应用FMEA模式降低静脉留置针堵管风险的临床研究

Clinical study on reducing the risk of indwelling catheter by using FMEA model

目的探讨失效模式与效应分析(FMEA)在降低留置针堵管风险中的应用效果。方法选取2015年1月—2016年1月行留置针置管患者320例,按随机数字表法分为对照组与观察组各160例。对照组给予常规护理及风险管理,观察组根据失效模式与效应分析工作流程,确定主题,组建团队,绘制流程图,进行潜在失效模式、失效原因及失效结果分析,计算优先风险指数(RPN),找出失效模式与相关原因,进行流程管理。结果观察组患者冲管无效、封管无效、夹管不当、健康教育不到位4个失效模式的RPN值均低于对照组,差异有统计学意义(P<0.01)。留置针堵管率为1.88%,低于对照组的9.38%,差异有统计学意义(P<0.05)。结论应用失效模式与效应分析理论前瞻性地对留置针维护流程进行分析改进,有助于降低导管堵塞风险,提高静脉输液治疗质量和患者满意度,值得在临床推广应用。

Objective Discussion on the effect of failure mode and effect analysis（FMEA）in reducing the risk of indwelling catheter. Methods 320 cases of patients with indwelling catheter in January 2016 January 2015 were selected,according to the random number table method is divided into the control group and the observation group of160 cases. The control group were given routine nursing and risk management,The observation group according to the failure mode and effect analysis workflow,determine the theme,the formation of the team,drawing flow chart.In the observation group,the potential failure mode,the failure reason and the failure result analysis,the calculation of the priority risk index（RPN）,identify the failure mode and the related reasons,and carry on the process management.Results the RPN value of the observation group was lower than that of the control group in the 4 failure modes of the observation group,punching tube was ineffective,the sealing tube was ineffective,the improper clamping tube and the health education were not in place. The difference was statistically significant（P〈0.01）.The rate of indwelling catheter was 1.88%,which was lower than that of the control group 9.38%.The difference was statistically significant（P〈0.05）.Conclusion Application failure mode and effect analysis theory,prospectively analyze the needle maintenance process improvement,to help reduce the risk of catheter jam,improve the quality of intravenous infusion treatment and patient satisfaction,is worth popularizing in clinical application.