失效模式和效应分析在脑卒中后预防误吸中的应用

Application of failure mode and effect analysis in preventing stroke patients from aspiration

目的探讨失效模式和效应分析（FMEA）在脑卒中后预防误吸中的应用效果。方法将2011年10月至2012年4月我科收治的48例未实施FMEA管理模式的脑卒中患者设为对照组，按神经内科护理常规进行护理；将2012年5-11月收治的48例脑卒中患者设为观察组，除执行神经内科护理常规外，还运用FMEA对脑卒中后患者可能发生误吸的失效模式进行前瞻性原因和操作流程分析、评价、计算，找出导致脑卒中患者发生误吸的高危因素及高危操作步骤，制定防范的优先行动计划和改进措施。比较2组患者住院期间误吸的发生情况、失效模式6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6个高危因子的危机值均显著低于对照组；2组患者及家属对防误吸相关知识掌握程度、住院时间、满意度比较，差异均具有统计学意义。观察组在住院期间未发生误吸，对照组发生误吸3例。结论应用FMEA对脑卒中后吞咽障碍患者进行评估、分析和采取相关措施，能有效防范风险，降低误吸的发生，提高护理质量，促进患者康复。

Objective To investigate the application effect of FMEA（failure mode and effect analysis） in prevention of aspiration after stroke. Methods From October 2011 to April 2012 48 stroke patients in our department without implementation of the FMEA management mode were set as the control group. From May 2012 to November 2012, another 48 cases were set as the observation group, in addition to the routine neuro- logical nursing care, we also used FMEA to find forward-looking reason of the failure mode of aspiration and operation process analysis, evaluation, calculation and identify the risk factors of aspiration in patients with cere- bral apoplexy and high-risk operation steps, prevention priority action plan and improvement measures. The in- cidence of aspiration, RPN value of six high risk factors, and satisfaction degree and mastering degree of aspira- tion related knowledge by patients and their families were compared. Results In the observation group, the crisis values of 6 high risk factors was significantly lower than those of the control group. Significant differences existed in satisfaction degree and mastering degree of aspiration related knowledge by patients and their families as well as hospitalization time. There was no aspiration cases during hospitalization in the observation group while 3 aspiration cases in the control group. Conclusions Application of FMEA to evaluate patients with swallowing disorder after stroke, analyzing and taking relevant measures can effectively prevent risks, reduce the occurrence of aspiration, improve the quality of nursing and promote patients recovery.