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·药事管理· 应用失效模式和效果分析提高病区高危药品的管理质量 张天华，方崇波(浙江省宁波市医疗中心李惠利医院，浙江 宁波 315040) 摘要：目的 通过应用失效模式和效果分析(FMEA)管理，提高病区高危药品管理质量，保证患者用药安全。方法 收集 各病区高危药品管理中存在的问题，如未放置专柜、未按储存要求、高危药品无明显标识、无专人管理、药品有效期的 管理不严格等。全院护士参与 FMEA，实施 12 个月后评价高危药品管理质量和效果。结果 实施12 个月后，高危药品 未按要求储存、未按规范放置、过期失效等问题明显改进，危险分值的计数(RPN)，除未及时清点一项外，其他各项均比 实施 FMEA 管理前显著降低(P0.05)。高危药品管理缺陷从 626 件下降至 46 件。结论 ??用失效模式和效果分析管理， 可有效提高病区高危药品管理质量，保证患者用药安全。 关键词：高危药品；失效模式；效果分析；管理 中图分类号：R954 文献标志码：B 文章编号：1007-7693(2012)06-0568-03 Application of Failure Modes and Effects Analysis (FMEA) Intervening in the Management of High Risk Medicine in Ward ZHANG Tianhua, FANG Chongbo(Li Huili Hospital, Ningbo Municipal Medical Center, Ningbo 315040, China) ABSTRACT: OBJECTIVE To promote the management quality of high risk medicine in ward and to ensure drug safety for patients. METHODS Collecting the problems in the management of high risk medicine in ward, such as the problem about classified positioned display of injection, internal used medicine, external used medicine and deadly poisonous medicine, the problem about medicine storage without standards requested, the problem about the mark of high risk medicine, which a specific cabinet was appointed for and a person was specifically appointed to take care of, the problem about strict period of validity of medicin, etc. The quality and effect would be valued in twelve months with the participation of all the nurses. RESULTS The incidence of the high risk medicine, which was stored and displayed without standards requested, had been modified while drug expiration date was more concerned than ever, basing on the analysis in twelve months. The defective managing events of high risk medicine were reduced from 626 to 46 while the scores of risk priority number(RPN) decreased from top 900 to 216. CONCLUSION With the applic