Using healthcare failure mode and effect analysis to improve adequacy of maintenance hemodialysis (运用医疗失效模式与效应分析提高维持性血液透析患者透析充分性)

Abstract

Objective To explore the adequacy of maintenance hemodialysis by using the Healthcare Failure Modes and Effects Analysis (HFMEA) method, so as to improve the dialysis quality and prognosis of hemodialysis patients. Methods A total of 78 patients who underwent maintenance hemodialysis in Zhongshan Hospital Fudan University (Xiamen Branch) from January 2021 to December 2021 were enrolled. The adequacy of hemodialysis was measured by using single-pool urea clearance (spKt/V). Patients were divided into the standard group (spKt/V≥1. 2) and the non-standard group (spKt/V <1. 2). HFMEA was used to measure and analyze the causes of hemodialysis insufficiency, and to formulate improvement measures. Results The healthcare failure mode and effect analysis (HFMEA) significantly improved dialysis adequacy in hemodialysis patients, the proportion of non-standard patients were reduced from 19. 23% to 2. 56% (P=0. 002). Conclusion Management using the HFMEA approach could improve dialysis adequacy in hemodialysis patients, reduce dialysis complications, improve patients' quality of life. (目的 运用医疗失效模式与效应分析法探究维持性血液透析充分性, 以提升血液透析患者透析质量, 提高生存率。方法 纳入2021年1月—12月在复旦大学附属中山医院厦门医院行维持性血液透析的患者78例, 根据单室尿素清除率(spKt/V)结果分为达标组(spKt/V≥1. 2)与未达标组(spKt/V＜1. 2), 运用医疗失效模式与效应分析法测量、分析导致血液透析不充分的原因, 制定改进措施。结果 运用医疗失效模式与效应分析法方法进行管理, 血液透析患者透析充分性明显提高, 实施前未达标组15(19. 23%)例, 实施后未达标2(2. 56%)例, 差异有统计学意义(P=0. 002)。结论 运用医疗失效模式与效应分析方法管理能提高血液透析患者透析充分性, 对减少透析并发症、改善患者生活质量和提高生存率具有积极意义。)

Keywords

• healthcare failure mode and effect analysis
• maintenance hemodialysis
• dialysis adequacy
• dialysis-associated complications
• quality of life
• 医疗失效模式及效应分析
• 维持性血液透析
• 透析充分性
• 透析并发症
• 生活质量