基于FMEA方法的抗菌药物治疗前病原学送检关键环节识别  

Identification of key links for etiological submission before antibiotic treatment based on FMEA

作　　者：肖佳庆[1] 任慧[2] 迟洋 张馨心[1] 付家宁 刘新研[3] XIAO Jia-qing;REN Hui;CHI Yang;ZHANG Xin-xin;FU Jia-ning;LIU Xin-yan(Heilongjiang Provincial Center for Disease Control and Prevention,Harbin,Heilongjiang 150030,China;不详)

机构地区：[1]黑龙江省疾病预防控制中心,黑龙江哈尔滨150030 [2]哈尔滨医科大学附属第一医院感染监控科,黑龙江哈尔滨150001 [3]哈尔滨医科大学卫生管理学院,黑龙江哈尔滨150086

出　　处：《中华医院感染学杂志》2024年第10期1569-1574,共6页Chinese Journal of Nosocomiology

基　　金：“感·动中国”医疗机构医院感染预防与控制科研项目(GY2023035-B)。

摘　　要：目的通过失效模式与效用分析(FMEA)方法,找出抗菌药物使用前病原学送检的关键环节,以降低不合理用药风险,提高抗菌药物治疗效果。方法通过头脑风暴与文献分析法,分析送检步骤,列出工作流程风险清单,运用风险评价,识别高风险步骤及流程,采用FMEA方法确定抗菌药物使用前病原学送检的潜在失效模式,对高风险步骤及输入流程进行风险评估,计算风险优先(RPN)值,最终找出关键环节。结果FMEA分析显示,RPN值总体排名前5的关键环节分别是信息系统提示、医生送检意识、医生对于送检指征把握、实验室开展的检测项目覆盖范围、行政管理部门及临床科室质控;此外,不同级别和不同类型的医疗机构也分别找出了对应的关键环节。结论运用FMEA方法,能够精准、科学地找出抗菌药物使用前病原学送检的关键环节,使得该工作管理有的放矢。针对关键环节,可有针对性地采取相应的改进措施并形成规范。OBJECTIVE To find out the key links for etiological submission before antimicrobial treatment by failure mode and effect analysis(FMEA)method so as to reduce the risk of unreasonable use of antibiotics and improve the effect of antimicrobial treatment.METHODS Brainstorming and literature analysis were carried out,the submission procedure was analyzed,detailed risk list of workflow was listed,high-risk procedures and flows were identified by risk evaluation,the potential failure modes of etiological submission were determined by means of FMEA,risk assessment was carried out for the high-risk procedures and import flows,the risk priority number(RPN)was calculated,and the key links were finally found out.RESULTS FMEA analysis showed that the top 5 key links ranking the RPN values were respectively as follows:information system prompts,doctors′awareness of submission,doctors′understanding of indications for submission,coverage of test items offered by clinical laboratory,quality control of administrative department and clinical department.In addition,the different grades and types of medical institutions also found out the corresponding key links.CONCLUSION The key links for the etiological submission before use of antibiotics can be precisely and scientifically found out by FMEA method,which may facilitate the targeted management.It is necessary to take targeted improvement measures for the key links and formulate the regulations.

关 键 词：失效模式与效用分析 抗菌药物 病原学送检率 风险评估 关键环节 

分 类 号：R197.323[医药卫生—卫生事业管理]