失效模式与效应分析在泌尿系肿瘤围手术期患者深静脉血栓非药物干预中的应用OA
Application of Failure Mode and Effects Analysis in Non-Pharmacological Interventions for Deep Vein Thrombosis in Perioperative Patients with Urological Tumors
目的 研究失效模式和效应分析(FMEA)在泌尿系肿瘤患者围手术期深静脉血栓(DVT)非药物预防管理中的风险优化及临床效果,旨在为完善该类患者护理服务提供参考.方法 2023年2月至2026年1月,采用便利抽样法选取安徽省某三级甲等医院收治的66例泌尿系肿瘤手术患者作为研究对象.根据入院时间将2023年2月至2024年2月入院的33例患者纳入对照组,实施常规DVT非药物预防措施;将2024年3月至2026年1月入院的33例患者纳入干预组,实施基于FMEA制定的优化措施.比较干预前后失效模式风险优先值(RPN),以及两组患者预防流程中过程质量指标、患者结局指标和康复指标.结果 干预后,5项高风险失效模式(风险评分不准确、术后早期活动不足、梯度压力袜未规范穿戴、间歇充气加压泵未规范使用、患者依从性不足)的RPN值均较干预前下降(P<0.01).干预组风险评分准确率、早期下床活动执行率、梯度压力袜规范穿戴率、间歇充气加压泵规范使用执行率及患者早期活动依从性评分均优于对照组(P<0.01);在结局指标方面,干预组DVT发生率、下肢肢体肿胀发生率、下肢皮肤损伤发生率均低于对照组(P<0.05),两组均未发生肺栓塞;康复指标上,干预组首次下床时间及平均住院时间均短于对照组(P<0.05).结论 运用FMEA可精准识别并优化泌尿系肿瘤围手术期DVT非药物预防的高风险环节,有效提升预防管理质量,加速患者术后康复.
Objective To investigate the risk optimization and clinical effects of Failure Mode and Effects Analysis(FMEA)in non-pharmacological prophylaxis for perioperative deep vein thrombosis(DVT)in patients with urological tumors,aiming to provide a reference for improving nursing care for these patients.Methods From February 2023 to January 2026,66 patients undergoing surgery for urological tumors at a Grade III-A hospital in Anhui Province were selected by convenience sampling.Based on the time of admission,33 patients admitted from February 2023 to February 2024 were assigned to the control group and received routine non-pharmacological prophylaxis for DVT;33 patients admitted from March 2024 to January 2026 were assigned to the intervention group and received optimized measures developed based on FMEA.The risk priority numbers(RPN)of failure modes were compared before and after the intervention;the process quality indicators,patient outcome indicators,and rehabilitation indicators in the prophylaxis process were compared between groups.Results After the intervention,the RPN values of 5 high-risk failure modes(inaccurate risk scores,insufficient early postoperative mobilization,improper wearing of graduated compression stockings,improper use of intermittent pneumatic compression pumps,and poor patient compliance)all decreased compared to pre-intervention levels(P<0.01).The risk score accuracy,early mobilization rate,proper wearing rate of graduated compression stockings,proper use rate of intermittent pneumatic compression pumps,and patient early mobilization compliance score were all better in the intervention group than in the control group(P<0.01);in terms of outcome indicators,the incidences of DVT,lower limb swelling,and lower limb skin injury in the intervention group were lower than those in the control group(P<0.05),and no pulmonary embolism occurred in either group;in terms of rehabilitation indicators,the time to first mobilization and the mean length of hospital stay in the intervention group were shorter than those in the control group(P<0.05).Conclusion FMEA can accurately identify and optimize high-risk links in the non-pharmacological prophylaxis of perioperative DVT in patients with urological tumors,thus improving prophylactic quality and accelerating postoperative recovery.
谢莉;刁兆香;余子强;王胜男;李华刚;杜和喜
安徽中医药大学第一附属医院,安徽 合肥 230031安徽中医药大学第一附属医院,安徽 合肥 230031安徽中医药大学第一附属医院,安徽 合肥 230031安徽中医药大学护理学院,安徽 合肥 230032安徽中医药大学第一附属医院,安徽 合肥 230031安徽中医药大学第一附属医院,安徽 合肥 230031
医药卫生
深静脉血栓泌尿系肿瘤围手术期康复失效模式和效应分析质量管理
Deep vein thrombosisUrological tumorPerioperative rehabilitationFailure Mode and Effects AnalysisQuality management
《上海护理》 2026 (9)
15-21,7
国家自然科学基金项目-青年科学基金项目(82100815).
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