运用医疗失效模式与效应分析改善住院病人用药安全流程

Useing healthcare failure mode and effect analysis to improve the medication safety process for inpatients

目的探究医疗失效模式与效应分析(HFMEA)在改善住院病人用药安全流程中的应用效果。方法以2020年9月至2021年4月为研究周期。深圳市龙华区中心医院通过实施HFMEA中的选题、组队、绘制流程图、改善分析及效果评价5大核心步骤,依次采用失效点分析、头脑风暴、危害分析、决策树分析、拟定成效指标、实施改善行动及效果确认等方法,确认HFMEA实施后9项成效指标达标情况,并通过比较流程改善前后用药错误发生率评价实施效果。结果HFMEA实施后,9项成效指标均已达标,该院住院病人用药安全流程得到改善。除假阴性医嘱差错率外,其余各环节用药差错发生率明显降低(P<0.05),其中医生开医嘱差错率、药品核销差错率、药品报失率由实施首月的0.2646%、85.7%、0.26%分别改善为实施尾月的0.0974%、65.71%和0.02%。结论运用HFMEA对住院病人用药各环节进行风险防范管理,可有效减少住院病人用药过程中差错发生率,进一步保障住院病人用药安全。

Objective To explore the efficacy of healthcare failure mode and effect analysis(HFMEA)in improving medication safety procedures for inpatients.Methods The study period was from September 2020 to April 2021.Shenzhen Longhua District Central Hospital through the implementation of HFMEA in the topic selection,team formation,flow chart drawing,improvement analysis and effect evaluation brainstorming of the 5 core steps,followed by failure point analysis,brainstorming,hazard analysis,decision tree analysis,formulation of effectiveness indicators,implementation of improvement actions and effect confirmation methods to confirm the implementation of HFMEA after the implementation of the 9 effectiveness indicators,and by comparing the incidence of medication errors before and after the improvement of the process to evaluate the implementation effect.Results After the implementation of HFMEA,all the 9 effectiveness indicators reached the standard,and the inpatient medication safety process in our hospital improved.In addition to the false-negative order error rate,the incidence of medication errors in another link decreased significantly.Among them,the error rate of doctor's orders,the error rate of drug write-off and the loss rate of drug report were improved from 0.2646%,85.7%and 0.26%in the first month of implementatio to 0.0974%,65.71%and 0.02%in the last month of implementation,respectively,and the difference was statistically significant(P<0.05).Conclusion HFMEA is used for risk prevention and management of all links of inpatients'medication in our hospital,which can effectively reduce the incidence of medication errors in inpatients,and thus ensure the safety of medication in inpatients.