HFMEA在预防ICU气管插管非计划性拔管中应用效果.docVIP

HFMEA在预防ICU气管插管非计划性拔管中应用效果 　　[摘要]目的 探讨应用HFMEA预防ICU气管插管非计划性拔管的应用效果。方法 选取2013年1～12月未实施HFMEA的气管插管≥24 h患者474例和2014年1～12月实施HFMEA的气管插管≥24 h患者547例，针对ICU气管插管非计划性拔管组成团队，分析操作流程并制作出流程图，进行失效模式与潜在风险原因分析，比较实施前后气管插管非计划性拔管事先风险值（RPN）和发生率。结果 实施后气管插管非计划性拔管的总RPN为2357.46分，显著低于实施前的3830.08分，差异有统计学意义（P0.05）。实施后气管插管非计划性拔管发生率为1.687%，较实施前的0.365 %有明显下降，差异有统计学意义（χ2=4.577，P0.05）。结论 应用HFMEA能有效预防气管插管非计划性拔管的发生，降低医疗风险。 　　[关键词]气管插管；非计划性拔管；重症监护室；预防 　　[中图分类号] R562.1 [文献标识码] A [文章编号] 1674-4721（2016）07（c）-0181-04 　　[Abstract]Objective To explore the practice effects of using HFMEA in prevention ICU unplanned extubation of tracheal intubation.Methods 474 patients who unimplemented HFMEA intubation and greater than 24 h from January 2013 to December and 547 patients who implemented HFMEA intubation and greater than 24 h from January 2014 to December were selected.For ICU tracheal intubation unplanned extubation composition team，the operation process was analyzed and the flow chart was made to analyze the failure mode and cause of potential risk.The RPN and incidence rate before and after ICU unplanned extubation of tracheal intubation were compared.Results After conducting， the total RPN of ICU unplanned extubation of tracheal intubation was 2357.46，obvious lower than that was 3830.08 before conducting，and the difference was statistical significance （P0.05）.After conducting， the incidence rate of ICU unplanned extubation of tracheal intubation was 1.687%，obvious devreased than that was 0.365 % before conducting，and the difference was statistical significance （χ2=4.577，P0.05）.Conclusion Using HFMEA can prevent the incidence of unplanned extubation of tracheal intubation effectively and decrease medical risk. 　　[Key words]Tracheal intubation；Unplanned extubation；ICU；Prevention 　　气管插管作为维持气道通气的重要手段广泛应用于危重症患者的治疗，而非计划性拔管是威胁患者生命的一个严重并发症[1]。医疗失效模式与影响分析（health care failure mode and effect analysis，HFMEA）为前瞻性评估系统流程的方法，通过根本原因分析及流程改进，以达到杜绝或减少缺陷发生的目的[2]。2014年1月起我院综合ICU应用HFMEA预防气管插管非计划性拔管的发生，取得良好效果，现报道如下。 　　1资料与