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.
目的： 探讨失效模式与效应分析（FMEA）风险评估方法在特重度烧伤患者肢体体位摆放护理中的应用效果。 方法： 采用回顾性观察性研究方法。根据采用的不同肢体体位摆放方法，将空军军医大学第一附属医院2018年1月—2019年6月收治的30例符合入选标准的行常规肢体体位摆放的特重度烧伤患者纳入常规肢体摆放组［男19例、女11例，年龄（40±10）岁］，将该单位2019年7月—2020年12月收治的30例符合入选标准的行FMEA风险管理肢体体位摆放的特重度烧伤患者设为FMEA肢体摆放组［男20例、女10例，年龄（38±10）岁］。常规肢体摆放组患者待肢体创面愈合后仅由康复治疗师每日行单纯徒手肢体体位摆放，直至出院。FMEA肢体摆放组患者入院24 h内由医师、康复治疗师、护士共同采用FMEA风险评估方法，分析患者肢体体位摆放的潜在失效模式，根据失效原因实施针对性的肢体体位摆放措施，直至出院。比较FMEA肢体摆放组患者干预前后6项主要失效模式的风险优先数（RPN），2组患者干预前后肩关节外展、肘关节伸展、腕关节背伸、踝关节跖屈的关节活动度（ROM）与手总主动活动度及改良Barthel指数评分。对数据行独立样本t检验、χ2检验、配对样本t检验。 结果： FMEA肢体摆放组患者干预后6项主要潜在失效模式中肢体体位摆放干预不及时、护士肢体体位摆放意识不强、肢体体位摆放评估标准不一致、护士肢体体位摆放相关知识缺乏、护士主动参与性差、患者肢体体位摆放效果不佳的RPN分别为（146±31）、（140±22）、（125±34）、（136±23）、（110±28）、（110±5）分，均明显低于干预前的（578±64）、（543±57）、（419±89）、（269±64）、（240±41）、（222±48）分（t=18.441、23.681、10.035、5.362、9.438、7.171，P<0.01）。干预后，FMEA肢体摆放组患者肩关节外展、肘关节伸展、腕关节背伸、踝关节跖屈的ROM及手总主动活动度明显优于常规肢体摆放组（t=-4.250、11.400、-15.928、10.963、-7.470，P<0.01），FMEA肢体摆放组、常规肢体摆放组患者肩关节外展、肘关节伸展、腕关节背伸、踝关节跖屈的ROM及手总主动活动度与干预前相比均明显改善（t=-35.573、33.670、-31.090、32.902、-19.647，-14.952、11.411、-33.462、-12.818、-13.672，P<0.01）。干预后，FMEA肢体摆放组患者改良Barthel指数评分［（78±9）分］明显高于常规肢体摆放组［（57±9）分，t=-9.055，P<0.01］，FMEA肢体摆放组、常规肢体摆放组患者改良Barthel指数评分均较干预前［（35±5）、（34±4）分］明显提高（t=-22.964、-12.329，P<0.01）。 结论： FMEA风险评估方法应用于特重度烧伤患者肢体体位摆放护理中，可有效规避患者肢体体位摆放中的高风险因子，进而维持肢体体位摆放效果，改善患者ROM，提高患者预后日常生活能力。.