预防住院患者跌倒的管理

目的：降低住院患者跌倒事件的发生，提高护理质量，确保患者安全。方法：采用失效模式与效应分析（FMEA）质量改进方法，成立分析小组、绘制流程图、列出潜在失效模式，查找及分析关键失效模式相关的根本原因，提出改善措施并落实。结果：改善措施实施后，患者跌倒失效模式中4项高风险失效模式的RPN值明显低于实施前（P〈0．05）；住院患者跌倒例次低于实施前。结论：运用FMEA管理办法，可有效降低住院患者跌倒事件的发生，减少护理投诉与纠纷，提高护理质量。

The application of FMEA on the prevention of falls in inpatients

Objective： To reduce the incidence rate of falls in inpatients, to assure the safety of inpatients and to improve the quality of nursing care. Methods： We adopted Failure Mode and Effects Analysis （FMEA）, established an analysis team, drew up a flowchart, listed potential failure modes, found and analyzed the root cause related to key failure mode, put forward improvement measures, and implemented them. Results： The risk priority number （RPN） values of four high-risk failure modes significantly decreased after implementing the measures （P〈0.05）. The incidence rate of falls in inpatients after implementing the measures （from Jan. to Dec. 2013） was significantly lower than that before implementing the measures （from Jan. to Dec. 2012） （P〈0.05）. Conclusion： The application of FEMA can effectively reduce the incidence rate of falls in inpatients, reduce nursing care complaints and disputes, and enhance the quality of nursing care.