失效模式与效应分析在降低神经外科置管患者非计划拔管率中的应用

Application of FMEA on reducing the unplanned extubation rates in patients with neurosurgical catheterization

目的探讨失效模式与效应分析(FMEA)在减少神经外科置管患者非计划拔管中的应用效果。方法应用FMEA理论分析神经外科置管患者的非计划性拔管原因,计算优先风险数值(RPN),入选RPN较高的失效模式,对其成因进行分析,制订改进措施,优化护理方案。选择解放军总医院第六医学中心神经外科2018年1月—2019年12月收治的585例患者为FMEA组,选择FMEA实施前2016年1月—2017年12月收治的631例患者为对照组。对照组采取神经外科管路常规护理方法,FMEA组在此基础上进行FMEA。比较实施FMEA前后两组患者非计划性拔管率的差异。结果FMEA组患者的非计划拔管总发生率为1.48%(21/1417),低于对照组的5.11%(72/1408),差异有统计学意义(P<0.001)。FMEA组的胃管、尿管、手术相关引流管非计划拔管发生率均低于对照组,差异均有统计学意义(P<0.05)。两组气管置管和深静脉置管的非计划拔管发生率比较,差异无统计学意义(P>0.05)。结论FMEA能够明显降低神经外科置管患者的非计划拔管率,值得临床推广应用。

Objective To explore the application effect of failure mode and effect analysis(FMEA)on reducing the unplanned extubation rates in patients with neurosurgical catheterization.Methods FMEA theory was used to analyze the causes of unplanned extubation in neurosurgical patients with catheterization.The Risk Priority Number(RPN)was calculated and the failure modes with higher RPN were selected.The causes were analyzed,and the improvement measures were formulated to optimize the nursing plan.A total of 585 patients admitted to the Department of Neurosurgery of the Sixth Medical Center of PLA General Hospital from January 2018 to December 2019 were recruited as the FMEA group,the 631 patients admitted before FMEA application,from January 2016 to December 2017,were recruited as the control group.The control group was given routine nursing of Neurosurgery pipeline,and the FMEA group was given FMEA intervention on this basis.The difference of unplanned extubation rate between the two groups was compared.Results The total incidence of unplanned extubation in FMEA group was 1.48%(21/1417),which was lower than 5.11%(72/1408)in control group,with statistical significance(P<0.001).The unplanned extubation rates of gastric tube,urinary tube and operation related drainage tube in FMEA group were lower than in control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of unplanned extubation of endotracheal intubation and deep vein catheterization between the two groups(P>0.05).Conclusions The FMEA model can be effective in reducing the rate of unplanned extubation for patients in neurosurgery,which is worthy of clinical application.