医疗失效模式与效应分析在预防社区脑卒中跌倒中的应用

目的]运用医疗失效模式与效应分析(HFMEA)方法对社区防跌倒管理流程进行改进并实施,以有效规避脑卒中患者跌倒高危因素,降低脑卒中患者跌倒发生率。方法]选取2016年1-12月静安区某社区卫生服务中心管理的脑卒中患者163名。首先,进行脑卒中患者跌倒风险调查,了解跌倒发生情况,并进行多因素分析筛选跌倒高危因素；然后,采用HFMEA 方法,将上述调查对象随机分为二组,实施6个月干预,并对二组脑卒中患者首次入户随访时间、跌倒风险因素及跌倒次数进行评价。结果]调查对象一年内跌倒发生率为31.29%,行走辅助用具、视力对日常的影响、对外界反应能力、脚无力是跌倒的独立危险因素,见表3。二组在首次入户干预时间、跌倒风险评估总分、跌倒次数方面存在显著差异 (P<0.05),见表4。结论]运用医疗失效模式与效应分析(HFMEA)方法改进并实施社区防跌倒管理流程和控制方案,可降低跌倒风险,减少跌倒发生。

The application of medical failure mode and effect analysis in the prevention of stroke in the community

(Pengpu Community Health Service Center of Jingan District, Shanghai 200435, China) ABSTRACTObjective: The medical failure mode and effect analysis (HFMEA) method was applied to improve and implement the community fall prevention management process, so as to effectively avoid the risk factors of falls and reduce the incidence of falls in stroke patients. Methods] A total of 163 stroke patients managed by a community health service center in Jingan District in 2016 1-12 were randomly divided into intervention group (81 cases) and control group (82 cases) according to the time sequence of entering the stroke management platform. The intervention group: first, the 163 stroke management objects fall risk investigation; using the HFMEA method of potential failure mode in the process management of stroke were analyzed to find the reasons, formulate rectification measures; comparison of intervention risk factors of nursing staff for the first time home follow-up time, stroke patients fell 6 the number of fall months and difference. results] There were 51 cases of falls in the past year, accounting for 31.29%. Walking aids, visual acuity, daily reaction, ability of external reaction and weakness of feet were independent risk factors for falls. There were significant differences between the 2 groups in the first time of family intervention, the total score of fall risk and the number of falls (P<0.05). Conclusion] Using the medical failure mode and effect analysis (HFMEA) method to improve and implement the community anti fall management process and control plan, it can reduce the risk of fall and reduce the occurrence of falls.