Zhang Ping, Zhu Haiyan, Qian Yuanyuan, Chen Minmin, Liu Lin
Department of Intensive Care Unit, Nantong Fourth People's Hospital, Nangtong, Jiangsu, China.
Department of Nursing, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
Front Psychiatry. 2025 Apr 4;16:1571858. doi: 10.3389/fpsyt.2025.1571858. eCollection 2025.
Psychiatric patients are particularly vulnerable to skin injuries, which can result in severe systemic complications and higher mortality rates. Therefore, improving skin wound management for ICU psychiatric patients through Failure Mode and Effects Analysis (FMEA) is crucial. This study aims to evaluate the effectiveness of FMEA in enhancing skin wound management in ICU settings, with a focus on identifying key risk factors and implementing targeted interventions to mitigate skin complications.
A real-world study was conducted in the ICU of the Fourth People's Hospital of Nantong, China, involving 615 psychiatric patients admitted between October 2022 and October 2024. Patients were divided into two groups: the control group received traditional wound care, while the observation group was managed using FMEA-based strategies. Key risk factors were evaluated through FMEA to prioritize interventions, Logistic regression analysis was used to assess the relationship between various risk factors and skin complications, helping to identify significant predictors of adverse skin events.
FMEA implementation led to a significant reduction in skin complications from 7.56% to 3.59% ( 4.69, = 0.03). FMEA analysis identified key risk factors, including positioning management, skin hygiene, and nutritional support, with corresponding Risk Priority Numbers (RPN) calculated for each factor. Logistic regression analysis revealed that FMEA implementation was significantly associated with a reduced risk of skin complications (coefficients = -1.44, p = 0.01). Additionally, factors such as ADL, hypoalbuminemia, diabetes, and ICU length of stay were found to significantly influence the risk of skin complications (p < 0.01).
FMEA is an effective tool for enhancing skin management practices and reducing skin complications in psychiatric ICU patients. Early identification of risk factors and the implementation of personalized skin care protocols can significantly improve patient outcomes and safety.
精神科患者特别容易发生皮肤损伤，这可能导致严重的全身并发症和更高的死亡率。因此，通过失效模式与效应分析（FMEA）改善重症监护病房（ICU）精神科患者的皮肤伤口管理至关重要。本研究旨在评估FMEA在加强ICU环境中皮肤伤口管理方面的有效性，重点是识别关键风险因素并实施有针对性的干预措施以减轻皮肤并发症。
在中国南通市第四人民医院的ICU进行了一项真实世界研究，纳入了2022年10月至2024年10月期间收治的615例精神科患者。患者分为两组：对照组接受传统伤口护理，观察组采用基于FMEA的策略进行管理。通过FMEA评估关键风险因素以确定干预措施的优先级，采用逻辑回归分析评估各种风险因素与皮肤并发症之间的关系，以帮助识别不良皮肤事件的重要预测因素。
实施FMEA后，皮肤并发症从7.56%显著降至3.59%（4.69，=0.03）。FMEA分析确定了关键风险因素，包括体位管理、皮肤卫生和营养支持，并为每个因素计算了相应的风险优先数（RPN）。逻辑回归分析显示，实施FMEA与皮肤并发症风险降低显著相关（系数=-1.44，p=0.01）。此外，还发现日常生活活动能力、低白蛋白血症、糖尿病和ICU住院时间等因素对皮肤并发症风险有显著影响（p<0.01）。
FMEA是加强精神科ICU患者皮肤管理实践和减少皮肤并发症的有效工具。早期识别风险因素并实施个性化皮肤护理方案可显著改善患者预后和安全性。
