Shih Ming-Chuan, Tsai Yi-Ching, Shen Yu-Hui, Hsieh Chia-Chi, Huang Pai-Yu
BSN, RN, Department of Nursing, Chang Bing Show Chwan Memorial Hospital, Taiwan, ROC.
BSN, RN, Stroke Case Manager, Division of Neurology, Chang Bing Show Chwan Memorial Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2020 Dec;67(6):70-80. doi: 10.6224/JN.202012_67(6).10.
BACKGROUND & PROBLEMS: Intra-arterial thrombectomy (IAT) is a novel surgery that may restore cerebral blood flow in patients with ischemic stroke and lower the risks of permanent brain damage and disability. Because the process of preoperative preparation for IAT is complicated, error rates for this process have been reported in previous studies to be as high as 100%. Although these errors did not result in serious damage to patients, the risk to patient safety remains. Therefore, reducing the error rate for IAT preoperative preparation is necessary to improve patient safety.
To reduce the rate of IAT preoperative preparation error in an emergency room.
This project applied healthcare failure mode and effect analysis (HFMEA) to evaluate the potential risks of IAT preoperative preparation in an emergency room. Based on the resultant hazard score, critical preventive measures were adopted, including creating a quick response code consent form, designing order packages, developing a checklist form, modifying stroke operating procedures and policies, planning suitable education content for staffs, developing criteria for evaluating preoperative preparation procedures, and installing vital signs equipment.
After implementation of these measures, the hazard scores of 13 out of the 16 potential failure causes decreased to < 8, and the progress rate was 81.3%. The follow-up error rate for preoperative preparation was 0% in October 2019, which fulfilled the goal of this project.
Preoperative preparation for IAT is complicated and time-consuming. In this project, HFMEA was introduced to ensure that preoperative preparation was accomplished in a complete and timely manner. Based on the results, after implementation, preparation work was effectively completed and operations were performed on schedule. Other hospitals may consider using this tool to evaluate potential risks to patient safety and to develop solutions to improve the quality of healthcare processes.
动脉内血栓切除术（IAT）是一种新型手术，可恢复缺血性中风患者的脑血流，并降低永久性脑损伤和残疾的风险。由于IAT术前准备过程复杂，以往研究报道该过程的错误率高达100%。尽管这些错误未对患者造成严重损害，但患者安全风险依然存在。因此，降低IAT术前准备的错误率对于提高患者安全是必要的。
降低急诊室IAT术前准备的错误率。
本项目应用医疗失效模式与效应分析（HFMEA）来评估急诊室IAT术前准备的潜在风险。基于所得的风险评分，采取了关键预防措施，包括创建快速响应码同意书、设计医嘱套餐、制定检查表、修改中风手术程序和政策、为工作人员规划合适的教育内容、制定术前准备程序评估标准以及安装生命体征设备。
实施这些措施后，16个潜在失效原因中的13个风险评分降至<8，进展率为81.3%。2019年10月术前准备的后续错误率为0%，实现了本项目的目标。
IAT术前准备复杂且耗时。本项目引入HFMEA以确保术前准备得以完整、及时地完成。根据结果，实施后准备工作有效完成，手术按时进行。其他医院可考虑使用此工具评估对患者安全的潜在风险，并制定解决方案以提高医疗流程质量。
