HFMEA在预防ICU气管插管非计划性拔管中的应用效果
目的探讨应用HFMEA预防ICU气管插管非计划性拔管的应用效果。方法 选取20丨3年1?丨2月未实施HFMEA的气管插管之24h患者474例和2014年I? 12月实施HFMEA的气管插管^24 h患者547例，针对ICU气管插管非计划性拔 管组成团队，分析操作流程并制作出流程图，进行失效模式与潜在风险原因分析， 比较实施前后气管插管非计划性拔管事先风险值（RPN)和发生率。结果实施 后气管插管非计划性拔管的总RPN为2357.46分，显著低于实施前的3830.08分， 差异有统计学意义（P〇.〇5h实施后气管插管非计划性拔管发生率为1.687%， 较实施前的0.365 %有明显下降，差异有统计学意义（Z2=4.577, PC0.05)。结 论应用HFMEA能有效预防气管插管非计划性拔管的发生，降低医疗风险。
[AbstractJObjective To explore the practice effects of using HFMEA in prevention ICU unplanned extubation of tracheal intubation.Methods 474 patients who unimplemented HFMEA intubation and greater than 24 h from January 2013 to December and 547 patients who implemented HFMEA intubation and greater than 24 h from January 2014 to December were selected.For ICU tracheal intubation unplanned extubation composition team* ihe operation process was analyzed and the flow chart was made to analyze the failure mode and cause of potential risk.The RPN and incidence rate before and after ICU unplanned extubation of tracheal intubation were compared.Results After conducting? the total RPN of ICU unplanned extubation of tracheal intubation was 2357.46* obvious lower than that was 3830.08 before conducting, and the difference was statistical significance (P0.05) .After conducting， the incidence rate of ICU unplanned extubation of tracheal intubation was 1.687%，obvious devreased than that was 0.365 % before conducting, and the difference was statistical significance (x2=4.577，P0.05) .Conclusion Using HFMEA can prevent the incidence of unplanned extubation of tracheal intubation effectively and decrease medical risk.
[Key words]Tracheal intubation； Unplanned extubation； ICU； Prevenlion
气管插管作为维持气道通气的重要手段广泛应用于危重症患者的治疗，而非 计划性拔管是威胁患者生命的一个严重并发症[1]。医疗失效模式与影响分析 (health care failure mode and effect analysis, HFMEA)为前瞻性评估系统流程的 方法，通过报本原因分析及流程改进，以达到杜绝或减少缺陷发生的目的[2]。 2014年丨月起我院综合丨CU应用HFMEA预防气管插管非计划性拔管的发生， 取得良好效果，现报道如下。
1资料与方法
1.1 一般资料
我院综合ICU开放床位12张，2013年1月?2014年12月收治患者共1499