根本原因分析法在肿瘤患者PICC拔管中的应用  

Application of Root Cause Analysis in PICC Extubation of Tumor Patients

作　　者：龚莉燕 饶玉莲 许丽贞 钟燕慧 陈燕丽 彭丽贞 林雅军 GONG Liyan;RAO Yulian;XU Lizhen;ZHONG Yanhui;CHEN Yanli;PENG Lizhen;LIN Yajun(Tumor center,73rd Army Group Military Hospital,Xiamen 361000,China)

机构地区：[1]陆军第七十三集团军医院肿瘤中心,厦门361000

出　　处：《中国医药指南》2024年第30期86-88,共3页Guide of China Medicine

摘　　要：目的 探析根本原因分析法(RCA)在肿瘤患者经外周静脉置入中心静脉导管(PICC)拔管困难中的应用效果。方法 从我院2021年1月至2023年12月诊治的肿瘤PICC拔管困难患者中选取60例为研究对象,根据时间分组,其中2021年1月至2022年6月的30例应用RCA质量改进前,即使用常规管理,2022年7月至2023年12月的30例应用RCA质量改进后,即组建RCA管理团队,借助RCA对肿瘤患者PICC拔管困难的根本原因进行分析,并根据患者存在的危险因素制订并实施相应的干预措施。统计RCA质量改进前及改进后地拔管成功率、并发症及护理质量(医院自制的护理质量调查问卷)。结果 改进后拔管成功率高于改进前(P <0.05)。改进后并发症发生率低于改进前(P <0.05)。改进后操作技术、患者满意度、服务态度、拔管效果的评分及总分均较改进前高(P <0.05)。结论 肿瘤PICC拔管困难患者进行RCA分析根本原因并实施相应干预措施,可提高拔管成功率,降低并发症风险,改善护理质量。Objective To explore the application effect of root cause analysis(RCA) in the difficulty of extubation of central venous catheter(PICC inserted through peripheral vein in tumor patients.Methods Sixty patients with difficult PICC extubation diagnosed and treated in the hospital from January 2021 to December 2023 were selected as the investigation objects and grouped according to time.Among them,30 patients from January 2021 to June 2022 were treated with conventional management before the application of RCA quality improvement.The 30 cases from July 2022 to December 2023 were after the application of RCA quality improvement,that is,the RCA management team was set up to analyze the root cause of PICC extubation difficulties in tumor patients with the help of RCA,and the corresponding intervention measures were developed and implemented according to the risk factors existing in patients.Statistics on the success rate of extubation,complications and nursing quality before and after RCA quality improvement(hospital self-made nursing quality questionnaire).Results The success rate of extubation after improvement higher than before improvement(P<0.05).The complication rate after improvement which was lower than before improvement(P<0.05).The scores and total scores of operation technique,patient satisfaction,service attitude and extubation effect after improvement were higher than those before improvement(P<0.05).Conclusions RCA analysis of the root cause and corresponding intervention measures for patients with PICC difficulty in extubation can improve the success rate of extubation,reduce the risk of complications and improve the quality of care.

关 键 词：肿瘤 根本原因分析法 经外周静脉置入中心静脉导管 拔管困难 

分 类 号：R73[医药卫生—肿瘤] R473.73[医药卫生—临床医学]