综合应用Delphi法、FMEA与Borda序值法评估接种门诊预防接种风险

Integrated application of Delphi consultation,FMEA,and Borda count methods in vaccination risk assessment in immunization clinics

目的评估嘉兴市接种门诊的预防接种风险，为制定相应风险应对策略提供依据。方法采用Delphi法、失效模式和效应分析（FMEA）、Borda序值法分析嘉兴市接种门诊各项预防接种风险发生的可能性、严重性及可探测性，确定风险水平和排序。结果本研究根据Delphi法构建了包含7项一级风险、26项二级风险的接种门诊预防接种评估指标体系。7项一级风险的Borda排序由高到低依次为疫苗接种实施、预检告知和健康宣教、管理和人力、疑似预防接种异常反应管理、疫苗和冷链管理、资料和数据管理、服务环境；FMEA风险优先指数（RPN）分别为280、180、120、96、90、60、36。26项二级风险的Borda排序最高、最低分别为接种前三查七对、门诊标识，其RPN分别为280、24。结论接种门诊预防接种仍存在许多潜在风险；可综合应用Delphi法、FMEA与Borda序值法构建多维度、全过程的预防接种风险管理机制。

Objective To assess vaccination risks in immunization clinics and to provide evidence for de- veloping risk response policies. Methods We used Delphi consultation, failure mode and effect analysis （FMEA） , and Borda count methods to analyze the possibility, severity, and detectability of various vac- cination risks in immunization clinics of Jiaxing city, and to determine risk levels and rankings. Results We established a system of performance indicators for vaccination risks in immunization clinics, including 7 indicators of level-1 risks and 26 indicators of level-2 risks, by Delphi consultation. The 7 level-1 indi- cators, ranked by Borda count, were vaccination implementation, notification and health education, man- agement and manpower, management of adverse event following immunization, vaccine and cold chain management, information and data management, and service environment, with corresponding FMEA risk priority numbers （RPNs） of 280, 180, 120, 96, 90, 60, and 36. The 26 level-2 indicators ranked from the clinic logo （lowest） to the pre-vaccination check （highest） according to Borda count, with RPNs ranging from 24 to 280. Conclusions Many potential risks exist in immunization clinics. We can in- tegrate Delphi consultation, FMEA, and Borda count methods to establish a multi-dimensional and whole- orocess risk management mechanism for immunization.