失效模式与效应分析在眼科局麻手术患者安全转运中的应用

Application of failure mode and effect analysis in the safe transfer of patients undergoing ophthalmic local anesthesia

目的探讨失效模式与效应分析方法在眼科局麻手术患者安全转运中的应用效果。方法选择2017年3月至2018年3月眼科手术患者100例作为对照组,采用常规转运;选择2018年5月至2019年2月眼科手术患者100例作为观察组,设计从接手术患者入手术等待区等待、进入手术间进行手术及手术结束后送患者回病房流程,使用失效模式与效应分析方法对眼科局麻手术患者安全转运中可能出现的失效模式进行评估、分析,制定改进措施,并加以评价和改善。结果眼科局麻手术患者转运中存在接送人员扶患者至手术间门口(RPN=324)、患者坐在手术间外的圆凳上等候(RPN=210)、巡回护士扶患者躺于手术床开始手术(RPN=405)、手术结束巡回护士将患者从手术床扶至轮椅(RPN=336)等高风险失效模式,经采取针对性的改进措施后,RPN值分别下降至0、0、60、30。观察组患者跌倒发生率低于对照组,但差异无统计学意义(P>0.05),观察组患者轮椅使用率、轮椅使用正确率均高于对照组,差异有统计学意义(P<0.05)。结论应用失效模式与效应分析方法于眼科局麻手术患者安全转运中效果良好,无跌倒等相关不良事件的发生。

Objective To explore the application effect of failure mode and effect analysis(FMEA)in the safe transfer of patients undergoing ophthalmic local anesthesia.Methods To select 100 cases of patients undergoing ophthalmic surgery from March 2017 to March 2018 was set as a control group using routine transfer.Another 100 cases of patients undergoing from May 2018 to February 2019 were selected as an observation group,and the possible failure modes in the safe transport of patients under ophthalmic local anesthesia during the process,such as the design of waiting for the patient to enter the operation waiting area,entering the operating room for surgery,and sending the patient back to the ward after the operation,which was evaluated,analyzed,and developed improved measures to evaluate and improve by using the FMEA method.Results During the transfer of patients undergoing local anesthesia in ophthalmology,there were high-risk failure modes,such as the shuttle staff helping the patient to the door of the operating room(RPN=324),the patient sitting on a stool outside the operating room and waiting(RPN=210),the roving nurse helping the patient to lie on the operating table to start the operation(RPN=405),and at the end of the operation the roving nurse helping the patient assist from the operating table to the wheelchair(RPN=336),etc.,after taking targeted improvement measures,the RPN values dropped to 0,0,60,and 30 respectively.The incidence of falls of patients in the observation group was lower than that in the control group,but the difference was no statistically significant(P>0.05).The usage rate of wheelchair and the correct rate of wheelchair usage in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The application of FMEA method in the safe transportation of patients undergoing ophthalmic local anesthesia had a good effect,and there were no related adverse events such as falls.