失效模式与效应分析在住院患者药物医嘱流程风险管理中的应用与评价

Application and effect evaluation of failure mode and effect analysis in risk management of inpatients medical orders process

目的:探讨失效模式与效应分析(failure mode and effect analysis,FMEA)在住院患者药物医嘱流程风险管理中的应用效果。方法:对住院患者药物医嘱流程中各个环节进行FMEA,选出优先风险数值(risk priority number,RPN)>125的失效模式,整理分析其失效原因,制定并实施改进措施。比较FMEA活动前后RPN值、临时医嘱率、不合理医嘱率、护士日均取药次数及临时取药次均等候时间,分析改进效果。结果:住院患者药物医嘱流程中共找出11项高风险失效模式,通过规范药物医嘱流程、优化信息系统医嘱执行程序、简化退药流程、修订完善制度及对医生、药师、护士培训等措施后,11项失效模式合计RPN值由2596降至622,降幅76.04%;临时医嘱率、不合理医嘱率、护士日均取药次数及临时取药次均等候时间均明显降低,且差异有统计学意义(P<0.05)。结论:将FMEA应用于药物医嘱流程风险管理,能够有效降低临时医嘱率及不合理医嘱率,确保患者药物治疗的及时性及准确性,更好的服务于患者。

OBJECTIVE To explore the application effect of failure mode and effect analysis(FMEA)in the risk management of inpatient medical order process.METHODS FMEA was performed on each link during the whole process of inpatients medical orders.The failure mode of risk priority number(RPN)with>125 was identified and failure causes analyzed for formulating and implementing improvement measures.RPN,rate of temporary/irrational orders,daily average frequency of taking medicine by nurses and average waiting time for taking medicine temporarily were compared before and after FMEA and improvement effect was examined.RESULTS A total of 11 failure mode with high risk levels were found during the whole process of inpatient medical orders.The total RPN value for 11 failure modes dropped by 76.04%from 2596 to 622 by standardizing medical order process,optimizing order execution procedure of information system,simplifying return drug process,revising the system,training physicians,pharmacists and nurses;rate of temporary/irrational orders,daily average frequency of taking medicine by nurses and average waiting time for taking medicine temporarily declined markedly and the differences were statistically significant(P<0.05).CONCLUSION Applying FMEA for risk management of inpatient medical order process can effectively reduce the rate of temporary/irrational orders and ensure the timeliness and accuracy of drug treatment for serving patients better.