摘要
目的观察失效模式与效应分析(Failure mode and effect analysis,FMEA)模式下构建急诊危重症患者临床护理路径管理的效果。方法淮安市第一人民医院于2019年1月开始施行FMEA模式下构建急诊危重症患者临床护理路径管理(简称FMEA临床路径),利用回顾性分析方法收集2018年1月-2018年12月就诊本院的急诊危重症患者82例(对照组),利用倾向性评分匹配法在2019年2月-2020年6月就诊患者中选择与对照组具有相同性别、年龄、急性生理和慢性健康评分(APACHEⅡ)、发病至入院时间、疾病类别的急诊危重症患者82例(观察组),两组匹配比例为1∶1,用于确定FMEA临床路径前后患者的抢救室滞留时间、抢救时间、住院时间、危重症交接时间、抢救成功率、转运相关不良事件发生情况、并发症控制情况差异。结果观察组患者抢救室滞留时间、抢救时间、危重症交接时间,转运期间血压下降、呼吸骤停、心搏骤停、管道脱落/堵塞、药品物品不齐、交接不清、转运延迟以及压疮、下肢深静脉血栓、跌倒发生率及并发症总发生率均低于对照组(P<0.05);观察组患者抢救成功率为95.12%(78/82),高于对照组抢救成功率(P<0.05);观察组健康教育完成度评分高于对照组,差异有统计学意义(P<0.05)。结论FMEA模式下构建急诊危重症患者临床护理路径管理方案能够有效降低抢救室滞留时间、抢救时间、危重症交接时间、转运期间风险事件及抢救后压疮、下肢深静脉血栓、跌倒并发症风险,有效提升抢救成功率,有助于提升护理人员健康教育完成度。
Objective To study the effects of clinical care path management for emergency critical patients in failure mode and effect analysis(FMEA).Methods A total of 164 patients admitted to the emergency department of Huai'an First People's Hospital were included in this study.82 patients admitted from January 2018 to December 2018 served as the control group.Another 82 patients admitted between February 2019 and June 2020 were selected as the observation group that began to implement FMEA by that time.Emergency room retention time,hospitalization time,critical illness handover time,rescue success rate,nosocomial infection and complication control of critical patients were analyzed and compared between two groups.Results The patient retention time,rescue time,handover time of critical illness,blood pressures decline during transit,respiratory arrest,cardiac arrest,pipe shedding/blockage,drugs,unclear delivery,delayed transport incidence,pressure ulcers,lower limb deep vein thrombosis,falls and complications of the observation group were lower than those of the control group(P<0.05).The rescue success rate of the patients in the observation group was 95.12%,which was higher than that of the control group(82.93%)(P<0.05).There was a significant difference in the completion of health education between the two groups(P<0.05).Conclusion Clinical care path management for emergency critical patients under FMEA mode can effectively reduce the retention time,rescue time,critical disease handover time,risk events during transit,post-rescue pressure ulcers,lower limb deep vein thrombosis and fall complications,and improve the success rate of rescue and the completion of health education for caregivers.
作者
黄沛君
冯进进
HUANG Peijun;FENG Jinjin(Emergency Department,Huai'an First People's Hospital,Huai'an Jiangsu 223000,China)
出处
《中国急救复苏与灾害医学杂志》
2024年第5期667-672,共6页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
失效模式与效应分析
急诊
危重症
临床护理路径
Failure mode and effect analysis(FMEA)
Emergency department
Critical disease
Clinical care path
