根本原因分析法在脑胶质瘤患者手术安全管理中的应用研究

Application of root cause analysis in surgical safety management of patients with brain glioma

目的:探究根本原因分析(RCA)法在脑胶质瘤患者手术安全管理中的应用。方法:选取医院收治需进行手术治疗的88例脑胶质瘤患者,采用随机数表法将其分为对照组和观察组,每组44例。对照组给予常规手术安全管理,观察组在对照组安全管理基础上应用RCA法管理,利用"鱼骨图"找出导致手术部位错误发生的直接原因,制定并实施整改措施,对比两组患者手术期间不良事件发生率及患者对于手术安全管理的满意度。结果:观察组出现手术过程操作不当、手术感染、错误用药、术前准备不足、术中患者低体温、器械或异物留在患者体腔、患者在等候室内停留时间>30 min及术中输血输液过敏反应等不良事件明显低于对照组,两组不良事件发生率比较差异有统计学意义(x^2=4.889,P<0.05)。观察组的技术操作、工作态度、疾病宣教和总满意度评分明显高于对照组,两组比较差异有统计学意义(t=9.751,t=13.909,t=12.522,t=14.627;P<0.05)。结论:常规手术安全管理基础上应用RCA法能有效降低手术期间脑胶质瘤患者不良事件发生率,提高脑胶质瘤患者对手术安全管理的满意度。

Objective:To explore the application of root cause analysis in the surgical safety management of patients with brain glioma.Methods:88 patients with brain glioma who should receive operative treatment were selected.And they were divided into control group and observation group according to random number table method,and each group included 44 cases.The control group received conventionally surgical safety management,while the observation group received the management of root cause analysis method on the basis of control group.The occurrence rate of adverse events during operation and the satisfaction degree of patients for surgical safety management between two groups were compared.Results:The series of adverse events,included misoperation in surgical process,surgical infection,drug misuse,preoperatively inadequate preparation,intraoperative lower body temperature of patients,instrument or foreign body that were left in body cavity of patient,the staying times of patients in waiting room were more than 30 min and allergic reaction intraoperative blood transfusion and transfusion,of observation group obviously lower than those of control group.And the difference of total rate of occurring adverse events between two groups was significant(x^2=4.889,P<0.05).The technical operation,work attitude,propaganda and education of disease and total satisfaction score of observation group were significantly higher than those of control group(t=9.751,t=13.909,t=12.522,t=14.627,P<0.05).Conclusion:The application of root cause analysis method on the basis of conventionally surgical safety management can effectively reduce incidence rate of adverse events in patients with brain glioma during surgery and can improve the satisfaction of patients with brain glioma for surgical safety management.