医疗失效模式与效应分析管理模式对肿瘤患者手臂输液港围手术期护理质量的影响

Effect of healthcare failure mode and effect analysis management mode on perioperative nursing quality of cancer patients at arm infusion port

目的探讨医疗失效模式与效应分析(HFMEA)管理模式对肿瘤患者手臂输液港围手术期护理质量的影响。方法采用便利抽样法,选择湖南省肿瘤医院2020年1—10月置入手臂输液港肿瘤患者68例为对照组,选择2020年11月—2021年8月置入手臂输液港肿瘤患者84例为干预组。对照组遵循医院原有的胸壁港及经外周置入中心静脉导管(PICC)置入的围手术期安全管理方法,干预组采用HFMEA管理模式进行手臂输液港围手术期安全管理。比较两组患者手臂输液港置入围手术期风险优先指数(RPN)、高危失效模式的发生情况及并发症发生情况。结果干预组术前评估不充分、术中配件丢失、穿刺位置过低、导管裁剪过短、导管与注射座连接不紧、切口缝合后再进行导管定位、术后健康教育不充分等失效模式RPN值均低于对照组,差异有统计学意义(P<0.05)。干预组术前评估不充分、术后健康教育不到位的发生率、术后并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论HFMEA管理模式可以降低肿瘤患者手臂输液港围手术期环节风险性,降低术后并发症发生率,值得临床推广。

Objective To explore the effect of healthcare failure mode and effect analysis(HFMEA)management mode on perioperative nursing quality of cancer patients at arm infusion port.Methods Using the convenient sampling,68 cancer patients with arm infusion port in Hunan Cancer Hospital from January to October 2020 were selected as the control group,and 84 cancer patients with arm infusion port from November 2020 to August 2021 were selected as the intervention group.The control group followed the hospital's original perioperative safety management of chest wall port and peripherally inserted central catheter(PICC)insertion,while the intervention group adopted the HFMEA management mode for the perioperative safety management of arm infusion port.The risk priority number(RPN),the occurrence of high-risk failure modes and complications of the two groups were compared.Results The RPN values of failure modes such as inadequate preoperative evaluation,loss of intraoperative accessories,low puncture position,too short catheter clipping,loose connection between catheter and injection base,catheter positioning after incision suture,and insufficient postoperative health education in the intervention group were lower than those in the control group,with statistical differences(P<0.05).The incidence of inadequate preoperative evaluation,inadequate postoperative health education and postoperative complications in the intervention group were statistically lower than those in the control group(P<0.05).Conclusions The HFMEA management mode can reduce the risk of perioperative links of cancer patients at arm infusion port and decrease the incidence of postoperative complications,which is worthy of clinical promotion.