医疗失效模式及效应分析在腹部引流管管周潮湿相关性皮肤损伤管理中的应用  

Application of health care failure mode and effect analysis in the management of moisture associated skin damage around abdominal drainage tubes

作　　者：钱彩华[1] 仲艳[2] 陆关珍[3] QIAN Caihua;ZHONG Yan;LU Guanzhen(Department of Nursing,Huzhou Central Hospital&Huzhou Normal University Affiliated Central Hospital,Huzhou 313000,Zhejiang,China;Department of General Surgery,Huzhou Central Hospital&Huzhou Normal University Affiliated Central Hospital,Huzhou 313000,Zhejiang,China;Department of Research,Huzhou Central Hospital&Huzhou Normal University Affiliated Central Hospital,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市中心医院,湖州师范学院附属中心医院护理部,浙江湖州313000 [2]湖州市中心医院,湖州师范学院附属中心医院普外科,浙江湖州313000 [3]湖州市中心医院,湖州师范学院附属中心医院科研部,浙江湖州313000

出　　处：《护士进修杂志》2024年第17期1863-1868,共6页Journal of Nurses Training

基　　金：浙江省医药卫生科技项目(编号:2023KY1176)。

摘　　要：目的探讨医疗失效模式与效应分析(health care failure mode and effect analysis,HFMEA)在腹部引流管管周潮湿相关性皮肤损伤(moisture associated skin damage,MASD)中的应用效果。方法采用方便抽样法,选取我院2023年1-7月外科病房术后放置腹部引流管的患者360例。其中1-3月应用前的180例患者为对照组,4-7月应用后的180例患者为观察组。根据HFMEA质量改进方法,成立外科腹部引流管管周潮湿相关性皮肤损伤管理流程改进小组,并对其流程进行失效模式及潜在的原因分析,比较改进前后引流管管周MASD的发生率,引流管管周MASDⅢ+Ⅳ度的发生占比以及主要失效模式风险指数(risk priority number,RPN)值。结果实施医疗失效模式与效应分析管理后,引流管管周MASD的发生率下降(P<0.05),Ⅲ-Ⅳ度引流管管周MASD的发生减少(P<0.05),14项RPN比较差异均有统计学意义(P<0.05)。结论HFMEA管理模式有利于规范引流管管周MADS管理流程,规避护理风险。Objective To explore the application effect of health care failure mode and effect analysis(HFMEA)in moisture associated skin damage(MASD)around abdominal drainage tube.Methods A total of 360 patients with abdominal drainage tube placed after surgery in the surgical ward of our hospital from January to July 2023 was selected by convenient sampling method.Among them,180 patients before application from January to March were in the control group,and 180 patients after application from April to July were in the observation group.According to the HFMEA quality improvement method,an improvement team for the management process of MASD around the surgical abdominal drainage tube was established,and the failure modes and potential causes of the process were analyzed.The incidence of MASD around the drainage tube before and after the improvement,the proportion of MASDⅢ-Ⅳaround around the drainage tube,and the risk index(RPN)value of the main failure modes were compared.Result After the implementation of HFMEA management,the incidence of MASD around the drainage tube decreased significantly(P<0.05),and the incidence of MASD around theⅢ+Ⅳdegree drainage tube decreased(P<0.05),and the differences of 14 RPN values were statistically significance(P<0.05).Conclusion HFMEA management model is conducive to standardizing the management process of MADS around the drainage tube and avoiding nursing risks.

关 键 词：引流管 医疗失效模式与效应分析 潮湿相关性皮肤损伤 护理管理 

分 类 号：R472[医药卫生—护理学]