FMEA在降低颈椎前路术后呼吸道梗阻发生率的应用
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摘要
目的探讨失效模式和效应分析(FMEA)在降低颈椎前路手术患者呼吸道梗阻发生率中的应用效果。方法选择2012年1月~2014年4月在本院行颈椎前路手术的120患者为对照组,选取2014年5月~2015年10月在本院行颈椎前路手术的120患者为观察组。对照组按围手术期护理常规进行护理,观察组运用FMEA对颈椎前路术后患者可能发生呼吸道梗阻的失效模式进行前瞻性分析、评估,找出导致呼吸道梗阻的最高危因素和高危护理流程,制定预防和改进措施并实施。计算实施改进措施前后风险优先数(RPN)值,比较两组呼吸道梗阻发生率、住院时间和患者满意度。结果实施改进措施后,观察组各项RPN值均较对照组明显降低。观察组呼吸道梗阻发生率为0.83%,对护理满意度为95.83%,住院时间为(10.03±2.56)d,对照组呼吸道梗阻发生率为6.67%,对护理满意度为76.67%,住院时间为(13.57±3.84)d,观察组患者呼吸道梗阻发生率低于对照组(P<0.05);观察组护理满意度高于对照组(P<0.01);观察组住院时间短于对照组(P<0.01)。结论应用FMEA对颈椎前路手术患者进行评估、分析和采取相关措施,能有效防范风险,降低呼吸道梗阻发生率,提高护理质量,保证患者安全。
Objective To investigate application effect by failure mode and effect analysis(FMEA) in reducing incidence of respiratory tract obstruction after anterior cervical operation in patients. Methods There were 120 patients receiving anterior cervical operation in our hospital during January 2012~April 2014 as control group and 120 patients receiving anterior cervical operation in our hospital during May 2014~October 2015 as observation group. The control group received conventional perioperative nursing. The observation group received prospective analysis and evaluation of respiratory tract obstruction failure mode by FMEA for anterior cervical operation patients to determine the highest risk factor and high risk nursing process for respiratory tract obstruction, and to formulate and implement prevention and improvement measures. Calculation was made on risk priority number(RPN) value before and after implement of improvement measures. Comparison was made on incidence of respiratory tract obstruction, hospital stay time and patients satisfaction degree between the two groups. Results After implement of improvement measures, the observation group had all lower RPN values than the control group. The observation group had incidence of respiratory tract obstruction as 0.83%, nursing satisfaction degree as 95.83%, and hospital stay time as(10.03±2.56) d. The control group had incidence of respiratory tract obstruction as 6.67%, nursing satisfaction degree as 76.67%, and hospital stay time as(13.57±3.84) d. The observation group had lower incidence of respiratory tract obstruction than the control group(P<0.05). The observation group had higher nursing satisfaction degree than the control group(P<0.01). The observation group had shorter hospital stay time than the control group(P<0.01). Conclusion Implement of FMEA for evaluation, analysis and related measures application in anterior cervical operation patients can effectively prevent risk, lower incidence of respiratory tract obstruction, improve quality of nursing, and guarantee safety in patients.
Objective To investigate application effect by failure mode and effect analysis(FMEA) in reducing incidence of respiratory tract obstruction after anterior cervical operation in patients. Methods There were 120 patients receiving anterior cervical operation in our hospital during January 2012~April 2014 as control group and 120 patients receiving anterior cervical operation in our hospital during May 2014~October 2015 as observation group. The control group received conventional perioperative nursing. The observation group received prospective analysis and evaluation of respiratory tract obstruction failure mode by FMEA for anterior cervical operation patients to determine the highest risk factor and high risk nursing process for respiratory tract obstruction, and to formulate and implement prevention and improvement measures. Calculation was made on risk priority number(RPN) value before and after implement of improvement measures. Comparison was made on incidence of respiratory tract obstruction, hospital stay time and patients satisfaction degree between the two groups. Results After implement of improvement measures, the observation group had all lower RPN values than the control group. The observation group had incidence of respiratory tract obstruction as 0.83%, nursing satisfaction degree as 95.83%, and hospital stay time as(10.03±2.56) d. The control group had incidence of respiratory tract obstruction as 6.67%, nursing satisfaction degree as 76.67%, and hospital stay time as(13.57±3.84) d. The observation group had lower incidence of respiratory tract obstruction than the control group(P<0.05). The observation group had higher nursing satisfaction degree than the control group(P<0.01). The observation group had shorter hospital stay time than the control group(P<0.01). Conclusion Implement of FMEA for evaluation, analysis and related measures application in anterior cervical operation patients can effectively prevent risk, lower incidence of respiratory tract obstruction, improve quality of nursing, and guarantee safety in patients.
引文
[1]刘晓敏,吴松,周天宝,等.颈椎前路手术并发呼吸系统疾病的防治探讨.中国医疗前沿,2010,5(21):8-9.
[2]周鑫,马向阳,杨进城,等.颈椎前路术后早期急性并发症的原因及治疗.中国矫形外科杂志,2015,23(23):2198-2201.
[3]秦庆友,罗宝凤,徐红英.颈椎前路术后呼吸道管理的护理现状.当代护士旬刊,2013(12):7-9.
[4]苏冰梅,谭富海,黄小敏,等.失效模式与效应分析在脊髓损伤并截瘫患者预防压疮中的应用.中国临床护理,2012,4(3):188-190.
[5]罗凯燕,王慧文.颈椎脊髓损伤呼吸管理量表的制订及临床应用.生物骨科材料与临床研究,2012,9(1):56-58.
[6]黄建新,吕守正,李志勇,等.颈椎前路手术早期并发症原因分析及对策.河北医学,2012,18(3):102-105.
[7]宋佳璐,王丽燕,史淑芳,等.颈椎前路手术后切口血肿的风险评估及对策.临床医药实践,2014,23(10):782-784.
[8]陈翠萍,刘洁珍,高兴华,等.失效模式和效应分析在髋关节置换术后护理中的应用.护理学杂志,2010,25(18):4-7.
[9]马洁.应用失效模式与效应分析防范手术室压疮的效果.检验医学与临床,2016(A02):59-62.
[10]占松莲,郑文娴,贾曼.颈椎前路手术后上呼吸道梗阻原因分析及抢救体会.护理与康复,2005,4(4):290-291.
[2]周鑫,马向阳,杨进城,等.颈椎前路术后早期急性并发症的原因及治疗.中国矫形外科杂志,2015,23(23):2198-2201.
[3]秦庆友,罗宝凤,徐红英.颈椎前路术后呼吸道管理的护理现状.当代护士旬刊,2013(12):7-9.
[4]苏冰梅,谭富海,黄小敏,等.失效模式与效应分析在脊髓损伤并截瘫患者预防压疮中的应用.中国临床护理,2012,4(3):188-190.
[5]罗凯燕,王慧文.颈椎脊髓损伤呼吸管理量表的制订及临床应用.生物骨科材料与临床研究,2012,9(1):56-58.
[6]黄建新,吕守正,李志勇,等.颈椎前路手术早期并发症原因分析及对策.河北医学,2012,18(3):102-105.
[7]宋佳璐,王丽燕,史淑芳,等.颈椎前路手术后切口血肿的风险评估及对策.临床医药实践,2014,23(10):782-784.
[8]陈翠萍,刘洁珍,高兴华,等.失效模式和效应分析在髋关节置换术后护理中的应用.护理学杂志,2010,25(18):4-7.
[9]马洁.应用失效模式与效应分析防范手术室压疮的效果.检验医学与临床,2016(A02):59-62.
[10]占松莲,郑文娴,贾曼.颈椎前路手术后上呼吸道梗阻原因分析及抢救体会.护理与康复,2005,4(4):290-291.