本文選題：失效模式與效應(yīng)分析 + 手術(shù)室護理��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景目前,隨著人們對醫(yī)療服務(wù)的要求越來越高,手術(shù)室護理質(zhì)量安全管理已經(jīng)成為醫(yī)療安全的熱點問題。特別是近年來不斷有新的技術(shù)在臨床開展應(yīng)用,手術(shù)設(shè)備更加先進,功能更加完善。為適應(yīng)外科的發(fā)展,手術(shù)室的護理質(zhì)量也需要不斷的完善進步和協(xié)調(diào)發(fā)展。否則,就會影響到手術(shù)治療的效果,甚至?xí){到患者的安全,引起醫(yī)患矛盾。因此,這就要求我們采用更為科學(xué)的工具和方法對原有的手術(shù)室護理質(zhì)量管理體系、流程以及各個工作環(huán)節(jié)進行科學(xué)分析,及早的找出高風(fēng)險環(huán)節(jié),提出改進措施和建議,消除隱患。失效模式與效應(yīng)分析(failure mode and effects analysis,FMEA)是一種基于團隊的、系統(tǒng)性和前瞻性的可靠的分析方法。通過分析對提供產(chǎn)品或服務(wù)的全部過程,識別所有流程中可能存在的故障,并對故障的嚴重度、發(fā)生率、可探測度進行綜合評估,借助量化指標判斷其失效程度,提出和制定合理的建議及措施,消除故障發(fā)生的可能性,使故障的不良結(jié)果降到最小,是持續(xù)的質(zhì)量改進過程。目前,失效模式與效應(yīng)分析法在醫(yī)療風(fēng)險控制方面的應(yīng)用已引起醫(yī)務(wù)工作者的廣泛關(guān)注。研究目的探討失效模式與效應(yīng)分析法(FMEA)在手術(shù)室護理質(zhì)量安全管理中的應(yīng)用,構(gòu)建手術(shù)室護理質(zhì)量安全管理FMEA模式;針對手術(shù)室護理質(zhì)量安全中存在的問題提出相關(guān)改進措施,規(guī)范手術(shù)室護理質(zhì)量安全管理。本研究探索在手術(shù)室護理質(zhì)量安全管理中采用失效模式和效應(yīng)分析法,探討失效模式和效應(yīng)分析在手術(shù)室護理質(zhì)量安全管理中的可行性,前瞻性地為手術(shù)室護理質(zhì)量安全管理中存在的風(fēng)險的預(yù)防提供依據(jù),規(guī)范手術(shù)室護理質(zhì)量安全管理,從而實現(xiàn)保障患者安全的目的,提高手術(shù)醫(yī)生的滿意度,踐行優(yōu)質(zhì)護理服務(wù)理念。研究方法根據(jù)研究主題,組建由相關(guān)專業(yè)背景專家組成的FMEA小組,繪制手術(shù)室護理實際流程圖,運用頭腦風(fēng)暴法對手術(shù)室護理流程進行分析,識別潛在失效模式分析原因,計算風(fēng)險優(yōu)先指數(shù),確定最需改善的模式并提出整改措施,根據(jù)整改措施對手術(shù)室護理質(zhì)量安全管理實施整改。比較實施整改措施前后RPN值的變化、手術(shù)不良事件發(fā)生率、器械護士和巡回護士工作質(zhì)量測評結(jié)果、手術(shù)醫(yī)生滿意度調(diào)查結(jié)果評估實施FMEA效果。結(jié)果與分析應(yīng)用FMEA法對手術(shù)室護理流程進行分析,識別出術(shù)前訪視不充分、溝通不足、接送患者保護措施欠缺等二十項潛在失效模式,分析原因并計算RPN值。根據(jù)RPN值確定了六項需要優(yōu)先整改的潛在失效模式,即:手術(shù)感染預(yù)防措施不到位、銳器傷預(yù)防措施不到位、手衛(wèi)生依從性差及洗手不規(guī)范、溝通不足、體位安置不當、手術(shù)用物清點欠規(guī)范。針對這六項潛在失效模式制訂并實施了整改措施。對實施整改措施效果評價:六項潛在失效模式的RPN值均明顯下降,六項潛在失效模式總RPN值由實施前的1154降低到486,其中溝通不足模式RPN值由175降低至80,銳器傷預(yù)防措施不到位模式RPN值由210降至100,手衛(wèi)生依從性差洗手不規(guī)范模式RPN值由210降至80,體位安置不當模式RPN值由175降至60,手術(shù)感染預(yù)防措施不到位模式RPN值由216降至96,手術(shù)用物清點欠規(guī)范模式RPN值由168降至70;相應(yīng)的手術(shù)不良事件發(fā)生顯著下降(P0.01);器械護士工作質(zhì)量測評的合格率由實施改進措施前的90%上升到98%,巡回護士工作質(zhì)量測評的合格率由實施改進措施前的88.33%提升到97.5%,合格率均有顯著提高(P0.01);手術(shù)醫(yī)生對改進措施實施后相關(guān)內(nèi)容的滿意度均明顯提高(P0.05)。FMEA的應(yīng)用規(guī)范了手術(shù)室的工作制度與流程,完善了手術(shù)室護理質(zhì)量監(jiān)測體系,強化了手術(shù)室護士的專業(yè)理論和專業(yè)技能的培訓(xùn),規(guī)范了手術(shù)室護理質(zhì)量安全管理。結(jié)論與對策建議運用FMEA對手術(shù)室護理流程進行分析,制定并實施整改措施可以降低失效模式的RPN值、相關(guān)手術(shù)不良事件發(fā)生率并提高器械護士、巡回護士工作質(zhì)量測評的合格率和手術(shù)醫(yī)生的滿意度;運用FMEA可使手術(shù)室護理質(zhì)量安全管理得到了有效地規(guī)范;失效模式與效應(yīng)分析法(FMEA)在手術(shù)室護理質(zhì)量安全管理中的應(yīng)用是有效、可行的,可降低手術(shù)風(fēng)險的發(fā)生,保障了患者的安全。實施FMEA,應(yīng)結(jié)合各自的實際情況構(gòu)建適合的FMEA管理模式。在實施FMEA管理中,應(yīng)正確運用頭腦風(fēng)暴,確保失效模式的評估、量化過程的科學(xué)性,還應(yīng)獲得管理層的支持,以爭取足夠的政策和資源的支持。還可將FMEA與RAC、HACCP等方法結(jié)合在一起使用,實現(xiàn)對FMEA的進一步優(yōu)化。
[Abstract]:At present, with the increasing demand for medical service, the quality and safety management of operation room nursing has become a hot issue in medical safety. Especially in recent years, new technology has been applied in clinical practice, the operation equipment is more advanced and the function is more perfect. In order to adapt to the development of surgery, the quality of nursing in the operation room is also It is necessary to improve the progress and coordinated development. Otherwise, it will affect the effect of surgical treatment, even threaten the safety of the patient and cause the contradiction between doctors and patients. Therefore, this requires us to use more scientific tools and methods to scientifically analyze the original operation room nursing quality management system, process and various work links. Failure mode and effects analysis (FMEA) is a team based, systematic and forward-looking analytical method based on the analysis of the whole process of providing products or services and identifying possible causes in all processes. It also makes comprehensive evaluation on the severity, occurrence rate and detectable measure of the fault, judges its failure degree with the help of quantitative index, puts forward and formulating reasonable suggestions and measures to eliminate the possibility of failure and minimize the bad results of the fault. It is a continuous quality improvement process. At present, the failure mode and effect analysis method is in the medical wind. The application of risk control has attracted the attention of medical workers. The purpose of this study is to explore the application of failure mode and effect analysis (FMEA) in the management of nursing quality and safety in operation room, to construct the FMEA mode of nursing quality safety management in operation room, and to put forward some relevant improvement measures for the problems existing in nursing quality safety. This study explored the feasibility of failure mode and effect analysis in nursing quality safety management, and prospectively provided the basis for the prevention of risk in nursing quality safety management. To standardize the management of nursing quality and safety in the operation room, to achieve the purpose of ensuring the safety of the patients, improve the satisfaction of the surgeons and practice the concept of high quality nursing service. Based on the research topic, the FMEA group, composed of relevant professional background experts, is set up to draw the actual flowchart of the nursing care in the operation room, and the brainstorming method is used to protect the nursing care. The process is analyzed to identify the causes of the potential failure mode analysis, to calculate the risk priority index, to determine the most improved model and to put forward corrective measures, to reform the nursing quality and safety management in operation room according to the corrective measures. The changes of the RPN value before and after the implementation of the corrective measures, the incidence of adverse events, the instrument nurses and the circuit protection are compared. The results of the evaluation of the quality of the staff and the results of the satisfaction survey of the surgeons assessed the effect of the implementation of the FMEA. Results and analysis of the nursing flow in the operation room with the analysis of the application of FMEA, twenty potential failure modes were identified, such as inadequate preoperative visits, insufficient communication, and the lack of protection measures for the patients. The reasons were analyzed and the RPN values were calculated. According to the RPN value, There are six potential failure modes that need to be rectify and rectify, that is, the prevention measures of surgical infection are not in place, the prevention measures of sharp instrument injury are not in place, the compliance of hand hygiene is poor and the hand washing is not standardized, the communication is inadequate, the position of the body is placed unproperly, the clearance of the operation is not standardized. The rectification measures are formulated and implemented for the six potential failure modes. Evaluation of the effect of the modified measures: the RPN value of the six potential failure modes decreased significantly, and the total RPN value of the six potential failure modes was reduced to 486 from 1154 before the implementation, of which the RPN value of the communication insufficiency mode was reduced from 175 to 80, the RPN value of the sharp instrument prevention measures was reduced from 210 to 100, the RPN value of the hand hygiene compliance poor hand washing was reduced from 210 to 210. To 80, the RPN value of improper placement of the body was reduced from 175 to 60, the RPN value of the surgical infection prevention measures was reduced from 216 to 96, the RPN value of the operating material inventory was reduced from 168 to 70, and the corresponding adverse events decreased significantly (P0.01); the qualification rate of the working quality assessment of the instrument nurses increased by 90% before the improvement measures. 98%, the qualified rate of the evaluation of the working quality of the itinerant nurses was raised from 88.33% to 97.5% before the implementation of the improvement measures. The qualified rate had been significantly improved (P0.01). The satisfaction of the surgeons on the related content after the implementation of the improved measures was obviously improved (P0.05) the application of.FMEA standardized the working system and process of the operation room, and improved the nursing quality of the operation room. The monitoring system has strengthened the training of professional theory and professional skills of nurses in operation room and standardized the nursing quality and safety management in the operation room. Conclusions and countermeasures are suggested to use FMEA to analyze the nursing process, and to formulate and implement the corrective measures can reduce the RPN value of the failure mode, the incidence of related adverse events and the improvement of the instruments. Nurses, the qualified rate of the evaluation of the working quality of the circuit nurses and the satisfaction of the surgeons; the use of FMEA can make the nursing quality safety management in the operation room effectively standardized; the application of the failure mode and effect analysis (FMEA) in the nursing quality safety management of the operation room is effective and feasible, which can reduce the occurrence of the operation risk and guarantee the suffering of the patient. In implementing the FMEA, we should build a suitable FMEA management model in combination with the actual situation. In the implementation of FMEA management, the brainstorming should be properly applied to ensure the evaluation of the failure mode, the scientificity of the quantitative process, and the support of the management level, in order to obtain sufficient policies and resources, and also the methods of FMEA and RAC, HACCP and so on. Combined with the use of FMEA to further optimize.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R472.3

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