Based On The Theory Of The FMEA,Preliminary Study In Risk Management Mode After Colorectal Surgery SSI And Clinical Application Research

PurposesApplication of failure mode and effect analysis(FMEA)theory in the prevention and control of SSI after colorectal surgery,to build a complete set of risk management system,form systematic standard operating procedures[SOP],establishing a clear quantitative evaluation indicator.To reduce the rate of SSI infection,regulate the use of perioperative antibiotics,reduce the length of hospital stay and hospital costs,So as to reduce the burden on patients,improve the economic and social benefits of medical institutions.Methods1.Data was managed using Epidata software and analysed with SPSS version 20.0,X 2 test,independent sample t test,Mann-Whitney U test,unconditional logistic regression,paired rank sum test were used to analyze the data.2.Using targeted monitoring combined with retrospective surveys,risk factors analysis data were collected from hospital patients from 2010 to 2014 in a third-level hospital 825 cases who were carried on colon or rectal surgery,we can know the factors of SSI though the statistical analysis,and analyse the possible causes of these results.3.I divided the data into two groups,the data for the trial group were prospectively collected,which were collected from the patients 366 cases who were underwent colorectal surgery from January 1,2015 to June 30,2016,from a hospital in Nanjing,performed a comprehensive intervention strategy based on FMEA during the study.The patients were received colorectal surgery from January 1,2013 to December 31,2014,in the control group in the same hospital,and the data were collected with reltrospective investigation.The two groups were matched by 1:1 ratio according to the matching conditions.We can find out the failure mode which was need to be addressed first though the FMEA theory,developing improvement measures,and assisting in the implementation of clinical medical staff.The data of the two groups were analyzed and compared,and the significance value of FMEA theory in the prevention and control of SSI after colorectal surgery were discussed.Result1.The univariate factor and multi-factor were used in study.The results of regression analysis showed that gender,age,intraoperative chemotherapy,ASA score,operation duration,postoperative ALB value,surgical site were closely related to SSI after the operation.Based on unconditional logistic regression analysis and two rounds of expert survey results.Using FMEA theory and Decision tree analysis to integrate the prevention and control of postoperative SSI process,a total of 10 links were need to be solved first,which were included points are given for ASA scores>2,the poor body resistance;experience medication,not timely in accordance with the results of microbiological examination of drug samples to adjust the medication,poorly controlled perioperative blood glucose,postoperative dressing operation was not standardized,intraoperative insulation measures are not in place,endotherm knife-related damage,intraoperative btood loss>300ml,postoperative drainage tube placed ≥ 5 days,surgical hand washing was not standardized,lengths of operations>180min.2.The analysis of the data of the two groups patients shows,after the implementation of the intervention,the experimental group of patients with SSI were 20 cases,accounting for 9.53%,the control group SSI were 43 cases,the infection rate of 20.48%,surpassing the expected target" SSI infection rate was compared with the experimental group and control group which was decreased by 5%’,the two groups of data were statistically significant(P<0.01).The average length of hospital stay was 23.64 days,the time of drainage was 8.11 days in the experimental group The average of hospital stay was reduced by 2 days and the time of drainage was reduced by 1 day with comparing with the control group,the difference was statistically significant(P<0.05).3.The median cost of hospitalization was reduced to 14660.70 yuan,the cost of Western medicine was reduced by 9328.45 yuan in the experimental group,with comparing with the control group(P<0.01),63.63%of the total reduction cost,and the reduction in cost of antibiotics in the trial group should be the main reason for the total cost reduction.The general medical service and nursing costs were increased by 257.50 yuan and 97.50 yuan respectively with comparing with the control group(P<0.01).Conclusion1.FMEA theory can be used to screen out the links which were need to solve first,developing targeted interventions,it is an effective risk management tool within the prevention and control of postoperative SSI.2.Based on the FMEA theory,the risk management strategy can effectively reduce the infection rate and mortality of SSI after colorectal surgery,reduce the medical cost,shorten the hospitalization time,reduce the economic burden of the patients and improve the quality of medical safety.