失效模式和效应分析的流程化护理干预在头面部医疗器械相关压力性损伤中的预防效果分析

Analysis of preventive effect of process-based nursing interventions in failure mode and effect analysis on medical device related pressure injuries in head and face

目的:研究失效模式和效应分析(FMEA)的流程化护理干预在头面部医疗器械相关压力性损伤(MDRPI)中的预防效果。方法:组建FMEA干预小组,查找头面部MDRPI预防失效模式原因,计算头面部MDRPI预防失效模式风险评分,分析头面部MDRPI预防失效模式原因并进行护理干预措施改进。选取2021年1月至2022年1月河北省人民医院收治并进行头面部MDRPI预防护理干预的96例患者,按照干预流程不同将其分为对照组和观察组,每组48例,对照组采用常规头面部MDRPI预防护理流程干预,观察组采用FMEA的流程化护理干预,预防头面部MDRPI,比较两组的高危失效模式风险优先指数(RPN)得分、高危失效模式发生率以及两组患者的头面部MDRPI发生率及严重程度。结果:观察组患者高危失效模式的风险评估中缺乏重点、敷料使用不当、管路固定不当、医疗器械管理不当和皮肤清洁不当RPN得分分别为(80.45±24.15)分、(74.86±22.63)分、(68.15±21.88)分、(79.11±20.33)分和(65.54±21.44)分,均低于对照组,差异均有统计学意义(t=8.951、8.979、11.399、9.284、12.090,P<0.05);而风险评估中缺乏重点、敷料使用不当、管路固定不当、医疗器械管理不当和皮肤清洁不当的发生率分别为2.08%(1/48)、0、2.08%(1/48)、0和0,亦均低于对照组,差异均有统计学意义(x^(2)=4.909、6.400、6.008、7.551、6.400,P<0.05)。观察组患者的头面部MDRPI总发生率和MDRPI严重程度Ⅲ期发生率分别为8.33%(4/48)和2.08%(1/48),均低于对照组,差异具有统计学意义(x^(2)=7.940、4.909,P<0.05)。结论:FMEA的流程化护理干预能有效识别头面部MDRPI风险,进而对患者实施针对性的预防护理措施,能够有效减少头面部MDRPI的发生并降低其发生严重程度。

Objective:To study the preventive effect of process-based nursing interventions based on failure mode and effect analysis(FMEA)on medical device related pressure injuries(MDRPI)of head and face.Methods:An FMEA team was formed to identify the causes of MDRPI failure modes in the head and face,the risk score of MDRPI failure mode in the head and face was calculated,the causes of MDRPI failure modes in the head and face were analyzed and nursing intervention improvements were performed.A total of 96 patients admitted to Hebei General Hospital from January 2021 to January 2022 who underwent the head and face MDRPI preventive nursing interventions were selected and divided into a control group and an observation group,with 48 patients in each group.The control group adopted conventional head and face MDRPI preventive nursing process interventions,the observation group adopted FMEA's process-based nursing interventions to prevent head and face MDRPI.The scores of high-risk failure mode risk priority numbers(RPN),the incidence of high-risk failure modes and the incidence and severity of head and facial MDRPI were compared between the two groups.Results:The RPN scores of the patients for lack of focus in risk assessment,improper use of dressings,improper fixation of pipelines,improper management of medical devices,and improper skin cleaning of highrisk failure modes in the observation group were(80.45±24.15)points,(74.86±22.63)points,(68.15±21.88)points,(79.11±20.33)points,and(65.54±21.44)points,respectively,which were lower than those in the control group,the difference was statistically significant(t=8.951,8.979,11.399,9.284,12.090,P<0.05),the incidence rates of lack of focus in risk assessment,improper use of dressings,improper fixation of pipelines,improper management of medical devices,and improper skin cleaning were 2.08%(1/48),0,2.08%(1/48),0 and 0,respectively,which were lower than those of the control group,the difference was statistically significant(x^(2)=4.909,6.400,6.008,7.551,6.400,P<0.05).The total incidence rate of MDRPI and the severity of MDRPI stageⅢin the head and face in the observation group were 8.33%(4/48)and 2.08%(1/48),respectively,which were lower than those in the control group,the difference was statistically significant(x^(2)=7.940,4.909,P<0.05).Conclusion:The process-based nursing intervention of FMEA can effectively identify the risk of MDRPI in the head and face,and then implement targeted preventive nursing measures for patients,which can effectively reduce the occurrence and severity of MDRPI in the head and face.