| Objective1.Identify risk factors in the prevention process of stress injury in spinal cord injury patients through healthcare failure mode and effect analysis,discuss priority failure modes and reasons,and propose and implement corresponding improvement strategies.2.By applying a stress injury prevention and improvement strategy based on healthcare failure mode and effect analysis for spinal cord injury patients,monitor the incidence of stress injury in patients,the frequency of stress injury nursing quality defects,the implementation rate of stress injury prevention measures by nurses,the risk index of medical failure,and the knowledge and attitude of nursing staff towards stress injury prevention,Evaluate the clinical application effectiveness of improvement strategies based on healthcare failure mode and effect analysis.Methods1.Determine the theme of this study through healthcare failure mode and effect analysis,establish a project team,draw a flowchart for pressure injury prevention in patients with spinal cord injury,conduct hazard analysis on various aspects of pressure injury prevention,conduct focus interviews and brainstorming among team members to analyze the causes of high-risk failure links in the flowchart,review the latest guidelines and best evidence,and develop and implement improvement strategies.2.Verify the clinical application effect of the improvement strategy for pressure injury prevention in spinal cord injury patients based on healthcare failure mode and effect analysis.The research subjects were spinal cord injury patients who met the admission and discharge standards and orthopedic nurses(49 people)who directly participated in the care during the period from January 2022 to January 2023 in the orthopedic departments A,B,and C of a tertiary A hospital in Hohhot city.The patients were compared before and after different cases,with 36 patients admitted from January 2022 to June 2022 as the control group;37 patients admitted from August 2022 to January 2023 were included in the intervention group;Nurses conducted their own pre and post controlled trials.The control group patients were cared for in accordance with the "Diagnosis,Treatment,and Nursing Standards for Stress Injury" compiled by the hospital;The intervention group applied a stress injury prevention improvement strategy for spinal cord injury patients based on medical failure mode and effect analysis.Using a patient general information questionnaire,a stress injury quality assessment and evaluation form,a stress injury prevention intervention checklist,and a nursing staff stress injury prevention knowledge and attitude questionnaire.Compare the incidence of stress injury,frequency of nursing quality defects in stress injury,risk index of medical failure,implementation rate of nursing intervention measures,and knowledge and attitude towards stress injury prevention among nursing staff between two groups of patients.Statistical analysis was conducted using SPSS 29.0 software,using X2-test,t-test,Mann Whitney U test,and other methods to analyze the data.Results1.The HFMEA pattern was used to identify 9 key links that affect the prevention measures of stress injury in patients with spinal cord injury,and corresponding improvement strategies were developed and implemented for the failure modes of the 9 key links.2.There was no statistically significant difference(P>0.05)in the general information of the two groups of patients,such as gender,age,BMI,and Braden score,indicating comparability.3.In the intervention group,37 patients experienced 1 case of stage I pressure injury,with an incidence rate of 2.7%;Among the 36 patients in the control group,4 had stage I pressure injury and 2 had stage II pressure injury.The incidence of pressure injury was 16.7%,and the difference was statistically significant(P<0.05).4.The frequency of nursing quality defects in stress induced injuries before intervention is10 times,and the incidence of nursing quality defects is 7.6%;The frequency of nursing quality defects in stress induced injuries after intervention was 2 times,and the incidence of nursing quality defects was 1.5%.The difference was statistically significant(P<0.05).5.By using the HFMEA,except for the "evaluation content" in the 9 key links,the risk index of medical failure decreased compared to before the intervention,with a statistically significant difference(P<0.05);Nursing staff’s attitude towards stress injury prevention in patients with spinal cord injury has improved in five dimensions: personal ability,priority,influence,sense of responsibility,and confidence(P<0.05);Nursing staff showed better knowledge of stress injury in patients with spinal cord injury in terms of etiology,nutrition,stress injury prevention,and special patients compared to before intervention,with statistically significant differences(P<0.05).However,there was no statistically significant difference in classification,observation,and risk factor assessment between these two dimensions(P>0.05);Among the 8 items of stress injury prevention behavior among nursing staff in patients with spinal cord injury,except for "whether to regularly use the Braden risk assessment scale for risk assessment",the execution of the remaining 7 items has improved compared to before the intervention,and the difference is statistically significant(P<0.05).ConclusionThe use of an improvement strategy for pressure injury prevention in spinal cord injury patients based on healthcare failure mode and effect analysis can reduce the incidence of pressure injury in the hospital,the frequency of quality defects in pressure injury care,improve the execution rate of pressure injury prevention measures by orthopedic nursing staff,and improve the attitude and knowledge of orthopedic nurses towards pressure injury prevention,Promote the application of the latest guidelines and best evidence by nursing staff to improve the quality of stress injury care. |
PDF Full Text Request