重症监护病房中的临床风险评估
Clinical risk assessment in intensive care unit.
作者信息
Asefzadeh Saeed, Yarmohammadian Mohammad H, Nikpey Ahmad, Atighechian Golrokh
机构信息
Qazvin Research Center for Social Determinants of Health, Qazvin University of Medical Sciences, Qazvin, Iran.
出版信息
Int J Prev Med. 2013 May;4(5):592-8.
BACKGROUND
Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin's Social Security Hospital (Razi Hospital) through Failure Mode and Effect Analysis (FMEA).
METHODS
This was a qualitative-quantitative research by Focus Discussion Group (FDG) performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique.
RESULTS
Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN) was in respiratory care "Ventilator's alarm malfunction (no alarm)" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8.
CONCLUSIONS
Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.
背景
临床风险管理致力于通过识别使患者面临伤害风险的情况与机会，并采取措施预防或控制这些风险，来提高医疗服务的质量与安全性。本研究的目的是通过失效模式与效应分析（FMEA）识别并评估加兹温社会保障医院（拉齐医院）重症监护室（ICU）的失效模式。
方法
这是一项于2011年在伊朗加兹温省通过焦点讨论小组（FDG）开展的定性定量研究。研究对象包括所有熟悉ICU流程的个人及负责人。采用目的抽样法，由研究者挑选FDG小组成员。研究工具为已被多位研究者使用的标准工作表。采用FMEA技术分析数据。
结果
共识别出48种临床失误和失效模式，结果显示，风险概率数（RPN）最高的是呼吸护理方面的“呼吸机警报故障（无警报）”，得分为288分，最低的是胃肠护理方面的“未冲洗鼻胃管”，得分为8分。
结论
小组成员可预防许多已识别出的失误。临床风险评估与管理是提供有效医疗服务的关键。
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