失效模式与效应分析在手术室护理质量安全管理中的应用效果研究

发布时间：2018-06-12 18:03

本文选题：失效模式与效应分析 + 手术室护理　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景目前,随着人们对医疗服务的要求越来越高,手术室护理质量安全管理已经成为医疗安全的热点问题。特别是近年来不断有新的技术在临床开展应用,手术设备更加先进,功能更加完善。为适应外科的发展,手术室的护理质量也需要不断的完善进步和协调发展。否则,就会影响到手术治疗的效果,甚至会威胁到患者的安全,引起医患矛盾。因此,这就要求我们采用更为科学的工具和方法对原有的手术室护理质量管理体系、流程以及各个工作环节进行科学分析,及早的找出高风险环节,提出改进措施和建议,消除隐患。失效模式与效应分析(failure mode and effects analysis,FMEA)是一种基于团队的、系统性和前瞻性的可靠的分析方法。通过分析对提供产品或服务的全部过程,识别所有流程中可能存在的故障,并对故障的严重度、发生率、可探测度进行综合评估,借助量化指标判断其失效程度,提出和制定合理的建议及措施,消除故障发生的可能性,使故障的不良结果降到最小,是持续的质量改进过程。目前,失效模式与效应分析法在医疗风险控制方面的应用已引起医务工作者的广泛关注。研究目的探讨失效模式与效应分析法(FMEA)在手术室护理质量安全管理中的应用,构建手术室护理质量安全管理FMEA模式;针对手术室护理质量安全中存在的问题提出相关改进措施,规范手术室护理质量安全管理。本研究探索在手术室护理质量安全管理中采用失效模式和效应分析法,探讨失效模式和效应分析在手术室护理质量安全管理中的可行性,前瞻性地为手术室护理质量安全管理中存在的风险的预防提供依据,规范手术室护理质量安全管理,从而实现保障患者安全的目的,提高手术医生的满意度,践行优质护理服务理念。研究方法根据研究主题,组建由相关专业背景专家组成的FMEA小组,绘制手术室护理实际流程图,运用头脑风暴法对手术室护理流程进行分析,识别潜在失效模式分析原因,计算风险优先指数,确定最需改善的模式并提出整改措施,根据整改措施对手术室护理质量安全管理实施整改。比较实施整改措施前后RPN值的变化、手术不良事件发生率、器械护士和巡回护士工作质量测评结果、手术医生满意度调查结果评估实施FMEA效果。结果与分析应用FMEA法对手术室护理流程进行分析,识别出术前访视不充分、沟通不足、接送患者保护措施欠缺等二十项潜在失效模式,分析原因并计算RPN值。根据RPN值确定了六项需要优先整改的潜在失效模式,即:手术感染预防措施不到位、锐器伤预防措施不到位、手卫生依从性差及洗手不规范、沟通不足、体位安置不当、手术用物清点欠规范。针对这六项潜在失效模式制订并实施了整改措施。对实施整改措施效果评价:六项潜在失效模式的RPN值均明显下降,六项潜在失效模式总RPN值由实施前的1154降低到486,其中沟通不足模式RPN值由175降低至80,锐器伤预防措施不到位模式RPN值由210降至100,手卫生依从性差洗手不规范模式RPN值由210降至80,体位安置不当模式RPN值由175降至60,手术感染预防措施不到位模式RPN值由216降至96,手术用物清点欠规范模式RPN值由168降至70;相应的手术不良事件发生显著下降(P0.01);器械护士工作质量测评的合格率由实施改进措施前的90%上升到98%,巡回护士工作质量测评的合格率由实施改进措施前的88.33%提升到97.5%,合格率均有显著提高(P0.01);手术医生对改进措施实施后相关内容的满意度均明显提高(P0.05)。FMEA的应用规范了手术室的工作制度与流程,完善了手术室护理质量监测体系,强化了手术室护士的专业理论和专业技能的培训,规范了手术室护理质量安全管理。结论与对策建议运用FMEA对手术室护理流程进行分析,制定并实施整改措施可以降低失效模式的RPN值、相关手术不良事件发生率并提高器械护士、巡回护士工作质量测评的合格率和手术医生的满意度;运用FMEA可使手术室护理质量安全管理得到了有效地规范;失效模式与效应分析法(FMEA)在手术室护理质量安全管理中的应用是有效、可行的,可降低手术风险的发生,保障了患者的安全。实施FMEA,应结合各自的实际情况构建适合的FMEA管理模式。在实施FMEA管理中,应正确运用头脑风暴,确保失效模式的评估、量化过程的科学性,还应获得管理层的支持,以争取足够的政策和资源的支持。还可将FMEA与RAC、HACCP等方法结合在一起使用,实现对FMEA的进一步优化。
[Abstract]:At present, with the increasing demand for medical service, the quality and safety management of operation room nursing has become a hot issue in medical safety. Especially in recent years, new technology has been applied in clinical practice, the operation equipment is more advanced and the function is more perfect. In order to adapt to the development of surgery, the quality of nursing in the operation room is also It is necessary to improve the progress and coordinated development. Otherwise, it will affect the effect of surgical treatment, even threaten the safety of the patient and cause the contradiction between doctors and patients. Therefore, this requires us to use more scientific tools and methods to scientifically analyze the original operation room nursing quality management system, process and various work links. Failure mode and effects analysis (FMEA) is a team based, systematic and forward-looking analytical method based on the analysis of the whole process of providing products or services and identifying possible causes in all processes. It also makes comprehensive evaluation on the severity, occurrence rate and detectable measure of the fault, judges its failure degree with the help of quantitative index, puts forward and formulating reasonable suggestions and measures to eliminate the possibility of failure and minimize the bad results of the fault. It is a continuous quality improvement process. At present, the failure mode and effect analysis method is in the medical wind. The application of risk control has attracted the attention of medical workers. The purpose of this study is to explore the application of failure mode and effect analysis (FMEA) in the management of nursing quality and safety in operation room, to construct the FMEA mode of nursing quality safety management in operation room, and to put forward some relevant improvement measures for the problems existing in nursing quality safety. This study explored the feasibility of failure mode and effect analysis in nursing quality safety management, and prospectively provided the basis for the prevention of risk in nursing quality safety management. To standardize the management of nursing quality and safety in the operation room, to achieve the purpose of ensuring the safety of the patients, improve the satisfaction of the surgeons and practice the concept of high quality nursing service. Based on the research topic, the FMEA group, composed of relevant professional background experts, is set up to draw the actual flowchart of the nursing care in the operation room, and the brainstorming method is used to protect the nursing care. The process is analyzed to identify the causes of the potential failure mode analysis, to calculate the risk priority index, to determine the most improved model and to put forward corrective measures, to reform the nursing quality and safety management in operation room according to the corrective measures. The changes of the RPN value before and after the implementation of the corrective measures, the incidence of adverse events, the instrument nurses and the circuit protection are compared. The results of the evaluation of the quality of the staff and the results of the satisfaction survey of the surgeons assessed the effect of the implementation of the FMEA. Results and analysis of the nursing flow in the operation room with the analysis of the application of FMEA, twenty potential failure modes were identified, such as inadequate preoperative visits, insufficient communication, and the lack of protection measures for the patients. The reasons were analyzed and the RPN values were calculated. According to the RPN value, There are six potential failure modes that need to be rectify and rectify, that is, the prevention measures of surgical infection are not in place, the prevention measures of sharp instrument injury are not in place, the compliance of hand hygiene is poor and the hand washing is not standardized, the communication is inadequate, the position of the body is placed unproperly, the clearance of the operation is not standardized. The rectification measures are formulated and implemented for the six potential failure modes. Evaluation of the effect of the modified measures: the RPN value of the six potential failure modes decreased significantly, and the total RPN value of the six potential failure modes was reduced to 486 from 1154 before the implementation, of which the RPN value of the communication insufficiency mode was reduced from 175 to 80, the RPN value of the sharp instrument prevention measures was reduced from 210 to 100, the RPN value of the hand hygiene compliance poor hand washing was reduced from 210 to 210. To 80, the RPN value of improper placement of the body was reduced from 175 to 60, the RPN value of the surgical infection prevention measures was reduced from 216 to 96, the RPN value of the operating material inventory was reduced from 168 to 70, and the corresponding adverse events decreased significantly (P0.01); the qualification rate of the working quality assessment of the instrument nurses increased by 90% before the improvement measures. 98%, the qualified rate of the evaluation of the working quality of the itinerant nurses was raised from 88.33% to 97.5% before the implementation of the improvement measures. The qualified rate had been significantly improved (P0.01). The satisfaction of the surgeons on the related content after the implementation of the improved measures was obviously improved (P0.05) the application of.FMEA standardized the working system and process of the operation room, and improved the nursing quality of the operation room. The monitoring system has strengthened the training of professional theory and professional skills of nurses in operation room and standardized the nursing quality and safety management in the operation room. Conclusions and countermeasures are suggested to use FMEA to analyze the nursing process, and to formulate and implement the corrective measures can reduce the RPN value of the failure mode, the incidence of related adverse events and the improvement of the instruments. Nurses, the qualified rate of the evaluation of the working quality of the circuit nurses and the satisfaction of the surgeons; the use of FMEA can make the nursing quality safety management in the operation room effectively standardized; the application of the failure mode and effect analysis (FMEA) in the nursing quality safety management of the operation room is effective and feasible, which can reduce the occurrence of the operation risk and guarantee the suffering of the patient. In implementing the FMEA, we should build a suitable FMEA management model in combination with the actual situation. In the implementation of FMEA management, the brainstorming should be properly applied to ensure the evaluation of the failure mode, the scientificity of the quantitative process, and the support of the management level, in order to obtain sufficient policies and resources, and also the methods of FMEA and RAC, HACCP and so on. Combined with the use of FMEA to further optimize.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472.3

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