Application Of Healthcare Failure Mode And Effect Analysis(Hfmea) In Risk Management Of Patient Monitor Using In ICU

Objective:To understand the current situation of the patient monitor using in a third-class hospital in Qingdao.Applying Healthcare Failure Mode and Effect Analysis(HFMEA)to analyze high risk failure mode of the process of patient monitor using in the ICU,making and implementing improvement measures and evaluating their effectiveness.Methods: This research is divided into three parts.The first part is to investigate the current situation of patient monitor using for a one-month in a third-class hospital in Qingdao through questionnaires and field observations.The second part is that analyze the patient monitor using process according the six-step procedure of HFMEA including determining the theme,building work team,drawing flow chart,assessing the risk,making improvement strategy,implementing improvement strategy and evaluating.The third part applies the improvement measures of the risk management about ICU patient monitor using.Through three months improving,the standard rate of ICU patient monitor using,the incidence of related patient adverse events,and evaluate the effect of HFMEA management mode in clinical application were compared.Results:1.Through the questionnaire survey of 175 nurses,the total score of the key practical links of nurses using patient monitor was(72.39±6.93),and the score rate was 72.39%.The highest score rate of each key link is the monitor setting(84.42%),and the lowest is the continuous use of the monitor,which is only 57.25%.In the 13 key points of the monitor,the highest standard rate is the correct reassuring electrode patch(95.07%)and the correct connection of oxygen saturation sensor(90.41%),the lowest standard rate is the correct cleaning of local skin or nails and the regular replacement of oxygen saturation sensor position,the standard rate is 51.96% and 52.48%,respectively.2.There are 16 items including incorrect cleaning of local skin or nails,uncheckedinspection and maintenance label before using,incorrect placement of electrocardiograph,wrong connection of heart electrode,poor contact of heart electrode were screened by risk matrix evaluation and decision tree analysis.After analysis of failure reasons,the following improvement measures were developed: firstly,we should unify and standard the operation process;secondly,we need to enhance patient safety culture training and patient monitor use training;thirdly,monthly inspection,correct filling in inspection records and inspection maintenance label are required;besides,hanging around patient monitor use process and electrocardiograph indication.What’s more,the replacement time of electrode paste,blood pressure cuff and oxygen saturation sensor position are supposed to be included in the patient transfer class list who were used the monitor,the patient using of the patient monitor was included in the department quality.3.Through the application of HFMEA for patient monitor use risk management,the implementation of improvement measures after the nurse son-in-law use patient monitor specification rate increased: clean local skin or nail specification rate increased from51.96% to 81.25%,pre-use inspection maintenance label specification rate from 55.90%to 91.84%,blood pressure monitor blood sleeve band placement specification rate increased from 84.25% to 92.57%,system time,monitoring object setting specification rate increased from 84.51 percent to 95.17%,observation,record monitoring index specification The rate increased from 71.79% to 83.52%,the alarm specification rate of the treatment monitor increased from 58.46% to 81.94%,the rate of timed replacement electrode paste specification increased from 50.96% to 90.71%,and the timed release of blood pressure was relieved.Sleeve strap specification rate increased from 58.68% to77.87%,the specification rate of regular replacement oxygen saturation sensor from52.48% to 67.52%,and the standard rate of cleaning and disinfection increased from71.91% to 87.80%t.The incidence of skin redness and itching at the paste electrode decreased from 36.10% to 14.21%,the incidence of skin damage at the paste electrode decreased from 7.32% to 2.03%,the incidence of skin moisture in the wearing blood pressure cuff strap decreased from 52.68% to 39.09%,and the incidence of insomnia anxiety caused by the monitor alarm decreased from 43.41% to 28.93%,with a statistically significant difference(P<0.05).After implementing the improvement measures,all other high-risk failure pattern scores were less than 8,except for the uncleaned monitor,and the difference between before and after the improvement was statistically significant(P<0.05).Conclusion:1.There are a lot of risks in the process of the patient monitor using,and the standard of use needs to be improved,so the risk management needs to be used;2.HFMEA is helpful to screen the high risk link in the process of patient monitor use,formulate targeted improvement measures;3.Implement improvement measures can improve the standard of ICU patient monitor use,reduce the incidence of related adverse events,prevent the patient monitor use related patient risk,can be popularized in other medical equipment use risk prevention.