Study On Nursing Risk Identification And Intervention Plan Of Adult Day Surgery Patients Based On HFMEA

Objective: 1.To comprehend the status quo of nursing risk management for adult day surgery patients.2.Based on the HFMEA mode,the idea and method of feedforward control were used to identify the risk factors of high risk nursing care for adult day surgery patients according to the diagnosis and treatment and nursing work process of adult day surgery patients.3.With regards to the risk factors of high-risk nursing,the failure modes and reasons were analyzed when making the nursing intervention plan through group discussion,literature review and Delphi letter consultation method.4.Some of the intervention measures were empirically applied in adult patients undergoing day surgery to validate the effects.Methods: 1.Investigate the status quo of nursing risk management for adult day surgery patients in a third-class A hospital in Nanjing Literature review,referring to hospital rules and regulations and related nursing process of ambulatory surgery patients diagnosis and treatment,designing ‘adult ambulatory surgery patients perioperative nursing rules form’,using the convenience sampling method to conduct one-month investigation of current situation about adult ambulatory surgery patients perioperative nursing process in a third-class A hospital in Nanjing.2.Based on the HFMEA method,identify the failure modes and reasons of nursing care for adult day surgery patients According to the steps of HFMEA,the failure modes and reasons of adult day surgery patients’ nursing were charged by defining the research topic,establishing the HFMEA team,making the flow chart of nursing work and risk assessment.Combined with the current investigation results,the research team sorted out all existing and potential nursing failure modes and influencing factors of adult day surgery patients in a third-class A hospital in Nanjing,Then the HFMEA team members scored their severity(S),occurrence frequency(O)and detectability(D)to calculated the RPN=S*O*D value.So high-risk nursing failure patterns and causes can be identified according to the scoring standard.3.Through group discussion,literature review and Delphi letter consultation,we blueprinted a nursing risk intervention plan for adult day surgery patients Through the literature retrieval and 2 rounds of Delphi expert enquiry,researchers built best nursing intervention measures against adult ambulatory surgery patients nursing risk events combining with HFMEA team members’ partial thoughts.4.Taking the risk factor of patients’ intraoperative hypothermia as an example,the application effect of the intervention plan based on HFMEA in the nursing risk management of adult day surgery patients was discussed The intervention plan constructed by HFMEA was applied to the intraoperative body temperature management of adult day surgery patients.One month after the implementation of the intervention plan,the current situation of intraoperative body temperature management of adult day surgery patients in a third-class A hospital in Nanjing was investigated again with the same method,and compared with the data obtained from the previous status survey.The body temperature at the beginning of operation,10 min,30 min and 60 min of operation were compared before and after operation.Results: 1.Current situation of nursing risk management for adult day surgery patients in a third-class A hospital in Nanjing According to the ‘adult day surgery patients perioperative nursing rules form’,a survey of 196 adults’ day surgery patients perioperative nursing process was carried out about their implementation and found that in outpatient ambulatory surgery management center,9.69% of the patients wasted time waiting due to incomplete information collection and evaluation;3.57% were not fully prepared before surgery body or mind,resulting in the delay of surgery;In the day ward,55.61% of patients developed preoperative anxiety;38.78% had poor preoperative health education,13.27% patients and their families lack effective evaluation of the safety awareness;2.04% of the patients delayed discharge due to postoperative anxiety;In the day operating room,10.71% of the patients had intraoperative hypothermia;3.57% had postoperative pain.According to the ‘Health Education Awareness Questionnaire for Day Surgery Patients’,it was found that in the stage of preoperative preparation,patients had a low score on the awareness of anesthesia methods.At the stage of intraoperative cooperation,the cognitive scores of the patients were all low.According to the ‘Ambulatory Surgery Patient Satisfaction Evaluation Table’,85.20% of the patients were completely satisfied with the ambulatory surgery,and 8.67% were not satisfied with the ambulatory surgery.4.59% were dissatisfied with the preoperative examination and explanation.2.Based on HFMEA,identify high-risk nursing failure modes and failure causes for adult day surgery patients.According to the diagnosis and treatment process of day surgery patients,the HFMEA team members drew up the perioperative nursing process of adult day surgery patients,including 11 main processes and 25 sub-processes.HFMEA team members conducted a risk assessment based on the process and identified 11 high-risk care failure modes that need to be improved like delayed operation,low patient satisfaction,low body temperature,postoperative pain and other failure modes.It is believed that the occurrence of nursing risk events is mainly related to imperfect clinical pathway,unreliable day operation information management system,incomprehensive professional knowledge for nursing staff and the lack of internet nursing services and other factors after cause analysis.3.Through group discussion,literature review and Delphi letter consultation method,the nursing risk intervention plan of adult day surgery patients was worked out.Sixteen clinical experts from inside and outside the province who have a high influence on the field of day surgery nursing management were included to conduct two rounds of letter consultation,and the positive number of the two rounds of expert letter consultation was 93.75% and 100% respectively.The expert authority coefficients were 0.875 and 0.905 respectively.The degree of opinion concentration and coordination is obviously good.After two rounds of expert consultation,the nursing risk intervention plan for adult day surgery patients was finally mapped out.4.Taking the risk factor of patients’ intraoperative hypothermia as an example,the application effect of the intervention plan based on HFMEA in the nursing risk management of adult day surgery patients was discussed After the intervention program was applied clinically,the core temperatures of patients at the beginning of surgery,10 min,30 min and 60 min of surgery were all higher than before,with statistically significant differences.Conclusion: 1.The current situation of nursing risk management for adult day surgery patients is generally good,but preoperative anxiety,poor health education effect,intraoperative hypothermia and other phenomena are common among patients,thus the working process should be further enhanced to improve the quality of work.2.HFMEA method can be used to prospectively and systematically screen out high-risk nursing risk factors and their causes in view of which expert letter consultation can be used to draw up an effective nursing risk intervention plan for adult day surgery patients based on evidence. 3.Intervention scheme based on HFMEA can effectively improve the status quo of nursing risk management for adult day surgery patients and reduce the occurrence of nursing risk events.