医疗失效模式与效应分析方法改进门诊检查用药信息化管理的实践

Optimizing Information Management of Outpatient Examination Medications Using Healthcare Failure Mode and Effect Analysis

关键词:  医疗失效模式与效应分析  门诊检查  药品管理  安全用药

Key words:  healthcare failure mode and effect analysis (HFMEA)  outpatient examination  medication management  safe medication use

摘要:

目的 探讨医疗失效模式与效应分析（health care failure mode and effect analysis，HFMEA）法在门诊检查用药信息化管理模式中的应用价值。方法 对传统门诊检查用药使用管理中5个主流程（医师开具医嘱、药师调剂、患者取药、检查室登记报到、医护人员给药）进行HFMEA分析，找出潜在失效模式，分析失效原因，量化并评估失效模式发生频率及严重程度，计算风险优先指数(risk priority number，RPN)，使用危险评分矩阵和决策树筛选出需要改进的环节，制定并实施改进措施，设计门诊检查用药智能模块，构建信息化管理流程。比较HFMEA改进前后的RPN值、患者满意度、医护满意度。结果 共筛选出11项潜在失效原因，改进后11项潜在失效原因的RPN均显著下降（P＜0.001），患者满意度和医护满意度均显著提高（P＜0.05）。结论 应用HFMEA方法构建门诊检查用药信息化管理模式效果显著，可有效降低检查用药使用管理各环节中已识别失效模式所致风险，有助于提高诊疗效率和患者满意度，保障患者用药安全。

Abstract:

OBJECTIVE Exploring the Application Value of Health Care Failure Mode and Effect Analysis (HFMEA) in the Information-based Management Model for Medication in Outpatient Examinations. METHODS HFMEA was applied to five main processes in the traditional management of medication for outpatient examinations (physician order writing, pharmacist dispensing, patient drug collection, registration and check-in at the examination room, and medication administration by healthcare personnel). Potential failure modes were identified, and the causes of failures were analyzed. The frequency and severity of the failure modes were quantified and evaluated, and the Risk Priority Number (RPN) was calculated. Critical processes requiring improvement were identified using a risk scoring matrix and decision tree. Improvement measures were then developed and implemented. An intelligent module for outpatient examination medication was designed to establish an information-based management process. Comparisons were made between pre-and post-improvement using HFMEA in terms of RPN values, patient satisfaction, healthcare worker satisfaction. RESULTS A total of 11 potential failure causes were identified. After the improvement, the RPN values of all 11 potential failure causes significantly decreased (P＜0.001), with both patient satisfaction and healthcare provider satisfaction demonstrating improvement (P＜0.05). CONCLUSION The application of the HFMEA method to construct an information-based management model for medication in outpatient examinations has yielded significant results, effectively mitigates risks associated with recognized failure modes across every phase of medication management in diagnostic testing, thereby improving diagnostic and therapeutic efficiency and patient satisfaction, and ensuring patient medication safety.