基于医疗失效模式与效应分析模型在术后患者镇痛随访管理中的应用

Effect of health failure and effect analysis mode on follow-up management of postoperative analgesia

目的分析基于医疗失效模式与效应分析(health failure mode and effect analysis,HFMEA)用于术后患者镇痛随访管理中的效果。方法采用不同病例前-后对照的研究方法,将2018年8月—11月在本院治疗术后需镇痛随访患者4859例设为对照组;2019年1月—4月需术后镇痛随访患者4953例设为观察组,根据术后患者镇痛随访管理流程,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改进并评价改进后的效果。结果观察组镇痛随访的失访发生风险指数值较对照组下降,差异有统计学意义(P<0.001);观察组患者术后镇痛随访的失访率(0.24%)较对照组(5.60%)低,差异有统计学意义(χ^2=250.30,P<0.001)。结论应用HFMEA前瞻性评估并预防术后镇痛随访管理发生的风险,可有效提高术后患者镇痛随访管理质量。

Objective To analyze the effect of the Health Failure Mode and Effect Analysis(HFMEA)on follow-up management of postoperative analgesia.Methods The pre-and post-control of different cases was used in the study.Totally,4,859 patients receiving postoperative analgesia follow-up in our hospital from August to November 2018 were selected as the control group and another group of 4953 patients receiving postoperative analgesia follow-up from January to April in 2019 were set as the observation group.The HFMEA was implemented based on the flowchart for postoperative analgesia follow-up.The main failure modes and related causes were analyzed,and the measures for solving the problems with priority were improved and evaluated.Results The risk of postoperative analgesia follow-up loss was significantly lower than that of the control group(P<0.001).After the implementation of HFMEA model,the loss rate of postoperative analgesia follow-up in the observation group was lower than that of control group(0.24%vs.5.60%,χ^2=250.30,P=0.001).Conclusion HFMEA is effective in reducing the follow-up loss of postoperative analgesia and its management quality.