失效模式和效应分析在预防骨科高危患者误吸中的应用(1)
【摘要】 目的：探讨失效模式和效应分析(FMEA)在预防骨科高危患者误吸中的应用。方法：将2014年1-12月笔者所在科室收治的25例未实施FMEA管理模式的骨科高危患者设为对照组，按骨科护理常规进行护理；将2015年1-12月收治的25例骨科高危患者设为观察组，除了骨科护理常规，骨科高危患者使用FMEA失效模式可能发生误吸的前瞻性和操作过程的分析、评价、计算，确定高危患者误吸的危险因素和高危操作步骤，制定优先行动计划和改进措施。比较两组患者住院期间误吸的发生情况、失效模式4个高风险因子的RPN值及患者与家属对防误吸相关知识掌握程度和满意度等指标。结果：观察组4个高危因子的危机值均明显低于对照组；两组患者及家属满意度、对防误吸相关知识掌握程度比较，差异均有统计学意义(P<0.05)。结论：应用FMEA对骨科高危患者进行评估、分析和采取相关措施，能降低误吸的发生，有效防范风险，提高护理质量，促进患者康复。
【关键词】 失效模式和效应分析； 骨科； 误吸
【Abstract】Objective：To investigate the application of failure mode and effect analysis(FMEA)in the prevention of high-risk orthopedic patients of aspiration.Method：From January to December 2014，25 cases of high-risk orthopedic patients in our department were treated with FMEA management mode as the control group，according to the department of orthopedics nursing routine nursing.From January 2015 to December 2015，25 cases in high-risk orthopedic patients were selected as the observation group，in addition to the conventional orthopedic nursing，but also the use of a FMEA to high-risk orthopedic patients may occur aspiration failure modes were looking reason and operation process analysis，evaluation，calculation， and found out the lead to the aspiration of the high-risk factors and high-risk operation steps in high-risk orthopedic patients，prevented the priority action planned development and improvement measures.Compared two groups of patients during hospitalization，the incidence of aspiration，failure mode of 4 high risk factors of RPN value and the patients and their families on the prevention and control of the degree and degree of knowledge and satisfaction and other indicators.Result：The 4 risk factors of the observation group were significantly lower than those of the control group.Two groups of patients and their families on the prevention and control of the degree of knowledge of the relevant knowledge，satisfaction，the difference was statistically significant(P<0.05).Conclusion：Application of FMEA in the department of orthopedics of high-risk patients to assess，analyze and take related measures，can effectively prevent the risk，reduce the incidence of aspiration，improve the quality of care，and promote the rehabilitation of patients.
【Key words】 Failure mode and effect analysis； Orthopedics； Aspiration
First-author’s address：Guangdong Province Traditional Chinese Medicine Hospital，Guangzhou 510120，China
doi：10.3969/j.issn.1674-4985.2016.32.027
誤吸是指来自胃、食道、口腔或鼻的物质从咽进入气管的过程。这些物质可以是固体，如食物或异物；也可以是液体，如血液、唾液或胃肠内容物[1]。误吸是临床患者，尤其是危重症患者常见的一种现象，其发生率为45.2%～88.9%[2]，当误吸物不能被完全有效地清除而存于肺内，可导致不同程度的肺部并发症，甚至发展为肺损伤或急性呼吸窘迫综合征，从而延长住院时间和增加死亡率[3-5]。所谓骨科误吸高危患者指的是老年髋部骨折患者，胸腰椎压缩性骨折绝对卧床期患者，骨科疾病合并脑神经疾病患者，如中风、脑外伤、帕金森综合征、重症肌无力、癫痫等。失效模式和效应分析(FMEA)是一种用来确定潜在失效模式及其原因的分析方法，强调的是提前预防，而非事后纠正，预见性地提出失效模式和改进措施，有效防范护理不良事件，对护理质量的提高有重大意义[6-8]。本科于2015年1月将FMEA管理模式应用于预防骨科高危患者误吸方面，效果良好，现报道如下。, http://www.100md.com(陈红云 李品 傅秀珍)
【关键词】 失效模式和效应分析； 骨科； 误吸
【Abstract】Objective：To investigate the application of failure mode and effect analysis(FMEA)in the prevention of high-risk orthopedic patients of aspiration.Method：From January to December 2014，25 cases of high-risk orthopedic patients in our department were treated with FMEA management mode as the control group，according to the department of orthopedics nursing routine nursing.From January 2015 to December 2015，25 cases in high-risk orthopedic patients were selected as the observation group，in addition to the conventional orthopedic nursing，but also the use of a FMEA to high-risk orthopedic patients may occur aspiration failure modes were looking reason and operation process analysis，evaluation，calculation， and found out the lead to the aspiration of the high-risk factors and high-risk operation steps in high-risk orthopedic patients，prevented the priority action planned development and improvement measures.Compared two groups of patients during hospitalization，the incidence of aspiration，failure mode of 4 high risk factors of RPN value and the patients and their families on the prevention and control of the degree and degree of knowledge and satisfaction and other indicators.Result：The 4 risk factors of the observation group were significantly lower than those of the control group.Two groups of patients and their families on the prevention and control of the degree of knowledge of the relevant knowledge，satisfaction，the difference was statistically significant(P<0.05).Conclusion：Application of FMEA in the department of orthopedics of high-risk patients to assess，analyze and take related measures，can effectively prevent the risk，reduce the incidence of aspiration，improve the quality of care，and promote the rehabilitation of patients.
【Key words】 Failure mode and effect analysis； Orthopedics； Aspiration
First-author’s address：Guangdong Province Traditional Chinese Medicine Hospital，Guangzhou 510120，China
doi：10.3969/j.issn.1674-4985.2016.32.027
誤吸是指来自胃、食道、口腔或鼻的物质从咽进入气管的过程。这些物质可以是固体，如食物或异物；也可以是液体，如血液、唾液或胃肠内容物[1]。误吸是临床患者，尤其是危重症患者常见的一种现象，其发生率为45.2%～88.9%[2]，当误吸物不能被完全有效地清除而存于肺内，可导致不同程度的肺部并发症，甚至发展为肺损伤或急性呼吸窘迫综合征，从而延长住院时间和增加死亡率[3-5]。所谓骨科误吸高危患者指的是老年髋部骨折患者，胸腰椎压缩性骨折绝对卧床期患者，骨科疾病合并脑神经疾病患者，如中风、脑外伤、帕金森综合征、重症肌无力、癫痫等。失效模式和效应分析(FMEA)是一种用来确定潜在失效模式及其原因的分析方法，强调的是提前预防，而非事后纠正，预见性地提出失效模式和改进措施，有效防范护理不良事件，对护理质量的提高有重大意义[6-8]。本科于2015年1月将FMEA管理模式应用于预防骨科高危患者误吸方面，效果良好，现报道如下。, http://www.100md.com(陈红云 李品 傅秀珍)