医疗失效模式与效应分析在神经外科术中获得性压力性损伤风险管理中的应用  

Healthcare failure mode and effect analysis in risk management of intraoperative acquired pressure injury in neurosurgery

作　　者：贾瑶 李思彤 李杨 张苗 姜雪 JIA Yao;LI Sitong;LI Yang;ZHANG Miao;JIANG Xue(The Air Force Medical University,Xi'an,Shaanxi 710032,China)

机构地区：[1]空军军医大学,陕西西安710032 [2]空军军医大学第二附属医院神经外科,陕西西安710038

出　　处：《中国临床研究》2023年第10期1589-1593,共5页Chinese Journal of Clinical Research

基　　金：空军军医大学第二附属医院护理科研基金项目(2021SHRC064)。

摘　　要：目的探讨医疗失效模式与效应分析(HFMEA)在神经外科患者术中获得性压力性损伤(IAPI)风险管理中的应用效果。方法采用便利抽样法选取2022年3月至8月在空军军医大学第二附属医院住院的160例手术患者作为研究对象,将3月至5月的手术患者设为对照组,6月至8月的手术患者设为试验组。同时纳入32名手术室护士。对照组采用传统流程预防术中IAPI,试验组在对照组的基础上成立压力性损伤多学科管理小组,应用HFMEA对流程步骤进行失效原因分析,制定并落实干预方案。比较实施前后高危失效环节的发生率、IAPI的发生率以及手术室护士预防IAPI的专业能力。结果实施HFMEA后高危失效环节发生率由16.92%降至2.55%,IAPI发生率由7.9%降至0,护士理论考核成绩从(84.09±3.48)分提升至(92.97±3.32)分、操作考核成绩从(85.06±2.90)分提升至(92.28±3.08)分,差异均有统计学意义(P<0.05)。结论应用HFMEA可优化神经外科患者IAPI管理流程,规范护理人员行为,从而提升护理质量。Objective To explore the application effect of healthcare failure mode and effect analysis(HFMEA)in the risk management of intraoperative acquired pressure injury(IAPI)in neurosurgery patients.Methods A total of 160 surgical patients admitted to the Second Affiliated Hospital of Air Force Medical University from March to August 2022 were selected by convenience sampling method as the research subjects.Patients from March to May were set as control group,and those from June to August were set as experimental group.Thirty-two operating room nurses were also included.The traditional process was used to prevent IAPI during operation in control group,and a multidisciplinary management team for stress injury was established on the basis of the control group in experimental group.The HFMEA mode were used to analyze the failure reasons of the process steps,and to formulate and implement the intervention plan.The incidence of high-risk failure link and IAPI,and the professional ability of operating room nurses in preventing IAPI were compared before and after implementation.Results After the implementation of HFMEA,the incidence of high-risk failure mode decreased from 16.92%to 2.55%,and the incidence of IAPI decreased from 7.9%to 0,while the scores of nurses theoretical examination increased from(84.09±3.48)to(92.97±3.32)and operation examination increased from(85.06±2.90)to(92.28±3.08),yielding statistically significant differences(P<0.05).Conclusion The application of HFMEA can optimize the IAPI management process of neurosurgical patients,standardize the behavior of nursing staff,and thus improve the quality of nursing.

关 键 词：神经外科 医疗失效模式与效应分析 术中获得性压力性损伤 护理质量 

分 类 号：R473.6[医药卫生—护理学]