Application effects of failure mode and effect analysis on the limb posture positioning nursing of extremely severe burn patients

Lu Ying; Zhou Qin; Wang Lina; He Ting; Zhao Haiyang; Cao Xiaoqin

doi:10.3760/cma.j.cn501120-20210412-00126

Volume 37 Issue 11

Nov. 2021

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2021 > 37(11): 1078-1084

Li J,Wu HB,Jin GZ,et al.Comparative study of the effects between second toe tibial dorsal artery flap and second toe tibial plantar proper artery flap in repairing finger skin and soft tissue defects[J].Chin J Burns Wounds,2022,38(10):937-943.DOI: 10.3760/cma.j.cn501120-20210909-00310.

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Lu Y,Zhou Q,Wang LN,et al.Application effects of failure mode and effect analysis on the limb posture positioning nursing of extremely severe burn patients[J].Chin J Burns,2021,37(11):1078-1084.DOI: 10.3760/cma.j.cn501120-20210412-00126.

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Application effects of failure mode and effect analysis on the limb posture positioning nursing of extremely severe burn patients

doi: 10.3760/cma.j.cn501120-20210412-00126

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

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Corresponding author: Zhou Qin, Email: 948306480@qq.com
Received Date: 2021-04-12

Abstract

Abstract

Objective To explore the application effects of risk assessment method of failure mode and effect analysis (FMEA) on the limb posture positioning nursing of extremely severe burn patients. Methods A retrospective observational study was conducted. According to the different limb posture positioning methods, 30 extremely severe burn patients who met the inclusion criteria and underwent routine limb posture positioning in the First Affiliated Hospital of Air Force Medical University from January 2018 to June 2019 were included into routine limb positioning group (19 males and 11 females, aged (40±10) years), and 30 extremely severe burn patients who met the inclusion criteria and underwent limb posture positioning with FMEA risk assessment from July 2019 to December 2020 in the department were included into FMEA limb positioning group (20 males and 10 females, aged (38±10) years). Patients in routine limb positioning group received only routine limb posture positioning by rehabilitation therapists with bare hand every day from the time when their limb wounds healed until they were discharged from hospital. Patients in FMEA limb positioning group received FMEA risk assessment by physicians, rehabilitation therapists, and nurses within 24 hours after admission to analyze the potential failure modes of limb posture positioning, and target-directed limb posture positioning measures were adopted until they were discharged. The risk priority numbers (RPNs) of six major failure modes of patients in FMEA limb positioning group before and after intervention were compared. The range of motion (ROM) of shoulder abduction, elbow extension, wrist dorsiflexion, ankle plantarflexion, total action motion of hand, and modified Barthel index scores of the patients in two groups before and after intervention were also assessed. Data were statistically analyzed with independent sample t test, chi-square test, and paired sample t test. Results The RPNs of 6 main potential failure modes of patients in FMEA limb positioning group i.e. untimely interference of limb posture positioning, not strong awareness of limb posture positioning of nurses, inconsistent of evaluation standards of limb posture positioning, nurses' lacking knowledge about limb posture positioning, nurses' lacking active participation, unsatisfying effects of patients' limb posture positioning were respectively (146±31), (140±22), (125±34), (136±23), (110±28), and (110±5) points after intervention, which were significantly lower than (578±64), (543±57), (419±89), (269±64), (240±41), and (222±48) points before intervention (t=18.441, 23.681, 10.035, 5.362, 9.438, 7.171, P<0.01). After intervention, the ROMs of shoulder abduction, elbow extension, wrist dorsiflexion, and ankle plantarflexion of patients in FMEA limb positioning group were significantly better than those in routine limb positioning group (t=-4.250, 11.400, -15.928, 10.963, -7.470, P<0.01); the ROMs of shoulder abduction, elbow extension, wrist dorsiflexion, and ankle plantarflexion of patients in FMEA limb positioning group and routine limb positioning group were significantly better than those before intervention (t=-35.573, 33.670, -31.090, 32.902, -19.647, -14.952, 11.411, -33.462, -12.818, -13.672, P<0.01). After intervention, the Barthel index score of patients in FMEA limb positioning group (78±9) was significantly higher than 57±9 in routine limb positioning group (t=-9.055, P<0.01), and the Barthel index scores of patients in FMEA limb positioning group and routine limb positioning group were significantly higher than those before intervention (35±5 and 34±4, t=-22.964, -12.329, P<0.01). Conclusions In the limb posture positioning nursing of extremely severe burn patients, risk assessment method of FMEA can effectively avoid the high risk factors in the limb posture positioning of patients, thus maintain the effects of limb posture positioning and improve the ROM of patients, as well as increase the daily living ability of patients in prognosis.
- Burns,
- Posture,
- Nursing care,
- Failure mode and effect analysis

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[1]	胡大海,易南,朱雄翔.实用烧伤康复治疗学[M].北京:人民卫生出版社,2016.
[2]	中华医学会烧伤外科学分会, 中国医师协会烧伤科医师分会. 烧伤康复治疗指南(2013版)[J].中华烧伤杂志,2013,29(6):497-504. DOI: 10.3760/cma.j.issn.1009-2587.2013.06.001.
[3]	温焕,徐菊玲,姚行,等.屈曲体位维持时间对全膝关节置换术后失血量和关节活动度的影响[J].护理研究,2020,34(9):1640-1643. DOI: 10.12102/j.issn.1009-6493.2020.09.033.
[4]	黄永宝,罗盛源,梁广.股骨侧假体与胫骨平台角度对膝关节活动度的影响[J/CD].中华关节外科杂志:电子版,2019,13(4):407-411. DOI: 10.3877/cma.j.issn.1674-134X.2019.04.004.
[5]	钱颖吉,唐红,曹燕,等.手功能位保持枕在脑卒中病人偏瘫手中的应用效果[J].护理研究,2019,33(22):3940-3944. DOI: 10.12102/j.issn.1009-6493.2019.22.025.
[6]	LeblebiciB,AdamM,BağişS,et al.Quality of life after burn injury: the impact of joint contracture[J].J Burn Care Res,2006,27(6):864-868. DOI: 10.1097/01.BCR.0000245652.26648.36.
[7]	SerghiouM,CowanA,WhiteheadC.Rehabilitation after a burn injury[J].Clin Plast Surg,2009,36(4):675-686. DOI: 10.1016/j.cps.2009.05.008.
[8]	杜庆玮,李克诚,陈培伟,等.基于失效模式与效应分析法评估闭环管理在多药耐药菌感控中的应用[J].中华医院感染学杂志,2020,30(14):2221-2225. DOI: 10.11816/cn.ni.2020-191924.
[9]	郑春玲,金慧玉,赵秀杰,等.失效模式与效应分析在降低神经外科置管患者非计划拔管率中的应用[J].中华现代护理杂志,2021,27(6):822-825. DOI: 10.3760/cma.j.cn115682-20201106-06090.
[10]	谢运娣,张春雨,刘娟梅,等.失效模式与效应分析法在外来医疗器械处理流程中的应用[J].护理学报,2014,21(20):19-22.
[11]	卢迎,周琴,王立娜,等.柏拉图分析法结合计划-实施-检查-处理循环模式在初级职称护士科研管理中的应用[J].中华烧伤杂志,2019,35(10):752-756. DOI: 10.3760/cma.j.issn.1009-2587.2019.10.009.
[12]	王艳梅,陈璐,任晓爽,等.基于特性因素图和柏拉图的PICC置管安全管理模式的构建[J].护理实践与研究,2018,15(12):1-4. DOI: 10.3969/j.issn.1672-9676.2018.12.001.
[13]	赵海洋,韩军涛,刘佳琦,等.手持续被动运动系统联合功能训练与压力手套治疗手背部烧伤后早期瘢痕挛缩的效果[J].中华烧伤杂志,2021,37(4):319-326. DOI: 10.3760/cma.j.cn501120-20201020-00443.
[14]	孙岚,徐俊峰,曲学坤,等.康复训练配合穴位电刺激对偏瘫患者手功能恢复的影响[J].中国康复理论与实践,2010,16(2):121-123. DOI: 10.3969/j.issn.1006-9771.2010.02.008.
[15]	王海燕,刘秋鸣,储明子,等.Barthel指数分级护理与Orem自理模式联合在脑卒中偏瘫病人护理中的应用[J].护理研究,2016,30(11A):3950-3952. DOI: 10.3969/j.issn.1009-6493.2016.31.034.
[16]	滕海英,彭雪娟,赵翠松,等.应用日常生活活动能力量表细化分级护理的实践[J].中华护理杂志,2015,50(2):145-147. DOI: 10.3761/j.issn.0254-1769.2015.02.004.
[17]	范飞,戴鑫华,占梦军,等.肢体大关节功能障碍残疾标准比较研究[J].中国司法鉴定,2019(3):92-97. DOI: 10.3969/j.issn.1671-2072.2019.03.016.
[18]	易南,王冰水,胡大海,等.系统康复治疗手烧伤的效果及成本评价[J].中华烧伤杂志,2009,25(6):422-425. DOI: 10.3760/cma.j.issn.1009-2587.2009.06.008.
[19]	杨丽,陈玉烛,车良菊,等.失效模式与效应分析对泌尿外科留置导尿患者尿路感染的影响[J].中华医院感染学杂志,2018,28(4):610-613. DOI: 10.11816/cn.ni.2018-171295.
[20]	姚瑶,马秀英,盛洁,等.基于失效模式与效应分析的病区低值耗材智能化管理[J].护理学杂志,2021,36(3):71-73. DOI: 10.3870/j.issn.1001-4152.2021.03.071.
[21]	RibarovaN, GladilovaA.Dynamics of distribution of nosocomial infections in Bulgaria during the period 2010-2011[J].Akush Ginekol (Sofiia),2012,51(5):26-37.
[22]	高玫.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[J].护理实践与研究,2020,17(8):128-130. DOI: 10.3969/j.issn.1672-9676.2020.08.048.
[23]	黄海桃,蒙莉萍,陈珊娜,等.失效模式及效应分析的环节管理模式对新生儿卡介苗接种安全的影响[J].解放军护理杂志,2020,37(10):81-84. DOI: 10.3969/j.issn.1008-9993.2020.10.021.
[24]	尹林.追踪方法学联合失效模式与效应分析在内镜室麻醉护理风险管理中的应用[J].护理研究,2021,35(1):151-154. DOI: 10.12102/j.issn.1009-6493.2021.01.028.
[25]	蔡玲,张映华,胡兰文,等.基于FMEA法在重症监护病房器械相关感染防控中的应用[J].中国感染控制杂志,2021,20(6):494-498. DOI: 10.12138/j.issn.1671-9638.20211055.
[26]	OmarMTA, Abd El BakyAM, EbidAA. Lower-limb muscular strength, balance, and mobility levels in adults following severe thermal burn injuries[J].J Burn Care Res,2017,38(5):327-333. DOI: 10.1097/BCR.0000000000000495.
[27]	毛世刚,张梅莹,于观潇,等.全膝关节置换术患者术后早期屈曲活动度对远期活动度的影响[J].中华保健医学杂志,2016,18(5):395-397. DOI: 10.3969/.issn.1674-3245.2016.05.015.
[28]	李东泽,徐代化,黄炬,等.交通事故致下肢伤残中关节功能评价的探讨[J].中国司法鉴定, 2014(5): 102-103. DOI: 10.3969/j.issn.1671-2072.2014.05.022.
[29]	杨天潼,于丽丽,项剑,等.《永久性残损评定指南》下肢关节活动度评定原则[J].中国法医学杂志,2018,33(1):112-114. DOI: 10.13618/j.issn.1001-5728.2018.01.036.
[30]	茹天峰,李菲虹,谢卫国,等.平衡训练联合常规治疗对严重烧伤后下肢运动及平衡功能障碍患者影响的前瞻性随机对照研究[J].中华烧伤杂志,2021,37(4):312-318. DOI: 10.3760/cma.j.cn501120-20201018-00441.
[31]	周琴,王青,李双双,等.多专科综合干预在特重度烧伤患者整合治疗中的效果观察[J].中华烧伤杂志,2018,34(10):701-706. DOI: 10.3760/cma.j.issn.1009-2587.2018.10.010.
[32]	易南,胡大海,王冰水.矫形器在烧伤后瘢痕挛缩处理中的重要作用[J].中华烧伤杂志,2013,29(6):516-519. DOI: 10.3760/cma.j.issn.1009-2587.2013.06.005.
[33]	易南,王冰水,张冬梅,等.支具在小儿烧伤康复中的作用与实施体会[J].中华烧伤杂志,2020,36(8):751-753. DOI: 10.3760/cma.j.cn501120-20190610-00267.
[34]	ChateauJ, GuillotM, ZevounouL, et al. Is there any place for spontaneous healing in deep palmar burn of the child?[J].Ann Chir Plast Esthet,2017,62(3):238-244. DOI: 10.1016/j.anplas.2016.09.007.
[35]	张健.持续被动训练机在全膝关节置换术后早期康复训练中的应用[J].医疗装备,2018,31(14):127-128. DOI: 10.3969/j.issn.1002-2376.2018.14.092.
[36]	施加加,沈爱明,孙莹,等.群体特重度烧伤患者伤后恢复期作业活动障碍的横断面调查[J].中华烧伤杂志,2018,34(9):624-628. DOI: 10.3760/cma.j.issn.1009-2587.2018.09.012.
[37]	王倩,仇兰香,薛艳.PDCA循环管理联合失效模式与效应分析在急诊输液患者用药管理中的应用[J].齐鲁护理杂志,2021,27(11):160-162. DOI: 10.3969/j.issn.1006-7256.2021.11.060.
[38]	洪志达,陈权耀,张雯雯,等.FMEA与FMECA在PIVAS事前防范用药错误中的应用[J].中国现代应用药学,2019,36(11):1425-1429. DOI: 10.13748/j.cnki.issn1007-7693.2019.11.024.

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Application effects of failure mode and effect analysis on the limb posture positioning nursing of extremely severe burn patients

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Application effects of failure mode and effect analysis on the limb posture positioning nursing of extremely severe burn patients

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