Application of failure mode and effect analysis in risk management of midline catheter of patients in neurosurgical department

Objective To explore the application value of failure mode and effect analysis (FMEA) in the risk management of midline catheter (MC) in patients of neurosurgical department.

Methods  A total of 106 patients with MC catheterization admitted from June 2020 to March 2021 were selected as control group and received routine nursing. A total of 114 patients with MC catheterization admitted from April 2021 to January 2022 were assigned to observation group, and FMEA management was implemented on the basis of routine nursing. The failure modes and potential risk factors existing in the operation process and system management of previous catheterization maintenance were found out, the priority risk value (RPN) of the failure mode was calculated, and a standardized management plan for MC catheterization, puncture and maintenance in patients of neurosurgery department was formulated. The RPN score of MC catheterization maintenance failure mode, the incidence of MC catheterization maintenance related complications, the incidence of unplanned extubation and patients′ satisfaction were observed and compared between the two groups.

Results  After the FMEA intervention, the RPN scores of incomplete evaluation, non-standardized operation, improper pretreatment, improper daily application and maintenance, inadequate handover patrol, improper restraint for sedation and poor patient self-management were (150.02±11.68), (113.01±7.35), (210.43±8.65), (180.00±24.70), (142.21±4.12) and (115.81±13.04) respectively, which were lower than (291.93±28.04), (279.14±9.03), (411.90±23.28), (322.81±21.58), (254.62±20.38) and (202.40±30.32) in the control group(P < 0.05). The total incidence of MC-related complications (bleeding, swelling, displacement, phlebitis, tube blocking) in the observation group was 10.53% (12/114), and the incidence of unplanned extubation was 0.88%(1/114), which were lower than 23.58%(25/106) and 2.83%(3/106), respectively in the control group (P < 0.05). The patients′ satisfaction of the observation group was higher than that in the control group(92.98% versus 83.02%, P < 0.05).

Conclusion  The application of FMEA in MC risk management of neurosurgical patients can establish standardized safety management model, effectively reduce the incidence rates of MC-related complications and unplanned extubation, improve patients′ satisfaction, and provide evidence-based basis for clinical practice for MC risk management of patients in neurosurgical department.