運用醫療照護失效模式與效應分析降低新型冠狀病毒應變風險

Applying Healthcare Failure Mode and Effects Analysis in Reducing the Risk of Response for COVID-19

許佳雯(Chia-Wen Hsu) ； 洪靖慈(Ching-Tzu Hung) ； 鄭思裴(Ssu-Pei Cheng) ； 吳玲琨(Lin-Kun Wu) ； 盧柏樑(Po-Liang Lu) ； 林俊祐(Chun-Yu Lin) ； 侯明鋒(Ming-Feng Hou)

《醫務管理期刊》 21卷3期 (2020/09) Pp. 258-274

https://doi.org/10.6174/JHM.202009_21(3).258

摘要

目的：2019年底武漢爆發新型冠狀病毒（COVID-19）感染造成嚴重特殊傳染性肺炎，並迅速傳播至世界各國。醫療照護失效模式與效應分析應可用於優化新興傳染病應變的策略，但目前缺少實務執行報告。方法：南部某醫學中心成立專案小組運用醫療照護失效模式與效應分析（Healthcare Failure Mode and Effects Analysis, HFMEA）依序繪製COVID-19應變流程，分析潛在失效模式及失效原因，進行危害分析及決策樹分析，提出並執行因應對策，最後評核專案執行成效。結果：從10項COVID-19應變主流程及21項次流程中，分析出21項潛在失效模式及31項失效原因，包括人員未配合TOCC管理、負壓隔離病床滿床、支援照護醫護人員人力有限等。對風險優先係數（RPN）大於8分者擬定對策，如設立檢疫站勾稽人員TOCC、設立自中港澳返國人士非感染症門診及戶外慢籤領藥區、設置防疫專用病房、規劃防疫津貼及獎勵制度等作為。結論：專案執行後，風險優先係數總分自268分降低至95分，執行成效達65%，HFMEA在COVID-19疫情發生時，可有效檢視並優化應變流程，期能提供病友更安全的就醫環境。

關鍵字

嚴重特殊傳染性肺炎 ； 新型冠狀病毒 ； 醫療照護失效模式與效應分析

並列摘要

Objectives: Taiwan Centers for Disease Control announced COVID-19 is a notifiable infectious disease in Taiwan on January 15, 2020. Therefore, we established a project team to improve and strengthen the emergency response capability of the hospital for emerging infectious diseases. Methods: Using the Healthcare Failure Mode and Effects Analysis method, the main and following processes for infectious disease emergency response were drawn by the project team. The failure modes and their potential causes of each process were listed accordingly. A decision tree to improve the process was also formulated. Results: The failure modes for infectious disease emergency response include i.) Employees with travel history, occupation, contact history and cluster; ii.) patients and visitors with travel history, occupation, contact history and cluster; iii.) negative pressure isolation beds at full capacity; and iv.) limited medical staff. We developed countermeasures for potential causes of failure modes with a risk priority number (RPN) greater than eight points, e.g., setting up quarantine stations at the entrance, a special outdoor outpatient, outdoor drug pickup area and referral wards, and establishing a reward system. Conclusions: After improvement, the RPN decreased from 268 to 95 points and the improvement effectiveness reached 65%. This project improved the processes for infectious disease emergency response, and provided a safer medical environment for patients.

並列關鍵字

Severe Pneumonia with Novel Pathogens ； COVID-19 ； Healthcare Failure Mode and Effects Analysis (HFMEA)

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