失效模式與效應分析在PICC風險管理中的應用*

□ 金婷婷 JIN Ting-ting 周堯英 ZHOU Yao-ying

Objective To explore the effect of Healthcare Failure Mode and Effect Analysis (HFMEA) in PICC risk management. Methods HFMEA was used to evaluate the Peripherally Inserted Central Catheter (PICC) catheterization and maintenance procedures, and to analyze the potential causes of six failure mode, including catheter obstruction, catheter prolapse, catheter thrombosis, hematogenous infection, catheter ectopia, and self-extubation. The probability, severity, and detectability of each failure mode were estimated, and Risk Priority Number (RPN) was calculated. PICC risk management was employed to reduce the incidence of failure modes. Results After applying HFMEA in PICC risk management, the RPN values of the six failure modes all significantly decreased, and the difference was statistically significant (p＜0.001). The unplanned extubation rate of PICC patients was reduced to 6.25%from 26.25%. Conclusion HFMEA is effective in PICC risk management. Evaluating potential risks and taking effective measure to prevent failure modes is conductive to improving nursing quality and patient satisfaction.

經外周置入中心靜脈導管(Peripherally Inserted Central Catheters，PICC)是由外周靜脈穿刺插管，使其尖端定位于上腔靜脈或鎖骨下靜脈，為患者提供中、長期的靜脈輸液治療[1]。對于需要反復進行化療的腫瘤患者來說，經外周置入中心靜脈導管是一種安全、可靠的選擇。然而，在PICC置管及維護過程中，患者可能出現導管堵塞、導管脫出、導管血栓、血行感染、甚至導管異位和導管脫落等并發癥，造成非計劃性拔管[2]。非計劃性拔管是指某些人為因素或并發癥造成留置時間未到達預期要求，不得不提前拔除導管[3]。因此，如何有效加強PICC置管及維護，減少非計劃拔管是當前臨床護理中亟待解決的問題。

作為系統化的流程評估方法，醫療失效模式與效應分析(Healthcare Failure Mode and Effect Analysis，HFMEA)采用量化方法尋找和分析問題的潛在原因，針對原因制定、實施改進措施、完善制度、建立規范，從而達到改進醫療質量的效果[4]。本研究采用HFMEA模式用于PICC風險安全管理，旨在降低非計劃性拔管。

資料與方法

1.臨床資料。選取2017年2月至2018年6月在我院收治的PICC置管患者160例，隨機分為實驗組和對照組，每組80例。所有患者均采用BARD(美國巴德)公司生產的安全型三向瓣膜式PICC導管，型號為4Fr，由具備PICC置管資質的護士置管。對照組患者采用常規護理，如健康宣教、病情監護等，實驗組患者在常規護理的基礎上應用HFMEA管理模式。對照組患者男性39例，女性41例，年齡28～88歲，平均年齡46.59±6.15歲。實驗組患者男性42例，女性38例；年齡26～85歲，平均年齡45.78±5.23歲。兩組患者在年齡、性別等人口學變量上差異無統計學意義(p＞0.05)。……