Failure mode and effect analysis for risk management of unplanned extubation after esophageal cancer surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAO Li , YIN Yuanyuan , ZHENG E ,  YANG Mei , LIN Lin , ZHAO Chunlin

Department of Thoracic Surgery, West China Nursing College of Sichuan University/West China Hospital of Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

YANG Mei, Email: yangmei69@126.com

Keywords：

Failure mode and effect analysis; unplanned extubation; management

DOI：

10.7507/1007-4848.202108068

Video：

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Objective To explore the application value of failure mode and effect analysis (FMEA) in the risk management of unplanned extubation after esophageal cancer surgery. Methods A total of 1 140 patients who underwent esophageal cancer surgery in our department from January 2015 to May 2017 were selected as a control group, including 948 males and 192 females with an average age of 64.45±4.53 years. FMEA was used to analyze the risk management process of unplanned extubation. The potential risk factors in each process were found by calculating the risk priority number (RPN) value, and the improvement plan was formulated for the key process with RPN>125 points. Then 1 117 patients who underwent esophageal cancer surgery from June 2017 to December 2019 were selected as a trial group, including 972 males and 145 females with an average age of 64.60±5.22 years, and the FMEA risk management mode was applied.Results The corrective measures were taken to optimize the high-risk process, and the RPN values of 9 high-risk processes were reduced to below 125 points after using FMEA risk management mode. The rate of unplanned extubation in the trial group was lower than that in the control group (P<0.05). Conclusion The application of FMEA in the risk management of unplanned extubation after esophageal cancer surgery can reduce the rate of unplanned extubation, improve the quality of nursing, and ensure the safety of patients.

Citation： YAO Li, YIN Yuanyuan, ZHENG E, YANG Mei, LIN Lin, ZHAO Chunlin. Failure mode and effect analysis for risk management of unplanned extubation after esophageal cancer surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 375-380. doi: 10.7507/1007-4848.202108068 Copy

1.	钟劲, 杨小月, 龚龙飞, 等. 项目管理在预防非计划拔管护理实践中的应用. 当代护士(下旬刊), 2021, 28(1): 174-176.
2.	周秀红. 失效模式与效应分析在预防心血管病患者意外拔管的临床应用. 天津护理, 2017, 25(5): 440-442.
3.	王颖妍. 强化护理干预策略在降低ICU气管插管患者非计划性拔管中的效果. 中国医药指南, 2021, 19(26): 41-43.
4.	楚佳琪, 马凌岚. 思维导图预防带胃管出院患者非计划性拔管效果. 中国城乡企业卫生, 2021, 36(9): 113-115.
5.	Morris HF, Schuller L, Archer J, et al. Decreasing unplanned extubation in the neonatal ICU With a focus on endotracheal tube tip position. Respir Care, 2020, 65(11): 1648-1654.
6.	鲁志卉, 郭晓贝, 王颖. 预防住院病人非计划性拔管安全管理策略的研究进展. 全科护理, 2021, 19(25): 3476-3481.
7.	Najafpour Z, Hasoumi M, Behzadi F, et al. Preventing blood transfusion failures: FMEA, an effective assessment method. BMC Health Serv Res, 2017, 17(1): 453.
8.	Anjalee JAL, Rutter V, Samaranayake NR. Application of failure mode and effects analysis (FMEA) to improve medication safety in the dispensing process—A study at a teaching hospital, Sri Lanka. BMC Public Health, 2021, 21(1): 1430.
9.	Piriyapatsom A, Chittawatanarat K, Kongsayreepong S, et al. Incidence and risk factors of unplanned extubation in critically Ⅲ surgical patients: The multi-center thai university-based surgical intensive care units study (THAI-SICU Study). J Med Assoc Thai, 2016, 99 Suppl 6: S153-S162.
10.	宋宏源, 何立, 刘俊. 医疗失效模式与效应分析在降低神经科非计划性拔管发生率中的应用. 中西医结合护理(中英文), 2019, 5(7): 13-15.
11.	邱健春. 失效模式与效应分析在降低麻醉恢复室全麻患者非计划拔管率中的应用. 中国医学创新, 2018, 15(36): 74-77.
12.	李静, 刘云, 吴丹. 失效与效应分析模式在儿科留置针非计划拔管和堵管中的应用. 齐鲁护理杂志, 2021, 27(7): 127-129.
13.	张含露, 陈龙奇, 耿英才, 等. 机器人辅助食管癌根治手术的应用. 中国胸心血管外科临床杂志, 2019, 26(3): 206-210.
14.	邱舫, 杨梅, 王维, 等. 肺叶切除术后患者无尿管留置的前瞻性队列研究. 中国胸心血管外科临床杂志, 2015, 22(7): 634-637.
15.	王雪莲, 周娇莹. 胸腔闭式引流术后意外拔管的危险因素分析. 中国乡村医药, 2021, 28(10): 11-12.
16.	秦雪燕, 魏雪梅, 李姗姗. 应用HFMEA对降低ICU气管插管非计划拔管率的效果分析. 当代护士(下旬刊), 2021, 28(5): 17-20.
17.	周洪霞, 杨梅, 廖虎, 等. 胸腔镜肺叶切除术后16F尿管胸腔引流可行性的前瞻性队列研究. 中国胸心血管外科临床杂志, 2016, 23(4): 334-340.
18.	杨梅, 陈娟, 车国卫, 等. 肺癌肺叶切除术患者围手术期有无尿管留置的成本效益分析. 中国胸心血管外科临床杂志, 2016, 23(5): 421-424.
19.	鲍映雪, 孙柳君, 袁勉, 等. 失效模式与效应分析在手术室护理质量安全管理中的应用效果评价. 中国药物与临床, 2019, 19(12): 2110-2112.
20.	董翠萍, 汪晖, 潜艳. FMEA在开胸术后压疮高危患者压疮管理中的运用. 当代护士(中旬刊), 2017, (11): 140-142.
21.	张桂兰, 周莹. FMEA失效模式在预防神经内科重症患者深静脉血栓形成中的应用. 当代护士(中旬刊), 2017, (3): 165-167.
22.	罗利珍. 失效模式与效应分析在麻醉复苏室护理风险管理中的应用. 广西医学, 2017, 39(2): 283-285.
23.	王翠云, 沈媛, 鲁显福. 医疗失效模式与效应分析在麻醉恢复室安全交接中的应用研究. 护士进修杂志, 2021, 36(19): 1782-1785.
24.	李相林, 米元元. 失效模式与效应分析在经颈静脉肝内门体分流术后穿刺部位出血护理中的应用. 解放军护理杂志, 2017, 34(22): 40-44.
25.	Jain K. Use of failure mode effect analysis (FMEA) to improve medication management process. Int J Health Care Qual Assur, 2017, 30(2): 175-186.
26.	Pueyo-López C, Sánchez-Cuervo M, Vélez-Díaz-Pallarés M, et al. Healthcare failure mode and effect analysis in the chemotherapy preparation process. J Oncol Pharm Pract, 2021, 27(7): 1588-1595.
27.	van Daalen FV, Smeulers M, Bartels EJH, et al. A healthcare failure mode and effect analysis to optimise the process of blood culture performance. Neth J Med, 2020, 78(6): 341-348.

1. 钟劲, 杨小月, 龚龙飞, 等. 项目管理在预防非计划拔管护理实践中的应用. 当代护士(下旬刊), 2021, 28(1): 174-176.
2. 周秀红. 失效模式与效应分析在预防心血管病患者意外拔管的临床应用. 天津护理, 2017, 25(5): 440-442.
3. 王颖妍. 强化护理干预策略在降低ICU气管插管患者非计划性拔管中的效果. 中国医药指南, 2021, 19(26): 41-43.
4. 楚佳琪, 马凌岚. 思维导图预防带胃管出院患者非计划性拔管效果. 中国城乡企业卫生, 2021, 36(9): 113-115.
5. Morris HF, Schuller L, Archer J, et al. Decreasing unplanned extubation in the neonatal ICU With a focus on endotracheal tube tip position. Respir Care, 2020, 65(11): 1648-1654.
6. 鲁志卉, 郭晓贝, 王颖. 预防住院病人非计划性拔管安全管理策略的研究进展. 全科护理, 2021, 19(25): 3476-3481.
7. Najafpour Z, Hasoumi M, Behzadi F, et al. Preventing blood transfusion failures: FMEA, an effective assessment method. BMC Health Serv Res, 2017, 17(1): 453.
8. Anjalee JAL, Rutter V, Samaranayake NR. Application of failure mode and effects analysis (FMEA) to improve medication safety in the dispensing process—A study at a teaching hospital, Sri Lanka. BMC Public Health, 2021, 21(1): 1430.
9. Piriyapatsom A, Chittawatanarat K, Kongsayreepong S, et al. Incidence and risk factors of unplanned extubation in critically Ⅲ surgical patients: The multi-center thai university-based surgical intensive care units study (THAI-SICU Study). J Med Assoc Thai, 2016, 99 Suppl 6: S153-S162.
10. 宋宏源, 何立, 刘俊. 医疗失效模式与效应分析在降低神经科非计划性拔管发生率中的应用. 中西医结合护理(中英文), 2019, 5(7): 13-15.
11. 邱健春. 失效模式与效应分析在降低麻醉恢复室全麻患者非计划拔管率中的应用. 中国医学创新, 2018, 15(36): 74-77.
12. 李静, 刘云, 吴丹. 失效与效应分析模式在儿科留置针非计划拔管和堵管中的应用. 齐鲁护理杂志, 2021, 27(7): 127-129.
13. 张含露, 陈龙奇, 耿英才, 等. 机器人辅助食管癌根治手术的应用. 中国胸心血管外科临床杂志, 2019, 26(3): 206-210.
14. 邱舫, 杨梅, 王维, 等. 肺叶切除术后患者无尿管留置的前瞻性队列研究. 中国胸心血管外科临床杂志, 2015, 22(7): 634-637.
15. 王雪莲, 周娇莹. 胸腔闭式引流术后意外拔管的危险因素分析. 中国乡村医药, 2021, 28(10): 11-12.
16. 秦雪燕, 魏雪梅, 李姗姗. 应用HFMEA对降低ICU气管插管非计划拔管率的效果分析. 当代护士(下旬刊), 2021, 28(5): 17-20.
17. 周洪霞, 杨梅, 廖虎, 等. 胸腔镜肺叶切除术后16F尿管胸腔引流可行性的前瞻性队列研究. 中国胸心血管外科临床杂志, 2016, 23(4): 334-340.
18. 杨梅, 陈娟, 车国卫, 等. 肺癌肺叶切除术患者围手术期有无尿管留置的成本效益分析. 中国胸心血管外科临床杂志, 2016, 23(5): 421-424.
19. 鲍映雪, 孙柳君, 袁勉, 等. 失效模式与效应分析在手术室护理质量安全管理中的应用效果评价. 中国药物与临床, 2019, 19(12): 2110-2112.
20. 董翠萍, 汪晖, 潜艳. FMEA在开胸术后压疮高危患者压疮管理中的运用. 当代护士(中旬刊), 2017, (11): 140-142.
21. 张桂兰, 周莹. FMEA失效模式在预防神经内科重症患者深静脉血栓形成中的应用. 当代护士(中旬刊), 2017, (3): 165-167.
22. 罗利珍. 失效模式与效应分析在麻醉复苏室护理风险管理中的应用. 广西医学, 2017, 39(2): 283-285.
23. 王翠云, 沈媛, 鲁显福. 医疗失效模式与效应分析在麻醉恢复室安全交接中的应用研究. 护士进修杂志, 2021, 36(19): 1782-1785.
24. 李相林, 米元元. 失效模式与效应分析在经颈静脉肝内门体分流术后穿刺部位出血护理中的应用. 解放军护理杂志, 2017, 34(22): 40-44.
25. Jain K. Use of failure mode effect analysis (FMEA) to improve medication management process. Int J Health Care Qual Assur, 2017, 30(2): 175-186.
26. Pueyo-López C, Sánchez-Cuervo M, Vélez-Díaz-Pallarés M, et al. Healthcare failure mode and effect analysis in the chemotherapy preparation process. J Oncol Pharm Pract, 2021, 27(7): 1588-1595.
27. van Daalen FV, Smeulers M, Bartels EJH, et al. A healthcare failure mode and effect analysis to optimise the process of blood culture performance. Neth J Med, 2020, 78(6): 341-348.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Failure mode and effect analysis for risk management of unplanned extubation after esophageal cancer surgery

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