Prevention of intraoperative acquired pressure injury in patient undergoing spinal surgery:effectiveness of preventive workflow in participatory observation based on HFMEA
10.3969/j.issn.1671-8283.2025.10.008
- VernacularTitle:基于参与式观察的医疗失效模式与效应分析在预防脊柱手术患者术中获得性压力性损伤的实践
- Author:
Peipei ZHANG
1
;
Miao MIAO
;
Xin XU
;
Ping LIU
;
Liping JIANG
Author Information
1. 上海交通大学医学院附属新华医院急诊手术室,上海,200000
- Publication Type:Journal Article
- Keywords:
participatory observation;
healthcare failure mode and effect analysis;
intraoperative acquired pressure injury;
spinal surgery;
prone position;
operating theatre nursing;
pre-and post-control studyi
- From:
Modern Clinical Nursing
2025;24(10):53-59
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effectiveness of a preventive workflow in participatory observation based on healthcare failure mode and effect analysis(HFMEA)in reducing intraoperative acquired pressure injury(IAPI)in patients undergoing spinal surgery,and to provide evidences for prospective nursing management.Methods A preventive workflow of participatory observation-based HFMEA was established,which included defining HFMEA topic,forming a multidisciplinary team,creating a process map(through participatory observation),conducting failure mode and hazard analysis(using a Hazard scoring matrix and decision tree analysis,and identifying the causes of key failure through Pareto chart analysis),implementing improvement actions,and tracking effectiveness.Ultimately,11 high-risk failure modes were identified for further improvement:poor design of form/information system,heavy workload and fast pace,lack of departmental regulations,risk factors of IAPI,and unclear duty and responsibility in a multidisciplinary team.A series measures for improvement were developed and implemented based on the identified key causes.A pre-and post-control study was carried out.A total of 180 patients who received spinal surgery between November and April 2024 and received traditional preventive methods were assigned to a control group.While further 218 patients who received spinal surgery between May and December 2023 were assigned to the trial group with the participatory observation on the basis of HFMEA prevention workflow.IAPI incidence rate and severity were compared between the two groups,as well as the completion rate of preoperative IAPI risk assessment in the trial group.Results The trial group demonstrated significantly lower IAPI incidence and severity compared with those in the control group(P<0.05).In the trial group,178 patients(98.92%)completed the preoperative IAPI risk assessment,and 172 patients(95.47%)completed the intraoperative assessment.Conclusion The participatory observation based HFMEA prevention workflow can effectively reduce an incidence and severity of IAPI in patients undergoing spinal surgery,ensure patient safety and thereby enhance the quality of nursing management.
