医疗失效模式与效应分析在降低肺癌化疗患者PICC脱出率中的应用效果

来源:用户上传      作者:邵秋月　　周萍　　俞新燕　　周爱娇　　尤林燕　　郑秋红

　　[摘要] 目的 探医疗失效模式与效应分析（HFMEA）在降低肺癌化疗患者PICC脱出发生率中的应用效果。方法 将2019年3月至2020年9月中国科学院大学附属肿瘤医院胸部肿瘤内科留置PICC肺癌化疗患者作为研究对象，其中2019年3―12月349例留置PICC肺癌化疗患者作为对照组，采用常规护理管理方法。将2020年1―9月307例留置PICC肺癌化疗患者作为观察组，运用HFMEA对PICC导管脱出潜在的失效模式进行分析、评估，计算出风险危机值（RPN），根据RPN值确立优先干预项目，制订并实施改进措施，对两组PICC脱出发生率进行比较。结果 实施HFMEA管理后，观察组PICC脱出发生率为0.65%，低于对照组的3.15%，差异有统计学意义（χ2=5.180，P=0.025）。观察组高危失效模式RPN值在PICC置管交接班制度不完善方面从9.01降低至6.34，护士PICC维护操作不规范从11.58降低至4.86，健康教育未达到预期效果从12.12降低至5.52，居家自我维护能力低从10.46降低至6.06。观察组患者满意率高于对照组，差异有统计学意义（χ2=131.451，P<0.001）。结论 HFMEA管理模式能够有效降低肺癌化疗患者PICC脱出发生率，对PICC患者带管过程中的不安全因素进行管理，延长导管有效留置时间，提高患者满意度。
　　[关键词] 医疗失效模式与效应分析;肺癌;化疗;PICC;脱出
　　[中图分类号] R473.7 [文献标识码] B [文章编号] 1673-9701（2022）09-0176-04
　　Application effect of health care failure mode and effect analysis in reducing PICC prolapse rate in patients with lung cancer undergoing chemotherapy
　　SHAO Qiuyue ZHOU Ping YU Xinyan ZHOU Aijiao YOU Linyan ZHENG Qiuhong
　　Cancer Hospital of University of Chinese Academy of Sciences （Zhejiang Cancer Hospital）， Institute of Cancer and Basic Medicine （IBMC）， Chinese Academy of Sciences， Hangzhou 310022， China
　　[Abstract] Objective To investigate the application effect of health care failure mode and effect analysis （HFMEA）in reducing the incidence of PICC prolapse in patients with lung cancer undergoing chemotherapy. Methods The patients with indwelling PICC lung cancer chemotherapy in the Department of Thoracic Medical Oncology of a hospital from March 2019 to September 2020 were selected as the study subjects. 349 patients with indwelling PICC lung cancer chemotherapy from March 2019 to December 2019 were selected as the control group， using conventional nursing management methods. A total of 307 patients with indwelling PICC lung cancer undergoing chemotherapy from January to September 2020 were selected as the observation group. HFMEA was used to analyze and evaluate the potential failure modes of PICC catheter prolapse. The risk crisis value （RPN）was calculated. The priority intervention project was established according to the RPN value. The improvement measures were developed and implemented. The incidence rate of PICC prolapse between the two groups was compared. Results After FMEA management， the incidence of PICC prolapse in the observation group was 0.65%， which was lower than 3.15% in the control group， with significant difference （χ2=5.180， P=0.025）. The high-risk failure mode RPN value of the observation group was reduced from 9.01 to 6.34 in terms of imperfect PICC shift system. The non-standard operation of PICC maintenance for nurses was reduced from 11.58 to 4.86. Health education not achieving the desired effect was reduced from 12.12 to 5.52. The low ability of home self-maintenance was reduced from 10.46 to 6.06. The patient satisfaction rate in the observation group was higher than that in the control group， with significant difference （χ2=131.451， P<0.001）. Conclusion HFMEA management model can effectively reduce the incidence of PICC prolapse in patients with lung cancer undergoing chemotherapy， manage the unsafe factors in the process of PICC patients with the catheter， prolong the effective indwelling time of catheter and improve patient satisfaction.

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