失效模式与效应分析风险管理在住院抑郁症患者自杀预防中的应用

王媛媛; 甘建光; 陈晶; 叶猛飞

doi:10.16766/j.cnki.issn.1674-4152.003468

失效模式与效应分析风险管理在住院抑郁症患者自杀预防中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003468

1.
绍兴市第七人民医院精一科，浙江绍兴 312000
2.
绍兴市第七人民医院精二病区
3.
绍兴市第七人民医院精三病区
4.
绍兴市第七人民医院医务科

基金项目:

浙江省医药卫生科技计划项目 2020ZH058

详细信息

通讯作者:
王媛媛, E-mail: 13454522103@163.com

中图分类号: R749.4 R473.74
计量
- 文章访问数: 200
- HTML全文浏览量: 85
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-30
- 网络出版日期: 2024-05-29

The application of failure mode and effect analysis in risk management for suicide prevention in hospitalized patients with depression

1.
Department of Psychiatry, Shaoxing Seventh People' s Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的分析失效模式与效应分析风险管理对住院抑郁症患者心理状态及自杀意念的影响，探讨其在患者自杀预防中的应用效果。方法选取2021年1月—2023年8月绍兴市第七人民医院收治的235例住院抑郁症患者，根据随机数字表法将其分为对照组(117例)和观察组(118例)。对照组应用常规风险管理，观察组在对照组基础上应用失效模式与效应分析风险管理干预。统计2组患者自杀(或未遂)发生率，对比2组患者干预前后风险优先指数、心理状态、负性自动思维及自杀意念评分。结果干预后，观察组风险优先指数(RPN)均低于对照组，且观察组自杀(或未遂)发生率为2.5%(3/118)，低于对照组的8.5%(10/117，P < 0.05)。干预后，2组患者心理状态均改善，观察组汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)得分分别为(15.73±3.11)分、(17.22±3.34)分，均低于对照组[(17.06±3.50)分、(19.29±4.01)分，P < 0.05]。干预后，2组患者负性自动思维状态均改善，观察组负性自动思维问卷(ATQ)中频繁程度及相信程度评分均低于对照组(P < 0.05)。干预后，2组患者自杀意念强烈程度均下降，观察组贝克自杀意念量表中文版(BSI-CV)总分为(16.30±3.82)分，低于对照组[(20.28±4.43)分，P < 0.05]。结论失效模式与效应分析风险管理能明显改善住院抑郁症患者心理状态及负性自动思维，能有效降低患者自杀意念水平，具有一定的自杀预防效果。
- 抑郁症 /
- 失效模式与效应分析 /
- 风险管理 /
- 自杀预防
Abstract: Objective This study aims to assess the effect of failure mode and effect analysis in risk management on the mental state and suicidal ideation of hospitalized patients with depression, and to explore its effectiveness in suicide prevention. Methods A total of 235 hospitalized patients with depression, admitted to Shaoxing Seventh People ' s Hospital from January 2021 to August 2023, were randomly divided into two groups using a random number table method: the control group (117 cases) and the observation group (118 cases). The control group received conventional risk management, while the observation group received risk management intervention using failure mode and effect analysis, based on the control group. The incidence of suicide (or attempted suicide) in both groups was analyzed. Furthermore, the risk priority index, mental state, negative automatic thinking, and suicidal ideation scores before and after intervention were compared between the two groups. Results After the intervention, the risk priority index (RPN) of the observation group was lower than that of the control group, with an incidence of suicide (or attempted suicide) of 2.5% (3/118) in the observation group, significantly lower than the 8.5% (10/117) in the control group (P < 0.05). After intervention, the psychological state of patients in both groups was improved. The observation group had lower scores on the Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) [(15.73±3.11) points and (17.22±3.34) points, respectively], compared to the control group [(17.06±3.50) points and (19.29±4.01) points, P < 0.05]. The intervention led to improved negative automatic thinking in both groups, with the observation group showing lower scores on the frequency and belief scores of ATQ compared to the control group (P < 0.05). Additionally, the intensity of suicidal ideation decreased in both groups. The total score of BSI-CV in the observation group was (16.30±3.82) points, which was lower than that in the control group [(20.28±4.43) points, P < 0.05]. Conclusion The implementation of failure mode and effect analysis in risk management can significantly improve the mental state and negative automatic thinking of hospitalized patients with depression. Moreover, it can effectively reduce the level of suicidal ideation, demonstrating its potential for suicide prevention.
- Depression /
- Failure mode and effect analysis /
- Risk management /
- Suicide prevention

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表 1 基于FMEA理论预防住院抑郁症患者自杀管理风险分析结果(分)

Table 1. Risk analysis results of suicide management in hospitalized depression patients based on FMEA theory (points)

失效模式	失效原因	S	O	D	RPN
护理人员自杀预防知信行水平较低	护理人员对住院抑郁症患者自杀预防知识、态度及行为能力较低	5.26	5.77	6.93	210.33
高危自杀风险筛查不足	缺乏统一的自杀风险评估量表，加强高危个体筛查	7.50	6.91	6.01	311.47
对患者及家属自杀防范及认知干预不足	缺少对患者及家属针对性安全告知及错误认知纠正	5.76	6.02	6.36	220.53
危险物品管理力度不足	对尖锐物品、房间等管理不足，患者易获取自杀工具	7.73	5.96	7.23	333.09
心理干预不足	缺少个体化认知行为疗法	5.88	6.24	4.70	172.45
对自杀未遂者后续关注度较低	护理人员对自杀未遂者后续深入关注度较弱，缺少对患者的后续针对性干预	5.62	6.11	5.11	175.47

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表 2 2组抑郁症患者基线资料比较

Table 2. Comparison of baseline data between two groups of patients with depression

项目	对照组(n=117)	观察组(n=118)	统计量	P值
性别(例)			0.227^a	0.634
男性	71	68
女性	46	50
年龄(x±s，岁)	33.92±4.18	33.77±4.53	0.264^b	0.792
抑郁严重程度(例)			0.268^a	0.605
中度	82	79
重度	35	39
婚姻状况(例)			0.110^a	0.741
未婚	83	86
已婚	34	32
住院时长(x±s，d)	31.22±7.56	31.30±6.81	0.085^b	0.932
既往自杀未遂史(例)			0.442^a	0.506
有	18	22
无	99	96
文化程度(例)			0.719^c	0.472
小学及以下	6	8
中学	37	29
大专及以上	74	81
经济水平(例)			0.124^c	0.902
较好	22	26
一般	78	72
困难	17	20
注：^a为χ²值，^b为t值，^c为Z值。

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表 3 2组抑郁症患者干预前后RPN值比较

Table 3. Comparison of RPN values between two groups of patients with depression before and after intervention

失效模式	对照组(n=117)		观察组(n=118)
失效模式	干预前	干预后	干预前	干预后
护理人员自杀预防知信行水平较低	210.33	165.81	210.33	66.18^a
高危自杀风险筛查不足	311.47	120.74	311.47	71.33^a
对患者及家属自杀防范及认知干预不足	220.53	146.58	220.53	82.56^a
危险物品管理力度不足	333.09	98.77	333.09	70.53^a
心理干预不足	172.45	135.02	172.45	80.27^a
对自杀未遂者后续关注度较低	175.47	106.71	175.47	75.64^a
注：与对照组干预后比较，^aP < 0.05。

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表 4 2组抑郁症患者干预前后心理状态比较(x±s，分)

Table 4. Comparison of psychological status between two groups of patients with depression before and after intervention (x±s, points)

组别	例数	HAMA		HAMD
组别	例数	干预前	干预后	干预前	干预后
对照组	117	18.88±3.64	17.06±3.50^b	24.75±4.28	19.29±4.01^b
观察组	118	19.02±3.81	15.73±3.11^b	24.66±4.19	17.22±3.34^b
统计量		0.288^a	4.033^c	0.163^a	5.227^c
P值		0.774	< 0.001	0.871	< 0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP < 0.05。

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表 5 2组抑郁症患者干预前后负性自动思维情况比较(x±s，分)

Table 5. Comparison of negative automatic thinking states between two groups of patients with depression before and after intervention(x±s, points)

组别	例数	ATQ频繁程度		ATQ相信程度
组别	例数	干预前	干预后	干预前	干预后
对照组	117	80.26±7.15	62.38±4.92^b	71.55±5.48	60.81±5.35^b
观察组	118	80.39±6.46	55.74±4.11^b	71.40±5.67	52.28±4.16^b
统计量		0.146^a	9.805^c	0.206^a	7.946^c
P值		0.884	< 0.001	0.837	< 0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP < 0.05。

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表 6 2组抑郁症患者干预前后自杀意念比较(x±s，分)

Table 6. Comparison of suicidal ideation between two groups of patients with depression before and after intervention(x±s, points)

组别	例数	自杀意念		自杀危险性		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	117	6.00±1.12	4.56±1.06^b	18.62±3.19	15.77±3.10^b	25.87±5.24	20.28±4.43^b
观察组	118	5.89±1.24	3.42±0.85^b	18.51±3.45	12.34±2.61^b	25.68±5.73	16.30±3.82^b
统计量		0.713^a	8.532^c	0.254^a	10.116^c	0.265^a	12.737^c
P值		0.476	< 0.001	0.800	< 0.001	0.791	< 0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP < 0.05。

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