摘要
目的探讨应用失效模式与效应分析(FMEA)方法对ICU高龄患者呼吸机相关性肺炎(VAP)发生的影响。方法选取2021年10月1日至2022年7月31日北京协和医院ICU病房收治的111例高龄患者作为研究对象,2021年10月1日至2022年2月28日收治的患者作为对照组,2022年3月1日至2022年7月31日收治的患者作为试验组。其中3例患者脱落,最终共108例患者完成本研究。对照组(n=53)运用常规VAP防范管理措施,试验组(n=55)运用FMEA管理模式制订的改进措施,比较两组患者潜在失效模式的风险优先指数、VAP发生率、VAP千日感染率和满意度。结果依据FMEA共识别出6项潜在失效模式,包括床头抬高不到位、声门下吸引不及时、气囊压力不足、口腔护理质量不达标、吸痰操作不规范、早期活动评估不全面。试验组的6项潜在失效模式的风险优先指数均低于对照组,差异有统计学意义(P<0.05)。试验组的VAP发生率和VAP千日感染率均低于对照组,差异有统计学意义(P<0.05)。试验组满意度高于对照组,差异有统计学意义(P<0.05)。结论FMEA管理模式可有效降低ICU高龄患者VAP的发生率,提高护理质量。
Objective To investigate the effect of failure mode and effect analysis(FMEA)on the occurrence of ventilator-associated pneumonia(VAP)in elderly patients in ICU.Methods A total of 111 elderly patients admitted to the ICU of Peking Union Medical College Hospital from October 1,2021 to July 31,2022 were selected as the study objects,and patients admitted from October 1,2021 to February 28,2022 were selected as the control group,patients admitted between March 1,2022 and July 31,2022 were elected as the experimental group.Three patients fell out,and a total of 108 patients completed the study.The control group(n=53)used the conventional VAP preventive management measures,and the experimental group(n=55)used the improvement measures formulated by FMEA management mode.The risk priority index of potential failure mode,VAP incidence,VAP 1000 day infection rate and satisfaction were compared between the two groups.Results According to FMEA consensus,six potential failure modes were identified,including inadequate bedside elevation,untimely subglottic aspiration,insufficient air bag pressure,substandard oral care quality,non-standard sputum aspiration operation,and incomplete early activity evaluation.The risk priority index of 6 potential failure modes in experimental group were lower than those in control group,and the differences were statistically significant(P<0.05).The VAP incidence and VAP 1000 day infection rate in experimental group were lower than those in control group,and the differences were statistically significant(P<0.05).The satisfaction of experimental group was higher than that of control group,and the difference was statistically significant(P<0.05).Conclusion FMEA management mode can effectively reduce the incidence of VAP in elderly patients in ICU and improve the quality of nursing.
作者
王颖
王新博
韩志慧
张玉瑶
金颖
胡浩琪
鲁梅珊
WANG Ying;WANG Xinbo;HAN Zhihui;ZHANG Yuyao;JIN Ying;HU Haoqi;LU Meishan(Department of Health Care ICU,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing100730,China;Department of Nursing,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing100730,China)
出处
《中国当代医药》
2025年第6期183-186,192,共5页
China Modern Medicine
基金
北京协和医院中央高水平医院临床科研专项(2022-PUMCH-B-026)。
关键词
失效模式与效应分析
ICU
高龄
呼吸机相关性肺炎
风险管理
Failure mode and effect analysis
ICU
Elderly patients
Ventilator-associated pneumonia
Risk management
