摘要
目的探讨失效模式与效应分析(failure model and effect analysis,FMEA)联合PDCA管理工具在感染性休克患者1 h抗生素使用中的效果。方法选取河北医科大学第二医院收治的感染性休克患者177例及医护人员32例为研究对象。采用不同时间段分组,2组医护人员相同。以2022年1—6月的感染性休克患者87例及医护人员32名为对照组。以2022年7—12月90例感染性休克患者及32名医护人员为观察组。对照组采用常规管理。观察组采用FMEA联合PDCA管理。对比2组一般资料、风险优先数(risk priority number,RPN)值、1 h抗生素使用达标率、28 d病死率及医护人员合作满意度,分析影响1 h抗生素使用达标率的因素。结果患者一般资料、28 d病死率差异无统计学意义(P>0.05)。观察组感染性休克患者1 h抗生素使用达标率及医护合作满意度明显高于对照组,前5位失效模式的RPN值明显低于对照组,差异有统计学意义(P<0.05)。多因素分析结果显示,基础疾病(OR=0.585,95%CI:0.405~0.845,P<0.05)、抗生素使用级别(OR=0.272,95%CI:0.134~0.551,P<0.05)、患者家属教育程度(OR=2.484,95%CI:1.100~5.611,P<0.05)是影响1 h内抗生素使用达标率的独立危险因素。结论FMEA联合PDCA管理工具可规范感染性休克患者1 h抗生素使用流程,提高1 h抗生素使用达标率,加强医护合作。
Objective To investigate the effect of failure model and effect analysis(FMEA)combined with PDCA management tool in 1-h antibiotic use in patients with septic shock.Methods In total,177 patients with septic shock and 32 medical staff were selected as research subjects in the Second Hospital of Hebei Medical University.The medical staff were grouped according to different time periods,with the same medical staff in each group.A total of 87 patients with septic shock and 32 medical staff from January 2022 to June 2022 were selected as control group.A total of 90 patients with septic shock and 32 medical staff from July 2022 to December 2022 were selected as the observation group.The control group was given conventional management,while the observation group was given FMEA combined with PDCA.The general data,risk priority number(RPN)value,compliance rate of 1-h antibiotic use,28-day mortality rate and cooperation satisfaction of medical staff were compared between the two groups,and the factors affecting the compliance rate of 1-h antibiotic use were analyzed.Results There was no significant difference in general information and 28-day mortality between the two groups(P>0.05).The compliance rate of 1-h antibioticuse and satisfaction degree of medical cooperation of septic shock patients in the observation group were significantly higher than those in the control group,and the RPN values of the first 5 failure modes were significantly lower than those in the control group,with statistical significance(P<0.05).The results of multivariate analysis showed that the underlying disease(OR=0.585,95%CI:0.405-0.845,P<0.05),antibiotic use grade(OR=0.272,95%CI:0.134-0.551,P<0.05)and family education level(OR=2.484,95%CI:1.100-5.611,P<0.05)were independent risk factors affecting the compliance rate of 1-h antibiotic use.Conclusion FMEA combined with PDCA management tools can standardize the process of 1-h antibiotic use in patients with septic shock,improve the compliance rate of 1-h antibiotic use,and strengthen medical coopera
作者
张曼莉
王国英
虎于丁
陈慧
宋璇
佟飞
ZHANG Man-li;WANG Guo-ying;HU Yu-ding;CHEN Hui;SONG Xuan;TONG Fei(Department of Intensive Care Unit,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)
出处
《河北医科大学学报》
CAS
2024年第11期1310-1316,共7页
Journal of Hebei Medical University
基金
河北省政府资助临床医学优秀人才培养项目(ZF2023113)。
