HFMEA在腹腔镜手术中转开放手术配合中的应用  

Application of HFMEA in Laparoscopic Conversion to Open Surgical Coordination

作　　者：吴彦 赵洁[1] 陈振毅[1] 洪素千[1] 曾丽端[1] 许惠春[1] 周珊 WU Yan;ZHAO Jie;CHEN Zhenyi;HONG Suqian;ZENG Liduan;XU Huichun;ZHOU Shan(Department of Anesthesiology and Surgery,the First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen Fujian 361000,China)

机构地区：[1]厦门大学附属第一医院麻醉手术科,福建厦门361000

出　　处：《中国卫生标准管理》2024年第12期189-194,共6页China Health Standard Management

摘　　要：目的探讨医疗失效模式与效应分析(healthfailuremode and effect analysis,HFMEA)在腹腔镜手术中转开放手术配合中的应用效果。方法选取2022年1—6月厦门大学附属第一医院收治的718例腹腔镜手术患者作为实施前;选取2022年7—12月厦门大学附属第一医院收治的662例腹腔镜手术患者作为实施后。2022年6月组建跨专业的多学科小组,梳理腹腔镜手术中转开放手术实施的关键环节,对中转开放手术实施过程中可能出现的失效模式进行严重度、发生的可能性、探测的可能性评分,根据危害评分矩阵评估风险优先指数(risk priority number,RPN),针对RPN>125分的5项失效模式进行改进。比较实施前后的RPN和应急抢救配合满意度。结果腹腔镜手术中转开放手术安全管理体系中包括手术间管理不符合要求、人员管理不符合要求、临床实施操作不规范、仪器及设备运行失效、手术护理记录不规范5个方面17个风险点;其中有8个风险点需要采取措施进行控制,实施控制措施后,8个风险点的RPN值均有下降,且均<8分。手术医护团队对于实施腹腔镜手术中转开放手术管理策略的实践均表示认可。结论基于HFMEA对腹腔镜手术中转开放手术配合应急抢救进行风险识别及评估,建立腹腔镜手术中转开放手术配合安全管理机制,可有效降低腹腔镜手术中转开放手术配合应急抢救RPN,保障腹腔镜手术中转开放手术配合顺利,保障患者安全。Objective To explore the application effect of health failure mode and effect analysis(HFMEA)in the cooperation of laparoscopic conversion open surgery.Methods A total of 718 laparoscopic surgery patients admitted to the First Affiliated Hospital of Xiamen University from January to June 2022 were selected as the pre-implementation,a total of 662 laparoscopic surgery patients admitted to the First Affiliated Hospital of Xiamen University from July to December 2022 were selected as the post-implementation.From June 2022,a multidisciplinary team will be formed to sort out the key links in the implementation of laparoscopic conversion to open surgery,score the possible failure modes in the process of conversion to open surgery for severity,possibility of occurrence and possibility of detection,and evaluate the risk priority number(RPN)according to the hazard scoring matrix.Five failure modes with RPN>125 points were improved.The satisfaction of RPN and emergency rescue cooperation before and after implementation was compared.Results The safety management system for laparoscopic conversion to open surgery included 17 risk points in 5 aspects,non compliant operating room management,non compliant personnel management,ineffective operation of instruments and equipment,non-standard operating procedures,and non-standard surgical nursing records;Among them,8 risk points required measures to be taken for control.After implementing the control measures,the RPN values of all 8 risk points decreased,and all were less than 8 points.The surgical care team recognized the practice of implementing the management strategy of laparoscopic conversion to open surgery.Conclusion Based on HFMEA,risk identification and evaluation of laparoscopic conversion to open surgery and emergency rescue cooperation can be carried out.Establishing a safety management mechanism for laparoscopic conversion to open surgery cooperation can effectively reduce the priority index of laparoscopic conversion to open surgery and RPN,ensure smooth cooperation b

关 键 词：医疗失效模式与效应分析 腹腔镜 中转开放手术 手术护理配合 患者安全 安全管理 

分 类 号：R473[医药卫生—护理学]