Failure mode and effect analysis for risk management of unplanned extubation after esophageal cancer surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAO Li , YIN Yuanyuan , ZHENG E ,  YANG Mei , LIN Lin , ZHAO Chunlin

Department of Thoracic Surgery, West China Nursing College of Sichuan University/West China Hospital of Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

YANG Mei, Email: yangmei69@126.com

Keywords：

Failure mode and effect analysis; unplanned extubation; management

DOI：

10.7507/1007-4848.202108068

Video：

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Objective To explore the application value of failure mode and effect analysis (FMEA) in the risk management of unplanned extubation after esophageal cancer surgery. Methods A total of 1 140 patients who underwent esophageal cancer surgery in our department from January 2015 to May 2017 were selected as a control group, including 948 males and 192 females with an average age of 64.45±4.53 years. FMEA was used to analyze the risk management process of unplanned extubation. The potential risk factors in each process were found by calculating the risk priority number (RPN) value, and the improvement plan was formulated for the key process with RPN>125 points. Then 1 117 patients who underwent esophageal cancer surgery from June 2017 to December 2019 were selected as a trial group, including 972 males and 145 females with an average age of 64.60±5.22 years, and the FMEA risk management mode was applied.Results The corrective measures were taken to optimize the high-risk process, and the RPN values of 9 high-risk processes were reduced to below 125 points after using FMEA risk management mode. The rate of unplanned extubation in the trial group was lower than that in the control group (P<0.05). Conclusion The application of FMEA in the risk management of unplanned extubation after esophageal cancer surgery can reduce the rate of unplanned extubation, improve the quality of nursing, and ensure the safety of patients.

Citation： YAO Li, YIN Yuanyuan, ZHENG E, YANG Mei, LIN Lin, ZHAO Chunlin. Failure mode and effect analysis for risk management of unplanned extubation after esophageal cancer surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 375-380. doi: 10.7507/1007-4848.202108068 Copy

1.	鐘勁, 楊小月, 龔龍飛, 等. 項目管理在預防非計劃拔管護理實踐中的應用. 當代護士(下旬刊), 2021, 28(1): 174-176.
2.	周秀紅. 失效模式與效應分析在預防心血管病患者意外拔管的臨床應用. 天津護理, 2017, 25(5): 440-442.
3.	王穎妍. 強化護理干預策略在降低ICU氣管插管患者非計劃性拔管中的效果. 中國醫藥指南, 2021, 19(26): 41-43.
4.	楚佳琪, 馬凌嵐. 思維導圖預防帶胃管出院患者非計劃性拔管效果. 中國城鄉企業衛生, 2021, 36(9): 113-115.
5.	Morris HF, Schuller L, Archer J, et al. Decreasing unplanned extubation in the neonatal ICU With a focus on endotracheal tube tip position. Respir Care, 2020, 65(11): 1648-1654.
6.	魯志卉, 郭曉貝, 王穎. 預防住院病人非計劃性拔管安全管理策略的研究進展. 全科護理, 2021, 19(25): 3476-3481.
7.	Najafpour Z, Hasoumi M, Behzadi F, et al. Preventing blood transfusion failures: FMEA, an effective assessment method. BMC Health Serv Res, 2017, 17(1): 453.
8.	Anjalee JAL, Rutter V, Samaranayake NR. Application of failure mode and effects analysis (FMEA) to improve medication safety in the dispensing process—A study at a teaching hospital, Sri Lanka. BMC Public Health, 2021, 21(1): 1430.
9.	Piriyapatsom A, Chittawatanarat K, Kongsayreepong S, et al. Incidence and risk factors of unplanned extubation in critically Ⅲ surgical patients: The multi-center thai university-based surgical intensive care units study (THAI-SICU Study). J Med Assoc Thai, 2016, 99 Suppl 6: S153-S162.
10.	宋宏源, 何立, 劉俊. 醫療失效模式與效應分析在降低神經科非計劃性拔管發生率中的應用. 中西醫結合護理(中英文), 2019, 5(7): 13-15.
11.	邱健春. 失效模式與效應分析在降低麻醉恢復室全麻患者非計劃拔管率中的應用. 中國醫學創新, 2018, 15(36): 74-77.
12.	李靜, 劉云, 吳丹. 失效與效應分析模式在兒科留置針非計劃拔管和堵管中的應用. 齊魯護理雜志, 2021, 27(7): 127-129.
13.	張含露, 陳龍奇, 耿英才, 等. 機器人輔助食管癌根治手術的應用. 中國胸心血管外科臨床雜志, 2019, 26(3): 206-210.
14.	邱舫, 楊梅, 王維, 等. 肺葉切除術后患者無尿管留置的前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2015, 22(7): 634-637.
15.	王雪蓮, 周嬌瑩. 胸腔閉式引流術后意外拔管的危險因素分析. 中國鄉村醫藥, 2021, 28(10): 11-12.
16.	秦雪燕, 魏雪梅, 李姍姍. 應用HFMEA對降低ICU氣管插管非計劃拔管率的效果分析. 當代護士(下旬刊), 2021, 28(5): 17-20.
17.	周洪霞, 楊梅, 廖虎, 等. 胸腔鏡肺葉切除術后16F尿管胸腔引流可行性的前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2016, 23(4): 334-340.
18.	楊梅, 陳娟, 車國衛, 等. 肺癌肺葉切除術患者圍手術期有無尿管留置的成本效益分析. 中國胸心血管外科臨床雜志, 2016, 23(5): 421-424.
19.	鮑映雪, 孫柳君, 袁勉, 等. 失效模式與效應分析在手術室護理質量安全管理中的應用效果評價. 中國藥物與臨床, 2019, 19(12): 2110-2112.
20.	董翠萍, 汪暉, 潛艷. FMEA在開胸術后壓瘡高危患者壓瘡管理中的運用. 當代護士(中旬刊), 2017, (11): 140-142.
21.	張桂蘭, 周瑩. FMEA失效模式在預防神經內科重癥患者深靜脈血栓形成中的應用. 當代護士(中旬刊), 2017, (3): 165-167.
22.	羅利珍. 失效模式與效應分析在麻醉復蘇室護理風險管理中的應用. 廣西醫學, 2017, 39(2): 283-285.
23.	王翠云, 沈媛, 魯顯福. 醫療失效模式與效應分析在麻醉恢復室安全交接中的應用研究. 護士進修雜志, 2021, 36(19): 1782-1785.
24.	李相林, 米元元. 失效模式與效應分析在經頸靜脈肝內門體分流術后穿刺部位出血護理中的應用. 解放軍護理雜志, 2017, 34(22): 40-44.
25.	Jain K. Use of failure mode effect analysis (FMEA) to improve medication management process. Int J Health Care Qual Assur, 2017, 30(2): 175-186.
26.	Pueyo-López C, Sánchez-Cuervo M, Vélez-Díaz-Pallarés M, et al. Healthcare failure mode and effect analysis in the chemotherapy preparation process. J Oncol Pharm Pract, 2021, 27(7): 1588-1595.
27.	van Daalen FV, Smeulers M, Bartels EJH, et al. A healthcare failure mode and effect analysis to optimise the process of blood culture performance. Neth J Med, 2020, 78(6): 341-348.

1. 鐘勁, 楊小月, 龔龍飛, 等. 項目管理在預防非計劃拔管護理實踐中的應用. 當代護士(下旬刊), 2021, 28(1): 174-176.
2. 周秀紅. 失效模式與效應分析在預防心血管病患者意外拔管的臨床應用. 天津護理, 2017, 25(5): 440-442.
3. 王穎妍. 強化護理干預策略在降低ICU氣管插管患者非計劃性拔管中的效果. 中國醫藥指南, 2021, 19(26): 41-43.
4. 楚佳琪, 馬凌嵐. 思維導圖預防帶胃管出院患者非計劃性拔管效果. 中國城鄉企業衛生, 2021, 36(9): 113-115.
5. Morris HF, Schuller L, Archer J, et al. Decreasing unplanned extubation in the neonatal ICU With a focus on endotracheal tube tip position. Respir Care, 2020, 65(11): 1648-1654.
6. 魯志卉, 郭曉貝, 王穎. 預防住院病人非計劃性拔管安全管理策略的研究進展. 全科護理, 2021, 19(25): 3476-3481.
7. Najafpour Z, Hasoumi M, Behzadi F, et al. Preventing blood transfusion failures: FMEA, an effective assessment method. BMC Health Serv Res, 2017, 17(1): 453.
8. Anjalee JAL, Rutter V, Samaranayake NR. Application of failure mode and effects analysis (FMEA) to improve medication safety in the dispensing process—A study at a teaching hospital, Sri Lanka. BMC Public Health, 2021, 21(1): 1430.
9. Piriyapatsom A, Chittawatanarat K, Kongsayreepong S, et al. Incidence and risk factors of unplanned extubation in critically Ⅲ surgical patients: The multi-center thai university-based surgical intensive care units study (THAI-SICU Study). J Med Assoc Thai, 2016, 99 Suppl 6: S153-S162.
10. 宋宏源, 何立, 劉俊. 醫療失效模式與效應分析在降低神經科非計劃性拔管發生率中的應用. 中西醫結合護理(中英文), 2019, 5(7): 13-15.
11. 邱健春. 失效模式與效應分析在降低麻醉恢復室全麻患者非計劃拔管率中的應用. 中國醫學創新, 2018, 15(36): 74-77.
12. 李靜, 劉云, 吳丹. 失效與效應分析模式在兒科留置針非計劃拔管和堵管中的應用. 齊魯護理雜志, 2021, 27(7): 127-129.
13. 張含露, 陳龍奇, 耿英才, 等. 機器人輔助食管癌根治手術的應用. 中國胸心血管外科臨床雜志, 2019, 26(3): 206-210.
14. 邱舫, 楊梅, 王維, 等. 肺葉切除術后患者無尿管留置的前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2015, 22(7): 634-637.
15. 王雪蓮, 周嬌瑩. 胸腔閉式引流術后意外拔管的危險因素分析. 中國鄉村醫藥, 2021, 28(10): 11-12.
16. 秦雪燕, 魏雪梅, 李姍姍. 應用HFMEA對降低ICU氣管插管非計劃拔管率的效果分析. 當代護士(下旬刊), 2021, 28(5): 17-20.
17. 周洪霞, 楊梅, 廖虎, 等. 胸腔鏡肺葉切除術后16F尿管胸腔引流可行性的前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2016, 23(4): 334-340.
18. 楊梅, 陳娟, 車國衛, 等. 肺癌肺葉切除術患者圍手術期有無尿管留置的成本效益分析. 中國胸心血管外科臨床雜志, 2016, 23(5): 421-424.
19. 鮑映雪, 孫柳君, 袁勉, 等. 失效模式與效應分析在手術室護理質量安全管理中的應用效果評價. 中國藥物與臨床, 2019, 19(12): 2110-2112.
20. 董翠萍, 汪暉, 潛艷. FMEA在開胸術后壓瘡高危患者壓瘡管理中的運用. 當代護士(中旬刊), 2017, (11): 140-142.
21. 張桂蘭, 周瑩. FMEA失效模式在預防神經內科重癥患者深靜脈血栓形成中的應用. 當代護士(中旬刊), 2017, (3): 165-167.
22. 羅利珍. 失效模式與效應分析在麻醉復蘇室護理風險管理中的應用. 廣西醫學, 2017, 39(2): 283-285.
23. 王翠云, 沈媛, 魯顯福. 醫療失效模式與效應分析在麻醉恢復室安全交接中的應用研究. 護士進修雜志, 2021, 36(19): 1782-1785.
24. 李相林, 米元元. 失效模式與效應分析在經頸靜脈肝內門體分流術后穿刺部位出血護理中的應用. 解放軍護理雜志, 2017, 34(22): 40-44.
25. Jain K. Use of failure mode effect analysis (FMEA) to improve medication management process. Int J Health Care Qual Assur, 2017, 30(2): 175-186.
26. Pueyo-López C, Sánchez-Cuervo M, Vélez-Díaz-Pallarés M, et al. Healthcare failure mode and effect analysis in the chemotherapy preparation process. J Oncol Pharm Pract, 2021, 27(7): 1588-1595.
27. van Daalen FV, Smeulers M, Bartels EJH, et al. A healthcare failure mode and effect analysis to optimise the process of blood culture performance. Neth J Med, 2020, 78(6): 341-348.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Failure mode and effect analysis for risk management of unplanned extubation after esophageal cancer surgery

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