医疗失效模式和效应分析论文：运用失效模式理论降低手术体位风险的研究.docVIP

医疗失效模式和效应分析论文：运用失效模式理论降低手术体位风险的研究 【中文摘要】本研究旨在通过对失效模式和效应分析(Failure Mode and Effects Analysis, FMEA)探讨,构建适合医疗护理风险管理的FMEA模式,并将其应用于手术体位风险管理,来检验FMEA是否适用于国内医疗护理风险管理,通过FMEA的临床应用,来降低手术体位相关损伤,提高患者的舒适度和手术医师的满意度。方法：首先通过临床调研和文献分析,确定手术室常见护理风险并确定研究主题,然后组建手术体位FMEA小组,运用头脑风暴法对每个子流程进行分析,找出失效模式、潜在原因与失效影响。根据国家患者安全中心(National Center for Patient Saftey, NCPS)的危险评估短矩阵表,确定风险高的子流程,进入FMEA进行危险序数(Risk Priofity Number, RPN)定值,对RPN分值高的失效模式,提出改善计划,并进行临床检验,评价效果。结果：运用失效模式理论分析并找出导致手术体位产生风险的主要原因：(1)手术进行中的体位管理；(2)医护人员的操作技术；(3)辅助设施及物品的准备；(4)手术环境准备；(5)患者状态评估；(6)术中转换体位应急预案.采取相应干预措施,使手术体位相关风险的RPN总值从实施前的1414分降至实施后的350分,并进行临床检验。手术体位相关损伤改进前为12例,改进后3例,统计后数据经X2检验比较差异有统计学意义；患者舒适度实施前171例患者中主诉不适20例,实施后141例患者中主诉不适4例；手术医师满意度调查,实施前171位手术医师,不满意18位,实施后141位手术医师无不满意者。两项调查统计数据后经秩和检验比较差异有统计学意义。结论：运用FMEA降低了手术体位风险,提高患者的舒适度和手术医师的满意度。FMEA虽然本身有其局限性,但对降低医疗护理风险确实是有效、可行、值得推广的。 【英文摘要】:This study aims to construct suitable mode for medical care risk management through the probe into FMEA, and apply it to surgical position risk management, to verify whether the FMEA is suitable for the medical care and risk management inland. Reduce surgical damage and improve the patients抍omfort level and the surgeons?satisfaction by means of the clinical practice of FMEA.Methods:First confirm the common weak procedures of operating nursing through clinical research and literature analysis, then build surgical position FMEA group, and use brainstorming to analyse each sub-process to find out failure modes, potential causes and impact. Confirm high-risk sub-processes according to risk assessment based on NCPS short matrix, enter into the FMEA for RPN value, propose improvement plan for high RPN score and evaluate the results by means of clinical examination.Result:Apply FMEA to risk management in operation to find out the main cause leading to position risk:(1) surgical position management, (2) technology of medical workers, (3) preparation of auxiliary facilities and materials, (4) surgical environment, preparation, (5) value of patient status, (