目的 优化气管切开非计划性拔管插管困难患者处理流程并验证临床效果。方法 成立专家团队,梳理气管切开患者非计划性拔管处理流程,应用医疗失效模式与效应分析法对流程步骤进行失效分析,制订优化方案并组织实施。比较流程优化前（2019年1月—12月）与流程优化后（2020年1月—12月）各项指标的差异。结果 流程优化后,气管切开非计划性拔管患者抢救用时从优化前的（32.18±3.21） min缩短为（23.28±2.01） min（P<0.05）;患者对护理工作的满意度从（86.24±4.93）分提高到（89.48±2.48）分（P<0.001）;医生对护理工作的满意度从（75.35±7.54）分提高到（84.80±3.65）分（P<0.05）。结论 引入医疗失效模式与效应分析优化气管切开患者非计划性拔管处理流程,可有效缩短救治时间,提高气管切开非计划性拔管患者满意度。
Objective To optimize and verify the clinical effect of management procedure for difficult intubation after unplanned extubation（UE）in patients with tracheotomy. Methods An expert team was set up to sort out the unplanned extubation management process of patients with tracheotomy,apply medical failure mode and effect analysis to conduct failure analysis on the process steps,formulate optimized plans and organize implementation. The differences of each indicator before（January-December 2019）and after（January-December 2020）process optimization were compared. Results After process optimization,the unplanned extubation rescue time of patients with tracheotomy was shortened from （32.18±3.21）min before optimization to （23.28±2.01）min（P<0.05）. Patients' satisfaction with nursing work increased from （86.24±4.93）to （89.48±2.48）（P<0.001）. Doctors' satisfaction with nursing work increased from（75.35±7.54）to （84.80±3.65）（P<0.05）. Conclusion The introduction of medical failure mode and effect analysis to optimize UE management process for patients with tracheotomy moved the risk window forward,which can effectively shorten the treatment time and improve the success rate and satisfaction of UE treatment for patients with tracheotomy.
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