis(HFMEA)in reducing the incidence of nursing interruption with negative outcome in operating room,so as to maximize the smooth progress of the surgical process.Methods This was a quasi experimental study.The gastrointestinal surgery room of Shandong Provincial Hospital Affiliated to Shandong First Medical University was selected for the study.According to the surgical sequence,38 surgeries performed in the gastrointestinal surgery suite from August 15-30,2021 were set as the control group,and the conventional healthcare cooperation model process was implemented;42 surgeries performed from September 15-30,2021 were set as the intervention group,and the operating room under the HFMEA model was implemented negative outcome care disruption event management process.A video tracking method combined with a surgical care disruption event register was used to investigate the occurrence of negative outcome care disruption events in the operating room,comparing the number,duration,source of disruption events and the incidence of near miss events in the operating room between the control group and the intervention group.Results In the control group,there were 38 observed surgeries,190 negative outcome care interruptions,negative outcome interruptions of(5.26±1.02)min duration,and no near misses;in the intervention group,there were 42 observed surgeries,84 negative outcome care interruptions,negative outcome interruptions of(2.06±0.08)min duration,and no near misses.There were statistically significant differences in the number,duration of negative outcome care interruptions between the intervention group and the control group(χ^(2)=-18.71,t=-20.28;all P<0.01).There was statistically significant difference in the source of negative outcome care interruptions between the intervention group and the control group(χ^(2)=-12.71,P<0.01).Conclusions HFMEA model can effectively reduce the number of negative nursing interruptions in the operating room,sho

关 键 词：手术室 医疗失效模式与效应分析 消极型结局 护理中断事件 

分 类 号：R473.6[医药卫生—护理学]