| 刘绪星,梁焕笑,吴玲,等.基于医疗失效模式与效应分析降低静脉用药集中调配中心贵重药品管理与使用风险[J].安徽医药,2025,29(5):1052-1056. |
| 基于医疗失效模式与效应分析降低静脉用药集中调配中心贵重药品管理与使用风险 |
| Reducing the risk of valuable medicines management and use in PIVAS based on healthcare failure mode and effect analysis |
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| DOI：10.3969/j.issn.1009-6469.2025.05.038 |
| 中文关键词: 药品监督管理 药剂科，医院 贵重药品 医疗失效模式与效应分析法 药品管理与使用 风险防范 破损药品金额 |
| 英文关键词: Drug administration Pharmacy service, hospital Valuable medicines Healthcare failure mode and effect analysis method Medication management and utilization Risk prevention Amount of damaged medicines |
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| 中文摘要: |
| 目的应用医疗失效模式与效应分析( HFMEA)构建降低贵重药品管理与使用风险的模式，促进用药安全，减少经济损失。方法 2023年 5月暨南大学附属第一医院运用 HFMEA找出贵重药品管理与使用的潜在失效模式，对所有潜在失效模式分别进行严重度( S)和发生率( O)评分，计算风险优先指数( RPN)对高风险失效模式进行决策树分析，得出需要采取改善行动的潜在失效模式，制定相应的改善方案并实施，统计分析 HFMEA实，施前后 RPN值，评估改善效果。结果应用 HFMEA法后，贵重药品管理与使用各环节的失效模式 RPN值下降范围为 67.74%~74.36%，改善前后对比差异有统计学意义(P<0.05)，相关不良事件数以及报损金额均降为 0。结论运用 HFMEA可以使贵重药品管理制度标准化、调配规范化以及成品输液输注标准化，有效降低贵重药品管理与使用的风险，并使护理质量提升。 |
| 英文摘要: |
| Objective To develop a model for reducing risk in the management and use of valuable medicines using healthcare fail-ure mode and effect analysis (HFMEA), so as to promote safe drug administration, and minimize economic losses.Methods HFMEA was employed to identify potential failure modes in the management and use of valuable medicines in the First Affiliated Hospital ofJi'nan University at May 2023. All identified failure modes were scored based on severity (S) and occurrence (O), and the risk prioritynumber (RPN) was calculated. High-risk failure modes were further analyzed using decision tree analysis to determine potential failuremodes that necessitate improvement actions. Formulating improvement programs and implementing them, we conducted statistical anal-ysis on the RPN values before and after the implementation of HFMEA to evaluate the effectiveness of the improvements.Results Af-ter applying the HFMEA method, the RPN values for failure modes in various stages of valuable medicines management and use de-creased by 67.74% to 74.36%. There was a statistically significant difference between the values before and after the improvements (P< 0.05). Additionally, the number of related adverse events and the amount of reported losses both dropped to zero.Conclusions The ap-plication of HFMEA can standardize the management system, regulation of preparation, and standardized infusion of finished productsfor valuable medicines. This effectively reduces the risks associated with the management and use of valuable medicines and enhancesthe quality of nursing care. |
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