失效模式和效应分析联合APACHEⅡ评分在ICU护理安全管理中的应用及效果评价

The application and effect assessment of combination failure mode and effect analysis with acute physiology and chronic health evaluation Ⅱ for safety management in intensive care unit

目的探讨失效模式和效应分析(FMEA)联合急性生理学和慢性健康状况评分(APACHEⅡ)在ICU患者护理安全管理中的应用效果。方法成立FMEA小组,运用APACHEⅡ评分法对患者的病情进行评分,依据评分结果弹性调配护理人力资源;并将危重患者救护过程中所有可能的失效原因用统计方法计算失效时的风险危机值(RPN),选择较高的10个失效模式进行分析。比较该法实施前后护理质量、护理不良事件及满意度情况。结果实施FMEA联合APACHEⅡ评分后的各项护理质量督查评分和满意度调查得分均高于实施前,尤其是基础护理、护理文书、消毒隔离和护士自身满意度提高明显(P<0.05);10个失效模式RPN值和不良事件发生率较之前明显降低(χ~2=9.324,P<0.05)。结论充分运用FMEA联合APACHEⅡ评分可综合两者优势,解决ICU危重患者救治过程中的系列护理难题,对加强危重症患者的基础护理和专科护理管理提供有效的管理方法。

Objective To study the application effect of combining failure mode and effect analysis(FMEA)with acute physiology and chronic health evaluationⅡ(APACHEⅡ)for safe management in intensive care unit(ICU).Method To apply of patient's score used by APACHEⅡto distributing human resource.Then find out and analysis the top ten failure modes which is from all failure reasons in the process of patient's treatment in terms of risk priority number(RPN).Finally,nursing quality,adverse events,satisfaction degree were analyzed and compared on the basis of RPN ranking.Result The score of basic nursing,nursing record,disinfection and nurses'satisfaction were increased(P<0.05);The RPN in top ten failure modes and adverse events had declined significantly(χ2=9.324,P<0.05).Conclusion It was recommended to apply for patients'treatment in ICU.It was effective to strengthen basic nursing and critical patient's management used by the combination of FMEA and APACHEⅡ.