医疗失效模式与效应分析在门急诊患儿静脉留置针安全管理中的应用

罗志攀; 汤玉霞; 任春霞; 胡少华; 周焕; 徐涛

doi:10.16766/j.cnki.issn.1674-4152.004170

医疗失效模式与效应分析在门急诊患儿静脉留置针安全管理中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004170

1.
安徽医科大学第一附属医院儿科，安徽合肥 230022
2.
蚌埠医科大学第一附属医院临床试验研究中心，安徽蚌埠 233004
3.
安徽医科大学药学院，安徽合肥 230022

基金项目:

安徽省卫生健康软科学研究项目 2020WR02001

详细信息

通讯作者:
徐涛，E-mail：815499239@qq.com

中图分类号: R197.323.2
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出版历程
- 收稿日期: 2024-08-02
- 网络出版日期: 2025-11-17

Application of medical failure mode and effect analysis in the safety management of intravenous indwelling needles in pediatric outpatient and emergency care

1.
Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的探索在门急诊患儿静脉留置针管理中医疗失效模式与效应分析的应用价值。方法以2022年12月—2023年12月在安徽医科大学第一附属医院就诊的年龄5~14岁需行静脉留置针穿刺治疗的86例门急诊患儿为研究对象，按简单数字法随机分为2组，观察组43例患儿采用医疗失效模式与效应分析管理，对照组43例患儿采用常规管理。比较2组患儿静脉留置针管理情况、不良事件发生情况，同时采用改良疼痛行为评估量表(MBPS)对患儿静脉留置针穿刺时的疼痛程度进行评分。结果采用医疗失效模式与效应分析管理的观察组患儿重复穿刺率为9.3%(4/43)，对照组患儿重复穿刺率为27.9%(12/43)，组间差异有统计学意义(P=0.027)；观察组不良事件发生率为7.0%(3/43)，对照组为23.3%(10/43)，组间差异有统计学意义(P=0.035)；观察组MBPS疼痛评分总分低于对照组[4(3, 5)分vs. 5(4, 6)分，P＜0.001]，组间差异有统计学意义。结论医疗失效模式与效应分析应用于门急诊患儿静脉留置针安全管理中，有利于提高静脉留置针使用期间的安全性，提升患儿就医体验。
- 医疗失效模式与效应分析 /
- 静脉留置针 /
- 安全管理
Abstract: Objective To investigate the application value of medical failure modes and effects analysis in the management of intravenous indwelling needles for pediatric outpatients and emergency patients. Methods A total of 86 pediatric outpatients aged 5-14 years at the First Affiliated Hospital of Anhui Medical University of Anhui Province from December 2022 to December 2023, requiring intravenous indentation needle puncture treatment were selected as the research objects. They were randomly divided into two groups according to simple number method, 43 children in the observation group received medical failure mode and effect analysis, while 43 children in the control group received routine management. The management outcomes and incidence occurrence of adverse events related to intravenous indwelling needle use were compared and analyzed between the two groups. At the same time, modified behavioral pain scale (MBPS) was used to assess the pain degree during indwelling needle puncture. Results The repeat puncture rate was significantly lower in the observation group (9.3%, 4/43) compared to the control group (27.9%, 12/43, P=0.027). The incidence of adverse events was also significantly reduced in the observation group (7.0%, 3/43) compared to the control group (23.3%, 10/43, P=0.035). Additionally, the MBPS pain score in the observation group was significantly lower than that of the control group [4 (3, 5) vs. 5 (4, 6), P < 0.001]. Conclusion The application of medical failure mode and effect analysis in the safety management of intravenous indwelling needles in pediatric outpatient and emergency departments effectively enhances patient safety and improves the overall medical experience for children.
- Medical failure mode and effect analysis /
- Intravenous indwelling needle /
- Safety management

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图 1 改进后门急诊患儿静脉留置针工作流程

Figure 1. Improving the work flow of intravenous indentation needle in children with backdoor emergency

下载: 全尺寸图片幻灯片

图 2 多功能一体式输液保护装置示意图

注：1为医用连接套框；2为无纺布固定带；3为魔术扣；4为托垫；5为棉布垫；6为透明保护罩；601为通气孔；602为出线口。

Figure 2. Schematic diagram of multifunctional integrated infusion protection device

下载: 全尺寸图片幻灯片

表 1 2组行静脉留置针输液患儿一般资料比较

Table 1. Comparison of general data of two groups of children who received intravenous indwelling needle infusion

组别	例数	年龄(x±s, 岁)	性别(例)		独生子女(例)		城镇户籍(例)		父母陪同(例)
组别	例数	年龄(x±s, 岁)	男	女	是	否	是	否	是	否
观察组	43	7.30±2.26	22	21	24	19	25	18	26	17
对照组	43	7.81±1.98	21	22	22	21	26	17	23	20
统计量		1.116^a	0.047^b		0.187^b		0.195^b		0.427^b
P值		0.268	0.829		0.665		0.659		0.514
注：^a为t值，^b为χ²值。

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表 2 潜在失效模式风险分析表

Table 2. Potential failure mode risk analysis table

系统流程	潜在失效因素	严重程度	发生频率	检测可能性	RPN
血管选择	血管选择不佳	6.1	5.3	5.7	184.3
合适的固定设备	缺乏合适的固定设备	5.2	5.4	5.1	143.2
健康教育	健康教育未到位	5.5	5.8	6.1	194.6
专业操作培训和考核	护士缺乏专业操作培训和考核	4.4	5.8	6.9	176.1
患儿居家期间留置针保护	患儿居家期间缺乏对留置针保护的依从性	4.8	5.9	6.8	192.6
留置期间情况评价	未对患儿在留置期间出现的情况进行及时评价	4.5	5.7	7.8	200.1

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表 3 2组行静脉留置针输液患儿MBPS疼痛评分比较[M(P₂₅, P₇₅), 分]

Table 3. Comparison of MBPS pain scores of children receiving intravenous indwelling needle infusion between the two groups[M(P₂₅, P₇₅), points]

组别	例数	面部表情	哭闹情况	行为情况	MBPS总分
观察组	43	1(1, 1)	2(1, 2)	1(0, 2)	4(3, 5)
对照组	43	1(1, 2)	2(1, 3)	2(1, 3)	5(4, 6)
Z值		-3.554	-2.557	-3.852	-5.264
P值		< 0.001	0.006	< 0.001	< 0.001

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