Sanchez-Izquierdo-Riera Jose Angel, Molano-Alvarez Esteban, Saez-de la Fuente Ignacio, Maynar-Moliner Javier, Marín-Mateos Helena, Chacón-Alves Silvia
From the *Intensive Care Department, University Hospital 12 de Octubre, Madrid, Spain; and †Intensive Care Department, University Hospital de Álava, Vitoria, Spain.
ASAIO J. 2016 Jan-Feb;62(1):74-9. doi: 10.1097/MAT.0000000000000286.
The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p < 0.05); less patients suffered circuit coagulation with inability to return the blood to the patient (25 patients [46.3%] vs. 16 patients [22.2%]; p < 0.05); 54 patients (100%) versus 5 (6.94%) did not get phosphorus levels monitoring (p < 0.05); in 14 patients (25.9%) versus 0 (0%), the CRRT prescription did not appear on medical orders. As a measure of improvement, we adopt a dynamic dosage management. After the process FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.
失效模式与效应分析（FMEA）可能会提高重症监护病房中连续性肾脏替代疗法（CRRT）的安全性。我们分三个阶段使用此工具：1）回顾性观察研究。2）进行流程FMEA，并实施已确定的改进措施。3）FMEA后的队列研究。我们将54例患者纳入FMEA前组，72例患者纳入FMEA后组。比较两组中每位患者的风险发生频率，我们发现FMEA后组中滤器存活时间不足24小时的病例更少（31例患者[57.4%] vs. 21例患者[29.6%]；p<0.05）；发生回路凝血且无法将血液回输给患者的患者更少（25例患者[46.3%] vs. 16例患者[22.2%]；p<0.05）；未进行磷水平监测的患者为54例（100%） vs. 5例（6.94%）（p<0.05）；CRRT处方未出现在医嘱中的患者为14例（25.9%） vs. 0例（0%）。作为一项改进措施，我们采用了动态剂量管理。经过流程FMEA后，接受CRRT的重症监护病房患者的管理有了多项改进，我们认为它是提高危重症患者安全性的有用工具。
