贾瑶, 梁新慧, 吴惟, 李思彤, 李杨, 姜雪. 医疗失效模式与效应分析在颅脑创伤急诊手术护理风险管理中的应用[J]. 实用临床医药杂志, 2024, 28(8): 127-133. DOI: 10.7619/jcmp.20234257
引用本文: 贾瑶, 梁新慧, 吴惟, 李思彤, 李杨, 姜雪. 医疗失效模式与效应分析在颅脑创伤急诊手术护理风险管理中的应用[J]. 实用临床医药杂志, 2024, 28(8): 127-133. DOI: 10.7619/jcmp.20234257
JIA Yao, LIANG Xinhui, WU Wei, LI Sitong, LI Yang, JIANG Xue. Application of healthcare failure mode and effect analysis in nursing risk management of emergency surgery for patients with traumatic brain injury[J]. Journal of Clinical Medicine in Practice, 2024, 28(8): 127-133. DOI: 10.7619/jcmp.20234257
Citation: JIA Yao, LIANG Xinhui, WU Wei, LI Sitong, LI Yang, JIANG Xue. Application of healthcare failure mode and effect analysis in nursing risk management of emergency surgery for patients with traumatic brain injury[J]. Journal of Clinical Medicine in Practice, 2024, 28(8): 127-133. DOI: 10.7619/jcmp.20234257

医疗失效模式与效应分析在颅脑创伤急诊手术护理风险管理中的应用

Application of healthcare failure mode and effect analysis in nursing risk management of emergency surgery for patients with traumatic brain injury

  • 摘要:
    目的 探讨医疗失效模式与效应分析(HFMEA)在颅脑创伤(TBI)急诊手术护理风险管理中的应用效果。
    方法 以HFMEA模型为理论框架, 对TBI急诊手术流程进行分析,并绘制流程图,分析潜在的风险因素。针对高危失效模式采取相应管理方案,其中2022年11月—2023年4月的80例患者接受HFMEA实施前的常规管理(对照组), 2023年5—10月的80例患者接受HFMEA实施后的管理(观察组)。比较2组手术效率(术前等待时间、手术准备时间、麻醉诱导时间、术后交接时间)、手术室不良事件发生率(物品准备不全、手术铺巾污染、术中器械不足或不良、护理记录单书写错误、交接信息传递错误或缺项)、围术期并发症发生率(术中低体温、压力性损伤、术中生命体征异常波动、切口感染、肺部感染)以及手术医生对当台护士(巡回护士、器械护士)的满意度。
    结果 观察组术前等待时间、手术准备时间、麻醉诱导时间、术后交接时间均短于对照组,差异有统计学意义(P<0.01)。观察组手术室不良事件发生率为16.25%, 低于对照组的46.25%, 差异有统计学意义(P<0.01)。观察组并发症发生率为8.75%, 低于对照组的26.25%, 差异有统计学意义(P<0.01)。观察组手术医生对当台护士满意度高于对照组手术医生,差异有统计学意义(P<0.05)。
    结论 将HFMEA模型应用于TBI急诊手术患者手术护理管理中可有效提高手术效率,降低护理不良事件及并发症发生率,提高手术医生对手术室护士的满意度。

     

    Abstract:
    Objective To explore the application effect of healthcare failure mode and effect analysis (HFMEA) in nursing risk management of emergency surgery for patients with traumatic brain injury (TBI).
    Methods Taking the HFMEA model as the theoretical framework, the emergency surgical process of TBI was analyzed, a flow chart was drawn, and the potential risk factors were analyzed. Corresponding intervention programs were adopted for high-risk failure modes, and 80 patients from November 2022 to April 2023 were conducted with routine management before implementation of HFMEA (control group), the other 80 patients from May to October 2023 were conducted with management after implementation of HFMEA (observation group). The surgical efficiency (preoperative waiting time, surgical preparation time, anesthesia induction time, postoperative handover time), the incidence rates of adverse events in the operation room (incomplete preparation of supplies, contamination of surgical drapes, insufficient or defective intraoperative instruments, errors in writing nursing records, incorrect or missing items in handover information), the incidence rates of perioperative complications (low intraoperative body temperature, pressure injury, abnormal fluctuations in vital signs during surgery, wound infection, lung infection) and satisfaction degree of surgical doctors to nurses for current operations (itinerant nurses, instrument nurses) were compared between two groups.
    Results The observation group had significantly shorter preoperative waiting time, surgical preparation time, anesthesia induction time, and postoperative handover time compared to the control group (P < 0.01). The incidence rate of adverse events in the operation room for the observation group was 16.25%, which was significantly lower than 46.25% of the control group (P < 0.01). The incidence rate of complications was 8.75% in the observation group, which was significantly lower than 26.25% in the control group (P < 0.01). Satisfaction degree of the doctors to nurses for the current operation in the observation group was significantly higher than that in the control group (P < 0.05).
    Conclusion Application of the HFMEA model in the perioperative nursing management of patients with emergency surgery for TBI can effectively improve surgical efficiency, reduce the incidence rates of nursing-related adverse events and complications, and enhance satisfaction degree of doctors to nurses in operation room.

     

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