Study On HFMEA Model In The Application Of Nursing Risk In The Peri Operation Period Of Aneurysm Rupture

Objective: The experiment will apply Healthcare Failure Mode and Effects Analysis(Healthcare Failure Mode and Effects Analysis, HFMEA) to find out the Risk of perioperative nursing of intracranial aneurysms ordinal Number(Risk Priority Number, RPN), to formulate corresponding nursing measures, with the purpose of reducing the occurrence of intracranial ruptured aneurysm rebleeding.Method: From March 2014 to November 2014,we collect 201 cases of patients. 14 special Department of Neurosurgery chief physician with experience were invited.They are spontaneous subarachnoid hemorrhage in our hospital neurosurgery, through inspection diagnosis of ruptured aneurysms included in the standard for the first time. The patients randomly divided into experimental group and control group. The thirteen director of the physician has the rich experience of neurosurgery. Each aneurysms in patients included in the standard case data integration is analyzed separately through the literature and clinical experience. They Use HFMEA analysis of the quantitative evaluation table to assess all the inducing factors of the Severity of causing aneurysm rebleeding(Severity, S), Frequency(Frequency of Occurrence, F) and Detection(Likelihood of Detection, D), to calculate RPN = F * D * S the inducing factors of RPN. We sort the risk inducing factors the statistical analysis of each RPN value of inducing factors applied Mean analysis method. We care the control group in routine nursing and treatment. We care the experimental group in the HFMEA analysis and nursing care of patients,according to the inducing factors of induced risk level to find out the main inducing factors of intracranial ruptured aneurysm occurred again bleeding, we formulate targeted nursing intervention and executed correctly in experimental group. Using table four compared the different of the incidence of intracranial aneurysm rebleeding after HFMEA application to assess application effect.Results: There was no statistically significant difference in two groups of terms of gender and cultural level. According to the RPN values determine the cause of rebleeding ruptured aneurysm inducing factors, high blood pressure, high cranial pressure, the short of hemostatic drugs application time, pain, epilepsy, be agitated, pulmonary infection, defecation, acuteness activity. We sort the nine kinds of risk factors by application of normal distribution mean statistical description, the sequence of sorting is blood pressure, acuteness activity, epilepsy, intracranial pressure, be agitated, defecation, pain, hemostatic, lung infection. The control group of not quoted HFMEA is 83 patients with ruptured aneurysm for the first time, there was no rupture hemorrhage in 70 cases, again happen again burst bleeding in 13 cases, control group again bleeding occurred at a rate of 15.66%.The experimental group of referenced HFMEA patients with 118 cases of ruptured aneurysm patients for the first time, there was no rupture hemorrhage in 110 cases, again occurrence rupture rebleeding for 8 cases, the experimental group again bleeding occurred at a rate of 6.78%(χ2= 4.11,P<0.05). The rate of rebleeding in ruptured aneurysms reduced from 15.66% to 6.78% in 8 months,The difference is statistically significant.Conclusion: This study used HFMEA model predictive nursing on perioperative patients with aneurysms can decrease the rate of aneurysm rebleeding, to ensure the safety of neurosurgery patients with aneurysms of medical care. It is worth promoting.