摘要
目的:基于信息系统提高用药医嘱开具安全性。方法:应用失效模式与效应分析(FMEA)方法,分析用药医嘱开具过程中可能造成不良事件的失效模式,并以风险优先指数(RPN值)进行评估,提出依托信息系统改造降低不良事件发生率的可行性方案,统计实施6个月的改造成效。结果:在用药医嘱开具各环节中共找出14项风险失效模式。其中RPN值排序前5位的分别是:医嘱审核置后、患者异常检查结果分散、溶媒配伍不适宜、需皮试药品未做皮试、院前用药获取方式复杂。针对前5项高风险失效模式,进行信息系统改造,增加了医嘱前置审核、"患者问题清单"、药品溶媒配伍、护士皮试结果回传、"电子用药清单"等功能。改造后RPN值由1939下降至876,统计改造前后6个月的用药医嘱开具不良事件发生率,同比下降40.74%(由6.48‰下降到3.84‰,P<0.001)。结论:基于信息系统应用FMEA方法,降低了用药医嘱开具不良事件发生率,提高了患者用药安全性。
Objective:To Improve the safety of the medical orders based on information system.Methods:The failure modes of adverse event for processes of the medical orders were investigated based on failure mode and effects analysis(FMEA)method.Combining with risk evaluation was proposed using priority number(RPN),the feasible schemes to reduce adverse event rate were proposed based on information system.The intervention effect was evaluated after 6 months.Results:In the links of the medical orders,14 risk failure modes had been found.Ranking the RPN scores from high to low,5 high-risk failure modes were medical order review lagged behind,abnormal results dispersed,improper solvent of medical orders,skin test ignored,pre-hospital medical obtained difficultly.Thus,risk control measures had been upgrated based on information system,including the pre-audit system of inpatient orders,patient problem list,module of compatible with solvents,system of backhaul of skin test results,development medical reconciliation list and so on.After intervention management,RPN in total were reduced from 1939 to 876;Adverse event rate of the medical orders showed a decline of 40.74%,which was reduced from 6.48‰to 3.84‰(P<0.001).Conclusion:The application of FMEA management method has reduced adverse event rate of the medical orders based on information system,improving the medical safety.
作者
刘子祺
黄兴环
孙百顺
田晓
LIU Zi-qi;HUANG Xing-huan;SUN Bai-shun(Information Department,Beijing Jiangong Hospital,Beijing 100054,P.R.C.)
出处
《中国数字医学》
2020年第10期64-67,共4页
China Digital Medicine
