石碧玉+李琼+黄婷婷+夏元石

[摘要]目的 探究在长途转运危重患者时采用医疗失效模式与效应分析（HFMEA）的临床应用价值。方法 选择2016年4月～2017年4月我院收治的120例需要长途转运的危重患者进行观察，其中60例采用传统转运方法的患者作为对照组，另60例采用HFMEA方法转运的患者作为观察组。记录两组患者平均转运时间、患者满意度、转运意外事件发生率、抢救成功率、护理人员对转运流程及风险管理相关知识知晓率。结果 观察组平均转运时间、转运意外事件发生率均低于对照组，差异有统计学意义（P<0.05）；观察组患者满意度、抢救成功率、护理人员知识知晓率明显优于对照组，差异有统计学意义（P<0.05）。结论 长途转运危重患者风险较大，采用HFMEA可以准确评估转运风险，优化转运程序，缩短转运时间，降低不良事件发生率，提高患者满意度，值得推广。

[关键词]长途转运；危重患者；医疗失效模式与效应分析；临床应用价值

[中图分类号] R197 [文献标识码] A [文章编号] 1674-4721（2017）09（c）-0095-04

[Abstract]Objective To explore the clinical value of healthcare failure mode and effect analysis （HFMEA） in long distance relay of critical patients.Methods 120 cases of long-distance transport of critical patients in our Hospital from April 2016 to April 2017 were selected in this reaserch，60 cases of patients was transfered by traditional transfer method were selected as the control group，60 cases of patients was transfered by HFMEA transfer method were selected as the observation group.The average transit time，patients′ satisfaction，accident rate oft ransshipment，the success rate of rescue，transshipment process and risk management knowledge awareness rate of the nursing staff were recorded.Results The average transit time，accident rate of transshipment in the observation group was lower than the control group，the difference was statistically significant （P<0.05）；the patients′ satisfaction，the success rate of rescue，knowledge rate of nursing staff in the observation group was better than that of the control group，the difference was statistically significant （P<0.05）.Conclusion Long distance relay of critical patients has high risk，HFMEA can accurately assess the risk of transport，optimized transport procedure，reduce the transit time and the incidence of adverse events，improve patient satisfaction，it is worthy of clinical promotion.

[Key words]Long distance transportation；Critical patients；HFMEA；Clinical application value

危重患者在进行长途转运时容易出现心律失常、窒息、心跳暂停等多种并发症，风险性较高[1]。长途转运时间长，转运的目的不仅仅只是将患者运送至医院，在转运途中对患者进行心电监护，稳定生命体征、保持呼吸通畅，通知院内医生做好交接准备可以有效降低并发症发生率，改善患者的预后。医疗失效模式与效应分析（health care failure mode and effect analysis，HFMEA）是一种具有团队性、系统性、前瞻性的医疗风险管理方法，通过检查医疗服务中可能发生风险，优化操作流程，制订有效的防控措施，最大限度降低医疗风险及损失[2]。目前，HFMEA主要用于识别患者、医疗服务各个环节的潜在危险因素，预防技术故障或设备缺损，提高患者治疗的安全性等。国内主要应用于护理操作、醫疗设备管理、手术操作、给药流程等方面，处于起步阶段。……