应用FMEA模式降低静脉留置针堵管风险的临床研究
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摘要
目的探讨失效模式与效应分析(FMEA)在降低留置针堵管风险中的应用效果。方法选取2015年1月—2016年1月行留置针置管患者320例,按随机数字表法分为对照组与观察组各160例。对照组给予常规护理及风险管理,观察组根据失效模式与效应分析工作流程,确定主题,组建团队,绘制流程图,进行潜在失效模式、失效原因及失效结果分析,计算优先风险指数(RPN),找出失效模式与相关原因,进行流程管理。结果观察组患者冲管无效、封管无效、夹管不当、健康教育不到位4个失效模式的RPN值均低于对照组,差异有统计学意义(P<0.01)。留置针堵管率为1.88%,低于对照组的9.38%,差异有统计学意义(P<0.05)。结论应用失效模式与效应分析理论前瞻性地对留置针维护流程进行分析改进,有助于降低导管堵塞风险,提高静脉输液治疗质量和患者满意度,值得在临床推广应用。
Objective Discussion on the effect of failure mode and effect analysis(FMEA)in reducing the risk of indwelling catheter. Methods 320 cases of patients with indwelling catheter in January 2016 January 2015 were selected,according to the random number table method is divided into the control group and the observation group of160 cases. The control group were given routine nursing and risk management,The observation group according to the failure mode and effect analysis workflow,determine the theme,the formation of the team,drawing flow chart.In the observation group,the potential failure mode,the failure reason and the failure result analysis,the calculation of the priority risk index(RPN),identify the failure mode and the related reasons,and carry on the process management.Results the RPN value of the observation group was lower than that of the control group in the 4 failure modes of the observation group,punching tube was ineffective,the sealing tube was ineffective,the improper clamping tube and the health education were not in place. The difference was statistically significant(P<0.01).The rate of indwelling catheter was 1.88%,which was lower than that of the control group 9.38%.The difference was statistically significant(P<0.05).Conclusion Application failure mode and effect analysis theory,prospectively analyze the needle maintenance process improvement,to help reduce the risk of catheter jam,improve the quality of intravenous infusion treatment and patient satisfaction,is worth popularizing in clinical application.
Objective Discussion on the effect of failure mode and effect analysis(FMEA)in reducing the risk of indwelling catheter. Methods 320 cases of patients with indwelling catheter in January 2016 January 2015 were selected,according to the random number table method is divided into the control group and the observation group of160 cases. The control group were given routine nursing and risk management,The observation group according to the failure mode and effect analysis workflow,determine the theme,the formation of the team,drawing flow chart.In the observation group,the potential failure mode,the failure reason and the failure result analysis,the calculation of the priority risk index(RPN),identify the failure mode and the related reasons,and carry on the process management.Results the RPN value of the observation group was lower than that of the control group in the 4 failure modes of the observation group,punching tube was ineffective,the sealing tube was ineffective,the improper clamping tube and the health education were not in place. The difference was statistically significant(P<0.01).The rate of indwelling catheter was 1.88%,which was lower than that of the control group 9.38%.The difference was statistically significant(P<0.05).Conclusion Application failure mode and effect analysis theory,prospectively analyze the needle maintenance process improvement,to help reduce the risk of catheter jam,improve the quality of intravenous infusion treatment and patient satisfaction,is worth popularizing in clinical application.
引文
[1]蒋红,黄莺,王桂娥,等.医疗失效模式与效应分析在医院口服给药安全管理中的应用[J].中华护理杂志,2010,45(5):394-396.
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[3]叶丽萍,夏海英,孙佩红.应用医疗失效模式和效果分析降低经外周静脉中心静脉导管置管风险的研究[J].中国实用护理杂志,2013,29(5):40-42.
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[7]PARK J Y,KIM H L.A comprehensive review of clinical nurse specialist-ed peripherally inserted central catheter placement in Korea:4101 cases in a tertiary hospital[J].J Infus Nurs,2015,38(2):122-128.
[8]THORNTON E,BROOK O R,MENDIRATTA LALA M,et al.Application of failure mode and effect anaysis in a radiology department[J].Radiographics,2011,31(1):281.
[9]王建荣,蔡虻,呼滨,等.输液治疗护理实践指南与实施细则[M].北京:人民军医出版社,2012:116.
[10]谢春梨,廖维芬,唐素荣,等.应用失效模式与效应分析提高防范针刺伤的效果[J].中华护理杂志,2013,48(3):230-231.
[2]刘晓婷,付雪梅.品管圈在降低留置针堵管率管理中的应用[J].中外医学研究,2016,14(1):73-74.
[3]叶丽萍,夏海英,孙佩红.应用医疗失效模式和效果分析降低经外周静脉中心静脉导管置管风险的研究[J].中国实用护理杂志,2013,29(5):40-42.
[4]SHARP R,CUMMINGS M,FIELDER A,et al.The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter(PICC):a prospective cohort study[J].Int J Nurs Stud,2015,52(3):677-685.
[5]钟华荪,李柳英,谢红珍,等.静脉输液治疗护理学[M].北京:人民军医出版社,2014:140.
[6]柴守霞,丁永红.静脉留置针发生堵管原因分析及对策[J].现代临床护理,2010,9(2):30-32.
[7]PARK J Y,KIM H L.A comprehensive review of clinical nurse specialist-ed peripherally inserted central catheter placement in Korea:4101 cases in a tertiary hospital[J].J Infus Nurs,2015,38(2):122-128.
[8]THORNTON E,BROOK O R,MENDIRATTA LALA M,et al.Application of failure mode and effect anaysis in a radiology department[J].Radiographics,2011,31(1):281.
[9]王建荣,蔡虻,呼滨,等.输液治疗护理实践指南与实施细则[M].北京:人民军医出版社,2012:116.
[10]谢春梨,廖维芬,唐素荣,等.应用失效模式与效应分析提高防范针刺伤的效果[J].中华护理杂志,2013,48(3):230-231.