Impact of failure mode and effects analysis-based emergency management on the effectiveness of craniocerebral injury treatment

BACKGROUND Craniocerebral injuries encompass brain injuries,skull fractures,cranial soft tissue injuries,and similar injuries.Recently,the incidence of craniocerebral injuries has increased dramatically due to the increased numbers of traffic accidents and aerial work injuries,threatening the physical and mental health of patients.AIM To investigate the impact of failure modes and effects analysis(FMEA)-based emergency management on craniocerebral injury treatment effectiveness.METHODS Eighty-four patients with craniocerebral injuries,treated at our hospital from November 2019 to March 2021,were selected and assigned,using the random number table method,to study(n=42)and control(n=42)groups.Patients in the control group received conventional management while those in the study group received FMEA theory-based emergency management,based on the control group.Pre-and post-interventions,details regarding the emergency situation;levels of inflammatory stress indicators[Interleukin-6(IL-6),C-reactive protein(CRP),and procalcitonin(PCT)];incidence of complications;prognoses;and satisfaction regarding patient care were evaluated for both groups.RESULTS For the study group,the assessed parameters[pre-hospital emergency response time(9.13±2.37 min),time to receive a consultation(2.39±0.44 min),time needed to report imaging findings(1.15±4.44 min),and test reporting time(32.19±6.23 min)]were shorter than those for the control group(12.78±4.06 min,3.58±0.71 min,33.49±5.51 min,50.41±11.45 min,respectively;P<0.05).Pre-intervention serum levels of IL-6(78.71±27.59 pg/mL),CRP(19.80±6.77 mg/L),and PCT(3.66±1.82 ng/mL)in the study group patients were not significantly different from those in the control group patients(81.31±32.11 pg/mL,21.29±8.02 mg/L,and 3.95±2.11 ng/mL respectively;P>0.05);post-intervention serum indicator levels were lower in both groups than pre-intervention levels.Further,serum levels of IL-6(17.35±5.33 pg/mL),CRP(2.27±0.56 mg/L),and PCT(0.22±0.07 ng/mL)were lower in the study group than in the control group(30.15±12.38 pg/mL,3.13±0.77 mg/L,0.38±0.12 ng/mL,respectively;P<0.05).The complication rate observed in the study group(9.52%)was lower than that in the control group(26.19%,P<0.05).The prognoses for the study group patients were better than those for the control patients(P<0.05).Patient care satisfaction was higher in the study group(95.24%)than in the control group(78.57%,P<0.05).CONCLUSION FMEA-based craniocerebral injury management effectively shortens the time spent on emergency care,reduces inflammatory stress and complication risk levels,and helps improve patient prognoses,while achieving high patient care satisfaction levels.

Comprehensive Reliability Allocation Method for CNC Lathes Based on Cubic Transformed Functions of Failure Mode and Effects Analysis

Reliability allocation of computerized numerical controlled（CNC）lathes is very important in industry.Traditional allocation methods only focus on high-failure rate components rather than moderate failure rate components,which is not applicable in some conditions.Aiming at solving the problem of CNC lathes reliability allocating,a comprehensive reliability allocation method based on cubic transformed functions of failure modes and effects analysis（FMEA）is presented.Firstly,conventional reliability allocation methods are introduced.Then the limitations of direct combination of comprehensive allocation method with the exponential transformed FMEA method are investigated.Subsequently,a cubic transformed function is established in order to overcome these limitations.Properties of the new transformed functions are discussed by considering the failure severity and the failure occurrence.Designers can choose appropriate transform amplitudes according to their requirements.Finally,a CNC lathe and a spindle system are used as an example to verify the new allocation method.Seven criteria are considered to compare the results of the new method with traditional methods.The allocation results indicate that the new method is more flexible than traditional methods.By employing the new cubic transformed function,the method covers a wider range of problems in CNC reliability allocation without losing the advantages of traditional methods.

Application of Fuzzy Decision-Making Theory and Conflict-Resolution Method to Failure Mode and Effect Analysis of Industrial Valve

It is not objective to rate the decision-making factors in the traditional failure mode and effect analysis,so fuzzy semantic theory is used in this paper.Six fuzzy semantic scales and their corresponding semantics are summarized,and a defuzzification method is studied to obtain the fuzzy value table of the six fuzzy semantic scales.For the conflicts between experts in the traditional failure mode and effects analysis,a conflict-resolution algorithm is studied to obtain the failure risk order.Finally,a certain type of industrial valve is used as an example to prove the validity of the theory proposed in this paper.

Effect of Healthcare Failure Mode and Effect Analysis on Reducing Error Risk of Neonatal Parenteral Nutrition Solution Dispensing

[Objectives]To investigate the effect of healthcare failure mode and effect analysis(HFMEA)on reducing error risk of neonatal parenteral nutrition solution dispensing.[Methods]A research team was established to identify the failure mode(FM)in each link of the formulation process of neonatal parenteral nutrition solution by HFMEA,quantify the severity(S),occurrence(O)and detection(D)of FM,and evaluate FM by risk priority number(RPN).For FM with the values of RPN>16,failure cause analysis was conducted,and corresponding improvement measures were formulated.The weight coefficient and random consistency ratio(CR)of deployment process were calculated in Matlab R2018a by compiling the Analytic Hierarchy Process(AHP)program.Six months after the implementation of improvement measures,the implementation effect was evaluated by comparing the changes of the values of RPN which was evaluated comprehensively and the rate of dispensing errors before and after the implementation of HFMEA.[Results]In the preparation process of neonatal parenteral nutrition solution,a total of 13 FMs with medium and above risk were found,the weight coefficient of medical order review,dosing and mixing was 0.2703,the weight coefficient of drug dispensing check and review was 0.1432,the weight coefficient of print label was 0.1015,the weight coefficient of distribution was 0.0716,and CR=0.0491<0.1.After six months of intervention,the total RPN value decreased by 64.81%from 127.8 to 45.0.The deployment error rates were significantly lower after the implementation,and the difference was statistically significant(P<0.05).[Conclusions]HFMEA can effectively reduce the error risk in preparation of neonatal parenteral nutrition solution,improve the quality of dispensing and promote the safety of neonatal medication.

Risk Evaluation in Blood Donation Using Failure Mode and Effective Analysis

The recognition and management of risk in donation process and blood product is critical to ensure donor and patient safety. To achieve this goal, the failure mode and effects analysis (FMEA) is a convenient method;moreover it was used to prevent the occurrence of adverse events and look at what could go strong at each step. This study aimed to utilize FMEA in central blood bank in Khartoum to evaluate the potential risk and adverse event that may occur during the donation process. According to the severity, occurrence and the detection of each failure mode, the risk priority number (RPN) was calculated to determine which of the failures should take priority to find a solution and applying corrective action to reduce the failure risk. The statistical package for social sciences (SPSS) version 11 was used as descriptive and analytical statistics tool. The FMEA technique provides a systematic method for finding vulnerabilities in a process before they result in an error, and in this study a satisfactory outcome was reached.

Failure Mode Effects and Criticality Analysis Method of Armored Equipment Based on Testability Growth

In view of the low level testability of armored equipment,the important significance of armored equipment testability growth is discussed in this paper.The failure mode effects and criticality analysis( FMECA) method to realize testability growth is introduced.Centering on the testability growth demands of new armored equipment,the deficiencies of traditional FMECA are analyzed.And an enhanced FMECA( EFMECA) method is proposed.The method increases the analysis contents,combines the information before the failure occurrence and impending failure modes together organically.Then the failure symptoms is analyzed,the failure modes and effects is determined,and the state development trend is predicted.Finally,the application of EFMECA method is illustrated by the example of the failure mode of typical armored equipment engine.

Failure Mode and Effects Analysis （FMEA） by Fuzzy Data Envelop Analysis （Fuzzy-DEA）

Failure mode and effects analysis （FMEA） offers a quick and easy way for identifying ranking-order for all failure modes in a system or a product. In FMEA the ranking methods is so called risk priority number （RPN）, which is a mathematical product of severity （S）, occurrence （0）, and detection （D）. One of major disadvantages of this ranking-order is that the failure mode with different combination of SODs may generate same RPN resulting in difficult decision-making. Another shortfall of FMEA is lacking of discerning contribution factors, which lead to insufficient information about scaling of improving effort. Through data envelopment analysis （DEA） technique and its extension, the proposed approach evolves the current rankings for failure modes by exclusively investigating SOD in lieu of RPN and to furnish with improving sca.les for SOD. The purpose of present study is to propose a state-of-the-art new approach to enhance assessment capabilities of failure mode and effects analysis （FMEA）. The paper proposes a state-of-the-art new approach, robust, structured and useful in practice, for failure analysis.

System failure analysis based on DEMATEL–ISM and FMECA

A new method of system failure analysis was proposed. First, considering the relationships between the failure subsystems,the decision making trial and evaluation laboratory(DEMATEL) method was used to calculate the degree of correlation between the failure subsystems, analyze the combined effect of related failures, and obtain the degree of correlation by using the directed graph and matrix operations. Then, the interpretative structural modeling(ISM) method was combined to intuitively show the logical relationship of many failure subsystems and their influences on each other by using multilevel hierarchical structure model and obtaining the critical subsystems. Finally, failure mode effects and criticality analysis(FMECA) was used to perform a qualitative hazard analysis of critical subsystems, determine the critical failure mode, and clarify the direction of reliability improvement.Through an example, the result demonstrates that the proposed method can be efficiently applied to system failure analysis problems.

Numerical analysis of pile–slope stability and the soil arching around two adjacent piles

Seismic pile–slope stability analysis and the formation mechanism of soil arching have not been well studied. This study used a threedimensional(3D) finite difference to determine soil and pile parameter changes in the static and seismic stability of the pile–slope caused by the interaction between stabilizing piles. Pile–slope stability analysis was performed to determine the optimal design of piles along a slope and the corresponding failure mode involving the formation of soil arching around two adjacent piles. The Factor of Safety(FS) of the slope was evaluated using the shear strength reduction method for static and seismic analyses. The results of the analysis show that suitable pile spacing(S) and a suitable pile diameter(D) in the middle of a slope result in the maximum FS for the pile–slope system and the formation of soil arching around two adjacent piles. FS of the pile–slope increased negligibly in the seismic analysis of piles located at the slope crest and toe. An optimized pile diameter and installation location afforded the maximum FS for the slope that corresponded to a specified slope failure mode for different pile locations. A pile spacing S ≤ 2.5D for piles installed in the middle of the slope is suggested for increasing the static and seismic pile–slope stability.

Analysis of Potential Failure Modes in an Assembly Line by Fuzzy Expert Systems

The failure modes and effects analysis （FMEA） is widely applied in manufacturing industries in various phases of the product life cycle to evaluate the system, its design and processes for failures that can occur. The FMEA team often demonstrates different opinions and these different types of opinions are very difficult to incorporate into the FMEA by the traditional risk priority number model. In this paper, for each of the Occurrence, Severity and Detectivity parameters a fuzzy set is defined and the opinion of each FMEA team members is considered. These opinions are considered simultaneously with weights that are given to each individual based on their skills and experience levels. In addition, the opinion of the costumer is considered for each of the FMEA parameters. Then, the Risk Priority Numbers （RPN） is calculated using a Multi Input Single Output （MISO） fuzzy expert system. The proposed model is applied for prioritizing the failures of Peugeot 206 Engine assembly line in IKCo （Iran Khodro Company）.

Analysis of Computer Network Reliability and Criticality: Technique and Features

The paper describes modern technologies of Computer Network Reliability. Software tool is developed to estimate of the CCN critical failure probability (construction of a criticality matrix) by results of the FME(C)A-technique. The internal information factors, such as collisions and congestion of switchboards, routers and servers, influence on a network reliability and safety (besides of hardware and software reliability and external extreme factors). The means and features of Failures Modes and Effects (Critical) Analysis (FME(C)A) for reliability and criticality analysis of corporate computer networks (CCN) are considered. The examples of FME(C)A-Technique for structured cable system (SCS) is given. We also discuss measures that can be used for criticality analysis and possible means of criticality reduction. Finally, we describe a technique and basic principles of dependable development and deployment of computer networks that are based on results of FMECA analysis and procedures of optimization choice of means for fault-tolerance ensuring.

Failure Modes of Machining Center in Test Run

To analysis the early failures of machining centers,the failure mode effect and criticality analysis( FMECA) method was used. Based on the failure data collected from production lines in test run,all the failure modes of machining centers were summarized and criticality of all subsystems is figured out. And the process of FMECA was improved. The most critical subsystem was manipulator subsystem. The most critical failure mode was impacted manipulator. Reasons and effect of some important failure modes were analyzed. And some suggestions to solve failures were given.

基于FMEA法的住院药房智能药柜用药安全研究

目的提高住院药房智能药柜(ADC)的用药安全管理。方法采用失效模型和效应分析(FMEA)法,经医院护士、药师等讨论后,从信息系统、人员操作、药品信息、硬件设备、管理方法5个方面建立20个失效模型(包括32个风险点),汇总为调查问卷,并通过专家咨询和药师讨论后建立问卷评分标准。于干预前发放问卷进行调查,根据发现的风险对其中30个可操作的风险点设定干预措施,持续干预5个月后(干预后)再次进行问卷调查,比较干预前后的风险优先级数(RPN)。结果干预后,30个风险点的RPN值均不同程度降低,其中22个显著降低(P<0.05)。管理方法方面的全部风险点RPN值均显著降低(P<0.05);硬件设备方面的全部风险点RPN值均无显著改变(P>0.05)。结论FMEA法用于住院药房ADC的用药安全研究,可减少其用药风险,促进药护共同管理安全使用ADC规则的形成,尤其适用于麻醉药品等特殊药品的用药管理。

医疗失效模式与效应分析在临床试验方案偏离管理中的应用

目的规范临床试验的管理,降低方案偏离的发生率,为提高临床试验的质量提供参考。方法运用医疗失效模式与效应分析方法(HFMEA)确定目前方案偏离发生的潜在失效模式,量化并评估失效模式发生频率、严重程度及可探测度,计算风险优先数(RPN),提出相应的改进措施,统计分析HFMEA实施前后RPN值,评估改进效果。结果开展HFMEA活动后,14项潜在失效模式的RPN值明显下降(P<0.05);12项潜在失效模式的风险等级下降。HFMEA小组成员在发现问题和解决问题能力、沟通配合等方面得到了显著提高。结论HFMEA活动的实施有助于临床试验方案偏离的管理,可有效降低方案偏离的发生,为提高药物临床试验质量提供经验。

基于多学科协作的HFMEA对医院感染的控制效果

目的:探讨基于多学科协作的医疗失效模式与效应分析(HFMEA)在降低医院感染率方面的应用效果。方法:对2022年1月至12月中山大学附属第三医院院感数据进行回顾性分析,运用HFMEA模式进行风险评估,针对高风险环节制定预防措施和整改方案,并在2023年1月至12月实施改进措施。2023年12月再进行风险评估,分析应用多学科协作的HFMEA后,医院感染的控制效果。结果:与2022年相比,2023年应用多学科协作的HFMEA后,医院感染发生率、多重耐药菌(MDRO)感染发生率和呼吸机相关性肺炎(VAP)发生率均无显著差异(P值分别为0.650、0.653和0.219),抗菌药物病原学送检率、导尿管相关性尿路感染(CAUTI)发生率、中心静脉导管相关性血流感染(CLABSI)发生率、手卫生依从率和手卫生正确率均有明显改善(P<0.05)。结论:基于多学科协作的HFMEA应用在医院感染管理中,可显著提高抗菌药物病原学送检率,显著降低CAUTI和CLABSI发生率,大幅提升手卫生依从率和正确率。

失效模式和效应分析在降低PICC导管移位管理中的应用

目的:探讨失效模式和效应分析(FMEA)在降低经外周静脉置入中心静脉导管(PICC)导管移位管理中的应用效果。方法:选取2023年1月—3月PICC置管治疗的104例病人作为对照组,实施常规护理;选取2023年4月—6月采用PICC置管治疗的110例病人作为观察组,实施FMEA管理模式,比较两组风险优先指数(RPN)、治疗间歇期导管移位率及护理满意度。结果:两组干预后5个失效模式的RPN值、PICC导管移位率、护理满意度比较,差异均有统计学意义(P<0.05)。结论:FMEA模式管理可以发现管理流程中潜在的问题和漏洞,降低PICC导管移位率,从而提高护理质量和护理满意度,保证病人安全。

失效模式与效应分析在骨科机器人手术流程改善中的应用

目的:探究失效模式与效应分析(FMEA)在骨科机器人手术流程改善中的应用效果。方法:选取2021年1月—2022年12月在我院实施骨科机器人手术的病人为研究对象,将2021年1月—12月(流程改善前)的300例病人作为对照组,将2022年1月—12月(流程改善后)的300例病人作为研究组。对照组实施常规骨科机器人手术流程,研究组实施采用FMEA改善后的骨科机器人手术流程。比较两组手术流程管理失效模式风险优先指数得分、手术时间、术中出血量、住院时间、并发症发生情况及病人满意度。结果:研究组手术流程管理失效模式风险优先指数得分低于对照组;研究组手术时间为(39.12±5.68)min,住院时间为(3.56±1.71)d,均短于对照组[手术时间为(48.31±6.71)min,住院时间为(5.12±1.98)d];研究组术中出血量为(65.23±8.36)mL,少于对照组(71.36±9.11)mL;研究组并发症发生率为3.33%,低于对照组(7.00%);研究组病人满意度为95.00%,高于对照组(89.67%),差异均有统计学意义(P<0.05)。结论:采用FMEA方法能够根据量化指标确定风险因素,从而制定针对性的预防措施,帮助临床医生改善骨科机器人手术流程,降低手术风险,提高手术质量。

医疗失效模式与效应分析在新生儿医院感染防控中的应用

目的研究医疗失效模式与效应分析(healthcare failure mode and effect analysis,HFMEA)在新生儿医院感染防控中的应用效果。方法选取揭阳市人民医院新生儿中心2020年7月—2021年6月住院患儿1150例为对照组,2021年7月—2022年6月住院患儿1353例为观察组。对照组应用常规感染防控管理模式,观察组应用HFMEA管理模式进行医院感染防控干预。比较2组新生儿医院感染例次发病率、工作人员(医护、保洁)医院感染知识知晓率、手卫生依从率和正确率。结果观察组新生儿医院感染例次发病率为3.92%,低于对照组的5.65%,差异有统计学意义(P<0.05)。观察组医护人员医院感染知识知晓率、手卫生依从率、手卫生正确率为93.25%、90.25%、88.98%,高于对照组的51.84%、80.64%、79.94%,差异有统计学意义(P<0.05)。观察组保洁人员医院感染知识知晓率、手卫生依从率、手卫生正确率为91.15%、76.71%、75.71%,高于对照组的65.31%、60.65%、62.50%,差异有统计学意义(P<0.05)。结论应用HFMEA对新生儿中心进行科学管理,可有效指导新生儿医院感染防控,提升医院感染管理水平。

FMEA联合PDCA在感染性休克1 h抗生素使用中的应用

目的探讨失效模式与效应分析(failure model and effect analysis,FMEA)联合PDCA管理工具在感染性休克患者1 h抗生素使用中的效果。方法选取河北医科大学第二医院收治的感染性休克患者177例及医护人员32例为研究对象。采用不同时间段分组,2组医护人员相同。以2022年1—6月的感染性休克患者87例及医护人员32名为对照组。以2022年7—12月90例感染性休克患者及32名医护人员为观察组。对照组采用常规管理。观察组采用FMEA联合PDCA管理。对比2组一般资料、风险优先数(risk priority number,RPN)值、1 h抗生素使用达标率、28 d病死率及医护人员合作满意度,分析影响1 h抗生素使用达标率的因素。结果患者一般资料、28 d病死率差异无统计学意义(P>0.05)。观察组感染性休克患者1 h抗生素使用达标率及医护合作满意度明显高于对照组,前5位失效模式的RPN值明显低于对照组,差异有统计学意义(P<0.05)。多因素分析结果显示,基础疾病(OR=0.585,95%CI:0.405~0.845,P<0.05)、抗生素使用级别(OR=0.272,95%CI:0.134~0.551,P<0.05)、患者家属教育程度(OR=2.484,95%CI:1.100~5.611,P<0.05)是影响1 h内抗生素使用达标率的独立危险因素。结论FMEA联合PDCA管理工具可规范感染性休克患者1 h抗生素使用流程,提高1 h抗生素使用达标率,加强医护合作。