CAJ | 학술논문

背景：医疗风险是医疗服务过程中可能发生的一切对患者造成损害或不安全的事件，现有的医疗风险管理主要以定性的经验为主，尚缺乏一种对既定的医疗救治过程进行系统规范的缺陷分析与风险评估的方法。 　　目的：构建医疗过程缺陷分析与风险评估模型，发现医疗过程可能存在的风险，提出消除或降低这些风险的有效措施。 　　方法：可靠性工程中的故障模式与影响分析方法应用于制造过程，即针对产品在生产过程中每个工序可能发生的工艺故障模式、原因及其对产品造成的所有影响，进行风险评估并对工艺薄弱环节制定改进措施，使风险达到可接受的水平。参考制造过程的故障模式与影响分析，可制定医疗过程缺陷分析与风险评估实施步骤，分析医疗过程中潜在缺陷，并对风险较高的薄弱环节提出改进措施，预防对患者造成重大不利影响的风险发生。结果与结论：借鉴故障模式与影响分析建立医疗过程缺陷分析和风险评估方法与基本步骤，以某医院目前急诊心肌梗死抢救过程为例，以抢救步骤中的“患者嚼服300 mg阿司匹林”为重点对象进行缺陷、原因和影响分析，并对不可接受的缺陷和原因提出改进措施和建议。从分析结果可见，文章提出的改进措施和建议可以显著降低该步骤的缺陷给患者带来的风险。因此将故障模式与影响分析应用到医疗过程，有较强的实用价值。
배경：의료풍험시의료복무과정중가능발생적일절대환자조성손해혹불안전적사건，현유적의료풍험관리주요이정성적경험위주，상결핍일충대기정적의료구치과정진행계통규범적결함분석여풍험평고적방법。 　　목적：구건의료과정결함분석여풍험평고모형，발현의료과정가능존재적풍험，제출소제혹강저저사풍험적유효조시。 　　방법：가고성공정중적고장모식여영향분석방법응용우제조과정，즉침대산품재생산과정중매개공서가능발생적공예고장모식、원인급기대산품조성적소유영향，진행풍험평고병대공예박약배절제정개진조시，사풍험체도가접수적수평。삼고제조과정적고장모식여영향분석，가제정의료과정결함분석여풍험평고실시보취，분석의료과정중잠재결함，병대풍험교고적박약배절제출개진조시，예방대환자조성중대불리영향적풍험발생。결과여결론：차감고장모식여영향분석건립의료과정결함분석화풍험평고방법여기본보취，이모의원목전급진심기경사창구과정위례，이창구보취중적“환자작복300 mg아사필림”위중점대상진행결함、원인화영향분석，병대불가접수적결함화원인제출개진조시화건의。종분석결과가견，문장제출적개진조시화건의가이현저강저해보취적결함급환자대래적풍험。인차장고장모식여영향분석응용도의료과정，유교강적실용개치。
BACKGROUND:Medical risks are al unsafe events or that damage to the patient during medical services. Present medical risk management is mainly qualitative experience, and lacks of regular failure analysis and risk assessment for established medical treatment. OBJECTIVE:To construct models of medical process failure analysis and risk assessment, find possible risks during medical treatment, and propose effective measures to eliminate or decrease above risks. METHODS:Failure mode and effects analysis during reliability engineering were used in production. That was, risk assessment was conducted in the possible technical failure modes, causes and al impacts on the product during each process. Improvement measures were made for weak link during the process. The risk could reach an acceptable level. In accordance with failure mode and effects analysis during production, the procedure of medical process failure analysis and risk assessment could be made to analyze the potential failures during medical treatment. Moreover, the improvement measures were proposed for weak link with high risks so as to prevent the occurrence of risk of significant adverse effects on patients. RESULTS AND CONCLUSION:The methods and basic procedures of medical process failure analysis and risk assessment were established by using the experience of failure mode and effects analysis. Taking the rescue process of myocardial infarction in the emergency of a hospital as an example, the analysis of failures, reasons and impacts was performed taking“chewing 300 mg aspirin”in the rescue steps as a key. The improvement measures and suggestions were proposed for unacceptable failures and reasons. Seen from the analysis results, proposed improvement measures and suggestions can obviously decrease the risks of failures caused by this step to patients. Therefore, the application of failure mode and effects analysis in medical treatment has a strong practical value.