失效模式与效应分析在降低骨科手术患者皮肤压疮发生率中的应用

Application of failure mode and effect analysis in reducing the incidence of skin pressure sore in patients after orthopaedic surgery

目的 探讨失效模式与效应分析(FMEA)在降低骨科手术患者皮肤压疮发生率的应用效果,为制定骨科手术患者护理方案提供参考。方法 将2016年1月至2017年1月我院收治的骨科手术患者186例作为对照组,采用常规护理路径进行护理;将2017年2月至2018年1月收治的骨科手术患者186例作为观察组,在对照组基础上实施FMEA。比较两组患者苏醒时、术后1周、术后2周、术后1个月自主体位变换率、焦虑与抑郁评分及住院期间压疮发生率。结果 两组患者术后苏醒时、术后1周自主变换体位率、焦虑、抑郁评分比较差异无统计学意义(P>0. 05);术后2周、术后1个月观察组患者自主体位变换率高于对照组(P <0. 05),焦虑、抑郁评分明显低于对照组(P <0. 05),术后1个月压疮发生率明显低于对照组(P <0. 05)。结论 FMEA在对患者压疮危险因素评估的基础上,充分利用该管理模式的纠错功能,不断完善护理过程中预防压疮的体系,尽可能降低压疮风险因素、发生率及严重程度,对骨科手术患者具有较高的临床应用价值。

Objective To explore the application effect of failure mode and effect analysis(FMEA)in reducing the incidence of skin pressure sore in patients after orthopaedic surgery,thus providing reference for the development of nursing programs for the patients after orthopaedic surgery.Methods A total of 186 orthopedic surgery patients who were admitted to our hospital from January 2016 to January 2017 were selected as the control group,and they were nursed by routine nursing pathways.A total of 186 patients who were admitted to the orthopedics department of our hospital from February 2017 to January 2018 were selected as the observation group,and on the basis of the control group,the FMEA was implemented.The rate of voluntary postural change,anxiety and depression scores,and the incidence of pressure ulcers during hospitalization of patients in the two groups were compared at the time of recovery,1 week,2 weeks,and 1 month after surgery.Results There was no significant statistical difference in the rate of voluntary postural change,anxiety and depression scores between the two groups when awaken after the surgery and at 1 week after the surgery(P>0.05).The rate of voluntary postural change in the observation group was higher than that of the control group at 2 weeks and 1 month after operation(P<0.05).The scores of anxiety and depression in the observation group were significantly lower than those in the control group(P<0.05).0x09The incidence of pressure sores in the observation group was significantly lower than that in the control group at 1 month after operation(P<0.05).Conclusion Based on the evaluation of the risk factors of pressure ulcers in patients,FMEA can make full use of the error correction function of the management model,and constantly improve the system of preventing pressure sores during the nursing process,thus minimizing the risk factors,incidence and severity of pressure ulcers.Therefore,it has high clinical application value for patients in the orthopedics department.