Application And Evaluation Of HFMEA In The Infusion Management During The Intra-hospital Transport Process Of Emergency Patients

Objective:1.To understand the current situation of infusion management during the intra-hospital transport process of emergency patients.2.Using the Healthcare Failure Mode and Effect Analysis method to analyze the infusion management process during the intra-hospital transport of emergency patients,screen high risk failure mode,and make improvment measures.3.Implement improvement measures and evaluate their effectiveness.Method:This study is divided into three parts.Part I: A convenient sampling method was used to conduct a one-month investigation using the self-designed questionnaire on patients who were transported from the wards and emergency rooms in the emergency department of a top-level hospital in ShanXi Province.Part II: The six-step procedure of HFMEA including determining the theme,building team,drawing flow chart,risk assessment,making improvement strategy,implementing and evaluating,was used to analyze the infusion management process.Part III: The HFMEA improvement measures were used in the infusion management process.After six months of implementation,the status of infusion management in the intra-hospital transport process of emergency patients was investigated again.The status of infusion management,the score of infusion related knowledge,attitude and behavior among emergency nurses and instructors,and the failure risk index of high risk failuremode were compared.Result:Part I: A total of 148 cases of infusion management during the intra-hospital transport process of emergency patients were investigated.47.3% of the patients did not carry the infusion frame;61.5% of the patients carried infusion pumps/syringe pumps,but3.3% of these patients had insufficient battery power for infusion pumps/syringe pumps;56.1% of the patients were receiving light-protection drugs,but 20.5% of them with inadequate light protection measures;4.7% of the patient's fluid margin was not enough;6.1% of the families adjusted the infusion rate without authorization;the venous access of16.2% of patients fixed loose;1.4% of patients developed fluid extravasation or exudation;1.4% of patients showed separation of convergence;36.5% of patients' blood returned to the infusion line;6.8% of patients' infusion line had blocked.Univariate analysis found that the transshipment purpose,whether to carry light-protection drugs,the number of other indwelling tubes,the number of infusion channel carried,the total number of liquids carried were the influencing factors.Part II: The process of infusion management process was described,including three main processes and 16 sub-process.A total of 15 high-risk failure modes to be improved were screened out by risk assessment.Among them,there were 10 failure modes during the preparation and evaluation stages before transportation and 5 failure modes during transportation.And we also analyzed the failure causes and failure results of high-risk failure modes,and developed the HFMEA improvement strategy.Part III: After the HFMEA improvement strategy was applied to the clinic,the scores of cognition,attitude and behavior of nurses and instructors in emergency department improved significantly;the current situation of infusion management in emergency patients during hospital transportation process was greatly improved in 6 items;the failure risk index of high-risk failure mode had obviously decreased,except 1G1's failure risk index was still greater than 8,other high-risk failure indexes were less than 8 points.Conclusion:Part I: The current situation of infusion management in the process of intra-hospital transport of emergency patients was not optimistic.It should arouse the attention of the nursing managers to improve the current situation.Part II: Using the HFMEA method,we can screen out high risk links and develop targeted improvement strategies.Part III: HFMEA improvement strategy can optimize infusion management process,improve infusion management status,and reduce infusion related adverse events and improve infusion quality and transport safety during transportation.