Application Of Failure Mode And Effect Analysis In Nursing Risk Management Of Consecutive Surgeries

Objectives:1.To understand the current situation of the risks in the nursing of consecutive surgeries and determine the high-risk failure mode;2.To explore the application effect of failure mode and effect analysis(FMEA)management mode in nursing risk management of consecutive surgeries.Methods:1.Establish a FMEA management team for consecutive surgeries,draw flow chart of the consecutive surgeries,identify the potential failure mode of the consecutive surgeries by brainstorming method,conduct hazard analysis,calculate the risk priority index,determine the high risk failure mode,analyze the causes,develop and implement improvement measures.The main improvement measures are:(1)Strengthen safety education in surgical nursing;(2)Develop standardized communication models;(3)Establish a collaborative team-working preoperative visit mode;(4)Modular management of surgical connection;(5)Standardize the surgical body position placement;(6)Standardize the inventory of surgical objects;(7)Improve hand hygiene compliance;(8)Standardize surgical safety verification.2.A total of 565 consecutive surgeries before managed from December 2020 to January 2021 were taken as the control group,and 567 consecutive surgeries after managed from June 2021 to July 2021 were taken as the experimental group.Compare the high-risk failure mode RPN values before and after implementing the improvement measures,the incidence of surgical adverse events,the patient waiting time,the self-purification time between surgery met the standard rate and connection delay rate,the patient satisfaction,the satisfaction of the surgeon and the work quality of the operating nurse,assess the effectiveness of the FMEA implementation.3.Statistical analysis of the data was performed using the IBM SPSS24.0software,for quantitative data satisfying the normal distribution,the mean±standard deviation was used,for the qualitative data,the intensity is described by rate.The independent sample t-test was used for comparing the overall means of two data between quantitative groups,comparison of group rates for qualitative data was performed using 2or non-parametric tests.Results:1.The potential high-risk failure mode of consecutive surgeries care is preoperative visits were inadequate(RPN=245 points),poor hand hygiene compliance(RPN=210points),improper position placement(RPN=168 points),self-cleaning between surgery is not standard(RPN=160 points),inadequate effective communication(RPN=150 points),the inventory of surgical objects is not standardized(RPN=140 points),pick up the next surgical patient too early or too late(RPN=126 points),non-standard tripartite verification(RPN=80 points,severity=8 points).2.After FMEA management,(1)the RPN value of all the 8 failure modes decreased significantly,and the total RPN score decreased from 1,279 points to 559 points,(2)the waiting time for consecutive surgeries patients decreased from 34.93±0.549 minutes to22.77±0.273 minutes,and the patient waiting time was significantly shortened,(t’=19.817,P<0.001),(3)the Standard rate of the self-purification time was increased from44.1%to 85.9%(χ~2=217.606,P<0.001),(4)the connection delay rate decreased from25.0%to 18.5%(χ~2=6.895,P=0.009).3.After FMEA management,(1)the overall incidence of adverse events in consecutive surgeries decreased significantly from 7.86%to 2.12%after(χ2=20.241,P<0.001);(2)patient satisfaction was increased from 96.3%to 99.1%(Z=-2.834,P=0.017);(3)physician satisfaction with the quality of nursing work increased from 80.2%to 92.7%(Z=-2.584,P=0.01);(4)the work quality assessment of scrub nurses was increased from90.17±3.61 to 93.38±2.96(t=-7.9,P<0.001),and the work quality assessment score of circulating nurses was increased from 86.96±5.76 to 92.52±3.74(t=-9.26,P<0.001).Conclusion:1.FMEA management can reduce the risk of consecutive surgeries care;2.FMEA management can reduce the waiting time of consecutive surgeries and improve the efficiency of the consecutive surgeries;3.FMEA management can improve the quality of nursing work for operating room nurses,and improve the satisfaction of the surgeon;4.FMEA management can improve the satisfaction of the surgical patients.