基于HFMEA模型预防住院精神分裂症患者暴力行为的效果评价

Prevention of violent behaviors in patients with schizophrenia in closed wards based on HFMEA mode

目的:分析基于医疗失效模式与效应分析(Health Failure Mode and Effect Analysis,HFMEA)的暴力行为管理用于预防住院精神分裂症患者暴力行为的效果.方法:采用便利抽样的方法,选取江苏省某三级甲等专科医院4个病房的住院精神分裂症患者为研究对象,2016年1-12月HFMEA实施前953例患者作为对照组,2017年1-12月HFMEA实施后884例患者作为实验组.根据住院精神分裂症患者暴力发生的流程,进行失效模式与潜在风险原因分析,找出主要的失效模式及相关原因,对于需要优先解决的问题进行措施改进并评价.结果:实施基于HFMEA的预防模式后,暴力行为发生率由40.50%降为32.58%,差异有统计学意义(x^2=12.398,P<0.001);暴力行为发生风险指数值明显下降,差异有统计学意义(P<0.05).结论:应用HFMEA前瞻性评估并预防封闭病房精神分裂症患者暴力行为的发生风险,可以有效降低暴力事件的发生率.

Objective: To investigate the effects of Health Failure Mode and Effect Analysis(HFMEA) on preventing violent behaviors in schizophrenic patients in hospital. Methods: Patients with schizophrenia from four wards of a third grade specialized hospital in Jiangsu Province were recruited using convenient sampling method. 953 patients admitted from January to December 2016 before the implementation of HFMEA were recruited as the control group, and 884 patients admitted from January to December 2017 after the implementation of HFMEA were selected as the experimental group. The HFMEA mode was used to analyze the process of schizophrenia-related violence to find out the main failure modes and related causes of potential risks, and measures to solve problems with top priority were improved and evaluated. Results: The incidence of violence decreased from 40.50% to 32.58% after the implementation of HFMEA, and the difference between the two groups was statistically significant(χ2=12.398, P<0.001). The risk value of violent behaviors significantly decreased with a statistical significance(P<0.05). Conclusion: HFMEA can be used to prospectively evaluate the risk of violent behaviors in schizophrenic patients in hospital to prevent the occurrence of such behaviors, which will effectively reduce the incidence of violent incidents.