Zhang Shu, Zheng Jing, Liu Xianfeng, Jiang Shuangyan, Guo Xuying, Li Baobao
Department of Cardiovascular Surgery Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China. Corresponding author: Zheng Jing, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Mar;35(3):269-273. doi: 10.3760/cma.j.cn121430-20220830-00800.
To analyze the application effect of health failure mode and effect analysis (HFMEA) model in patients with artificial airways in the cardiovascular surgery intensive care unit (CSICU) by establishing a HFMEA project team, and to develop targeted improvement measures and processes.
The patients undergoing cardiovascular surgeries and with established artificial airways in the Shandong Provincial Hospital Affiliated to Shandong First Medical University were recruited from October 2021 to March 2022. The enrolled patients were divided into the conventional management group and the HFMEA model management group according to random number table method. The conventional management group applied the conventional procedures for monitoring the air bag pressure. The HFMEA model management group used the HFMEA model to implement and improve the airbag pressure monitoring process. The efficacy of HFMEA was assessed by comparing the incidence of ventilator-associated pneumonia (VAP), the pass rate of airbag pressure monitoring, the duration of endotracheal intubation and the length of CSICU stay between two groups. The practicability of HFMEA model was evaluated by analyzing the theoretical assessment scores and practical skill scores of nurses and their satisfaction scores with HFMEA.
Compared with the conventional management group, the patients in the HFMEA mode management group had a significantly higher rate of passing airbag pressure monitoring [94.99% (2 994/3 152) vs. 69.97% (1 626/2 324), P < 0.01], shorter duration of endotracheal intubation and length of CSICU stay [duration of endotracheal intubation (hours): 6 (7, 12) vs. 6 (8, 13), length of CSICU stay (hours): 40 (45, 65) vs. 41 (46, 85), both P < 0.05], but the incidences of VAP between the two groups were similar. The theoretical assessment scores and practical skill scores of nurses were significantly higher (theoretical assessment score: 44.47±2.72 vs. 37.59±6.56, practical skill score: 44.56±2.66 vs. 40.03±4.32, total score: 89.03±3.07 vs. 77.63±9.56, all P < 0.05) in the HFMEA mode management group. And the satisfaction scores with airbag pressure management were also significantly higher in the HFMEA mode management group (7.72±1.11 vs. 6.44±1.32, P < 0.05).
The application of the HFMEA can improve the airbag pressure measures and standardize the monitoring procedures in patients with artificial airways, and reduce the risk of clinical nursing. It is safe and effective for patients with invasive mechanical ventilation in the CSICU.
通过组建健康失效模式与效应分析（HFMEA）项目团队，分析HFMEA模式在心血管外科重症监护病房（CSICU）人工气道患者中的应用效果，并制定针对性的改进措施与流程。
选取2021年10月至2022年3月在山东第一医科大学附属山东省立医院行心血管手术并建立人工气道的患者。将入选患者按随机数字表法分为传统管理组和HFMEA模式管理组。传统管理组采用常规气囊压力监测程序。HFMEA模式管理组运用HFMEA模式实施并改进气囊压力监测流程。通过比较两组呼吸机相关性肺炎（VAP）发生率、气囊压力监测合格率、气管插管时间及CSICU住院时间评估HFMEA的效果。通过分析护士的理论考核成绩、实践技能成绩及对HFMEA的满意度评分评估HFMEA模式的实用性。
与传统管理组相比，HFMEA模式管理组患者气囊压力监测合格率显著更高[94.99%（2994/3152）比69.97%（1626/2324），P<0.01]，气管插管时间及CSICU住院时间更短[气管插管时间（小时）：6（7，12）比6（8，13），CSICU住院时间（小时）：40（45，65）比41（46，85），均P<0.05]，但两组VAP发生率相近。HFMEA模式管理组护士的理论考核成绩和实践技能成绩显著更高（理论考核成绩：44.47±2.72比37.59±6.56，实践技能成绩：44.56±2.66比40.03±4.32，总成绩：89.03±3.07比77.63±9.56，均P<0.05）。且HFMEA模式管理组对气囊压力管理的满意度评分也显著更高（7.72±1.11比6.44±1.32，P<0.05）。
HFMEA的应用可改善人工气道患者的气囊压力措施，规范监测流程，降低临床护理风险。对CSICU有创机械通气患者安全有效。
