医疗失效模式与效应分析在血气分析标本采集管理中的应用

Application of health failure mode and effect analysis in the collection and management of blood gas analysis specimens

目的分析医疗失效模式与效应分析(HFMEA)在重症监护病房(ICU)血气分析标本采集管理中的应用效果。方法组建HFMEA项目团队,应用HFMEA进行血气分析标本采集流程的风险评估及原因分析,并制定出有针对性的改进措施。选择北京大学滨海医院(天津市第五中心医院)应用HFMEA前(2020年1月至4月)收治的ICU患者1846份血气标本作为对照组;将应用HFMEA后(2020年5月至8月)收治的ICU患者1839份血气标本作为干预组。比较两组的首次穿刺成功率、标本合格率(包括标本无凝集、标本血量>1 mL、标本无气泡)和血肿发生率,同时记录护士对动脉血气分析标本管理的综合能力(理论考核成绩、实践技能成绩和总成绩)以及医生和护士对标本管理满意度的差异。结果干预组首次动脉穿刺成功率、标本合格率均明显高于对照组,患者血肿发生率明显低于对照组〔首次动脉穿刺成功率:98.10%(1804/1839)比94.47%(1744/1846),标本无凝集:98.64%(1814/1839)比95.77%(1768/1846),标本血量>1 mL:99.29%(1826/1839)比96.10%(1774/1846),标本无气泡:99.35%(1827/1839)比96.42%(1780/1846),患者血肿发生率:2.12%(39/1839)比2.65%(49/1846),均P<0.05〕。干预组与对照组延迟检测发生率比较差异无统计学意义〔2.66%(49/1839)比2.44%(45/1846),P>0.05〕。干预组护士的血气分析标本管理实践技能成绩和总成绩均明显高于对照组〔实践技能成绩(分):46.10±2.94比39.78±5.67,总成绩(分):91.87±3.47比81.52±6.20,均P<0.01〕,干预组与对照组护士理论考核成绩比较差异无统计学意义(分:44.60±2.78比43.37±2.56,P>0.05)。干预组医生和护士总满意度均明显高于对照组〔医生总满意度:100.0%(16/16)比87.5%(14/16),护士总满意度:87.5%(42/48)比79.2%(38/48),均P<0.05〕。结论运用HFMEA模式能够有效筛查血气分析标本采集的失效模式,规范护士进行血气分析标本采集的操作流程,保障血气标本的质量,提高了医生、护士对血气分析标本管理的满意度,提升了护理质量。

Objective To explore the application effect of health failure mode and effect analysis(HFMEA)in the collection and management of blood gas analysis samples in Intensive Care Unit(ICU).Methods The HFMEA project team was set up to apply HFMEA to carry out risk assessment and cause analysis of blood gas analysis sample collection process and work out targeted improvement measures.In Peking University Binhai Hospital(Tianjin Fifth Central Hospital),the 1846 blood gas samples of ICU patients treated before using HFMEA(January to April 2020)were selected as the control group,and 1839 blood gas samples of patients treated after applying HFMEA(May to August 2020)were selected as the intervention group.The first puncture success rate,qualified sample rate[including sample without agglutination,sample with blood volume>1 mL,and sample without bubbles]and incidence of hematoma were compared between the two groups,the nurses'comprehensive ability to manage specimens of arterial blood gas analysis(including theoretical knowledge,practical skills,and total scores)and differences in satisfaction degree with the specimen management between doctors and nurses were recorded.Results In the intervention group,the success rate of the first arterial puncture and the qualified rate of specimens were significantly higher than those in the control group,while the incidence of hematoma was significantly lower than that in control group[success rate of the first arterial puncture:98.1%(1804/1839)vs.94.47%(1744/1846),incidence of no coagulation in specimens:98.65%(1814/1839)vs.95.77%(1768/1846),incidence of blood volume of sample>1 mL:99.29%(1826/1839)vs.96.10%(1774/1846),incidence of specimen without bubbles:99.35%(1827/1839)vs.96.42%(1780/1846),incidence of hematoma:2.12%(39/1839)vs.2.65%(49/1846),all P<0.01].There was no significant difference in the proportion of delayed detection between intervention group and control group[2.66%(49/1839)vs.2.44%(45/1846),P>0.05].The nurses'practical skills and total scores of blood gas analysis specimens management in the intervention group were obviously higher than those in the control group[score of practical skills:46.10±2.94 vs.39.78±5.67,total score:91.87±3.47 vs.81.52±6.20,both P<0.01],and there were no significant differences in the nurse theoretical scores between intervention group and control group(44.60±2.78 vs.43.37±2.56,P>0.05).The total satisfaction degrees of doctors and nurses in the intervention group were markedly higher than those in the control group[total satisfaction of doctors:100.0%(16/16)vs.87.5%(14/16),total satisfaction of nurses:87.5%(42/48)vs.79.2%(38/48),both P<0.05].Conclusions The application of HFMEA mode can effectively screen the failure mode of blood gas analysis,standardize the operation process of nurse blood gas analysis,ensure the quality of blood gas samples,elevate the satisfaction degrees of doctors and nurses on blood gas analysis management and improve the quality of nursing.