失效模式和效果分析在降低ICU患者气管插管非计划性拔管中的应用

目的应用失效模式和效果分析（failure mode and effect analysis，FMEA）进行ICU患者气管插管非计划性拔管的风险防范管理．以降低气管插管患者的非计划性拔管率。方法应用失效模式与效果分析对气管插管患者非计划性拔管主要原因进行分析，选择其中失效模式的优先风险数值（risk priority number，RPN）最高的10个失效模式，并对其影响因素进行分析，同时制订改善措施并实施。比较实施FMEA前后RPN值和患者非计划拔管率的差别。结果实施FMEA后10个失效模式的RPN值均较前明显降低。气管插管患者的非计划性拔管发生率由实施FMEA管理前的3．69％下降到1.44％，两组比较，X^2=4．83，P〈0．05，差异具有统计学意义。结论充分应用FMEA找到气管插管患者非计划性拔管的原因，制订改进措施，规范护理操作程序、严密监护和适时拔管撤机对于降低气管插管非计划性拔管率有特可行的．

Objective To reduce the unplanned extubation rates of endotracheal intubation. Methods Failure mode and effect analysis （FMEA） model was used to analyze the main reasons of unplanned extubation in patients with tracheal intubation. The nursing intervention for the fixation of the endotracheal tube were improved. Results After improvement of methods for fixing the endotracheal tube, the risk priority number in the failure mode was lowered. The rate of unplanned extubation decreased from 3.69% before FMEA performance to 1.44% after that （X^2 = 4.83, P 〈 0.05）. Conclusions The FMEA model can be used to screen the key factors of unplanned extubation in patients with tracheal intubation. The standardized care procedures, close monitoring and timely extubation are effective in reducing the rate of unplanned extubation.