胸腹腔恶性积液患者穿刺置管护理的失效模式与效应分析

目的探讨失效模式与效应分析(failure mode and effect analysis,FMEA)在胸腹腔恶性积液患者穿刺置管护理中的应用效果。方法便利选择2011年3月至2012年5月安徽医科大学附属巢湖医院肿瘤内科胸腹腔穿刺置管患者51例作为试验前组,进行常规护理;选择2012年6月至2013年8月的47例患者作为试验组,用FMEA对置管术后可能出现的失效模式进行前瞻性分析,找出导致并发症的最高危因素,制定防范优先行动计划和改进措施。结果应用FMEA后,10个高危因素的危机值较试验前组显著降低,胸腹腔穿刺置管患者术后导管滑脱、堵塞或引流不畅、穿刺点感染的发生率均有不同程度的下降(均P0.05),患者对导管护理的满意度有所提升(P0.01)。结论应用FMEA能够准确把握胸腹腔穿刺置管术后护理的重点环节,如导管固定、风险评估等,有效减少置管术后并发症,促进护理质量的持续改进。

Effect Analysis and Failure Mode in Nursing Care of Catheterization for Patient with Thoracic and Abdominal Malignant Effusion

Objective To investigate the effect of failure mode and effect analysis （FMEA）in nursing care of catheterization for patient with thoracic and abdominal malignant effusion.Methods By convenience sampling,a total of 51 cases accepted thoracic and abdominal cavity puncture in our department from 2011 March to 2012 May were assigned to the control group,and routine nursing was delivered to the control group.47 cases from 2012 June to 2013 August were selected as experimental group.Analyze the possible reasons for the failure mode after catheter by FMEA,to find the highest risk factors that lead to complications,and make priority prevention plans and improvement measures.Result After the application of FMEA,10 risk factors in the experimental group were significantly lower than that in the control group, and the incidence of postoperative catheter slippage,blockage or poor drainage and puncture site infection in two groups were both declined in varying degrees （all P〈0.05）,and patient satisfaction with nursing was improved.Conclusion Application of FMEA can grasp the key points of nursing care of thoracic and abdominal puncture,such as the fixation of tube,the risk assessment,and it can effectively reduce the post-operative complications of catheterization,and promote the continues improvement of nursing quality.