【摘要】 目的探讨医疗失效模式与效应分析(failure mode and effect analysis,FMEA)在预防髋关节置换术患者并发症发生中的应用,以期为优化该类患者护理服务提供参考性依据。方法选取2015年2月至2016年4月和2016年6月至2017年8月,在我院行髋关节置换术的患者118例,分为改善前组(n=58)和改善后组(n=60),改善前组患者接受骨外科围术期常规护理,改善后组患者接受基于FMEA的风险管理。比较两组风险优先指数(risk priority number,RPN)评分及术后关节脱位、感染、下肢深静脉血栓形成(deep vein thrombosis,DVT)等并发症发生率,于患者出院前1天,采用我院护理科自行设计的护理满意度调查问卷,调查患者对护理服务的满意程度。结果改善后组患者自身体质评估、术后患肢护理、功能锻炼、导尿管护理、药物应用、操作者准备等的RPN值分别为(112.50±11.38)分、(59.81±7.05)分、(82.05±8.86)分、(72.46±7.33)分、(60.13±7.27)分、(98.74±9.47)分,分别低于改善前组(189.55±20.14)分、(227.48±26.95)分、(298.30±31.47)分、(219.64±25.17)分、(198.64±22.16)分、(265.49±28.64)分,差异均有统计学意义(P<0.05);改善后组术后不良事件发生率为5.00%(3/60),明显低于改善前组17.24%(10/58),差异有统计学意义(P<0.05);改善后组患者护理满意度调查问卷中健康宣教、心理护理、疼痛护理、操作水平等得分分别为(17.88±1.96)分、(16.07±2.48)分、(16.15±2.96)分、(17.85±2.04)分,分别高于改善前组(14.05±4.16)分、(10.39±3.84)分、(11.48±4.20)分、(13.26±3.79)分,差异有统计学意义(P<0.05)。结论 FMEA可显著降低髋关节置换术后并发症发生率,提高患者对护理服务的满意程度,值得临床推广和应用。更多还原

【Abstract】 Objective To explore the application of failure mode and effect analysis( FMEA) on the prevention of complications after hip arthroplasty, and further to provide references for nursing service optimizing. Methods February 2015-April 2016, June 2016-August 2017, 118 patients after hip arthroplasty in our hospital were selected. All were divided into pre-improved group( n = 58) and post-improved group( n = 60). Pre-improved group received routine perioperative care, while the post-improved group received risk management based on FMEA. The Risk Priority Number( RPN), the incidence of postoperative dislocation, infection, deep vein thrombosis( DVT) were compared between the 2 groups. The nursing satisfaction was evaluated by self-designed questionnaire 1 day before the discharge. Results The RPN values of high risk factors for patients’ own constitutional assessment, postoperative limb care, functional exercise, catheterization, drug use, operator preparation were( 112.50 ± 11.38) points,( 59.81 ± 7.05) points,( 82.05 ± 8.86) points,( 72.46 ± 7.33) points,( 60.13 ± 7.27) points,( 98.74 ± 9.47) points in post-improved group, which were lower than( 189.55 ± 20.14) points,( 227.48 ± 26.95) points,( 298.30 ± 31.47) points,( 219.64 ± 25.17) points,( 198.64 ± 22.16) points,( 265.49 ± 28.64) points in the pre-improved group with statistically significant differences between the 2 groups( P <0.05). The incidence of postoperative adverse events was 5.00%( 3/60) in the post-improved group, which was lower than 17.24%( 10/58) in the pre-improved group with statistically significant differences between the 2 groups( P < 0.05). The scores of health education, psychological nursing, pain care and operational level were( 17.88 ± 1.96) points,( 16.07 ± 2.48) points,( 16.15 ± 2.96) points,( 17.85 ± 2.04) points in post-improved group, which were higher than( 14.05 ± 4.16) points,( 10.39 ± 3.84) points,( 11.48 ± 4.20) points,( 13.26 ± 3.79) points in the pre-improved group with statistically significant differences between the 2 groups( P < 0.05). Conclusions Risk management based on FMEA can significantly reduce the incidence of complications after hip arthroplasty and improve the patients’ nursing satisfaction. It is worthy of clinical promotion and application.更多还原