[目的]完善临床输血护理流程，加强临床输血安全管理。[方法]成立输血安全护理管理团队，应用失效模式与效应分析(FMEA)方法，列出输血护理流程的各个步骤，以及各步骤可能发生的失效模式，并计算失效模式的危机值(RPN)，查找目前输血护理流程中存在的危险因素，针对影响安全输血的高危因素，制定改进措施并应用于临床输血过程中。比较实施FMEA 前后 RPN 值及病人安全输血效果。[结果]实施 FMEA 后取血、输血时间不合格率明显下降，护士输血查对实践考核合格率较实施前提高，影响安全输血高危因素的 RPN 值明显下降。[结论]FMEA 模式应用于临床输血护理管理中有利于提高护士评估风险意识与能力，前瞻性地发现流程中潜在的危险因素，提高病人输血护理安全。

Objective:To improve and perfect nursing process of clinical transfusion,enhance the safety management of clinical transfusion.Meth-ods:The blood transfusion safety nursing management team was estab-lished,and the failure mode and effect analysis(FMEA)method was used. The various steps of transfusion nursing process were listed and to list failure modes may occur in all steps,and to calculate the crisis of value (RPN)of the failure modes,find out the current risk factors of transfusion nursing process,aiming at the high risk factors of influencing the safety of transfusion,to formulate improvement measures and apply it in clinical transfusion process.To compare the RPN value and safe blood transfusion effect of patients before and after implementation of FMEA.Results:After the implementation of FMEA,unqualified rate of the blood taking and transfusion time decreased,practice examination qualified rate of the nurse check blood transfusion raise before the implementation,RPN va

目的应用医疗失效模式与效应分析(Healthcare Failure Mode and Effect Analysis,HFMEA)方法对呼吸机相关性肺炎(VAP)影响因素进行干预,降低感染率。方法在VAP监测过程中,通过组建专业的FMEA团队,制定VAP操作标准及规程,从中分析导致患者感染的各种原因,找出每一步骤的潜在失效模式,计算风险优先数值(Risk priority number,RPN)以及优先干预因素,针对高风险因素采取相应的改进措施并落实。结果与VAP基线调查时的数据相比,进行FMEA后,RPN值由1 615下降至476,差异有统计学意义(P0.05),平均下降了70.5%;VAP感染率由最初的39.55‰降为16.62‰,明显下降。结论 FMEA方法在VAP中的应用,有助于控制VAP的发生,降低感染率。

OBJECTIVE To intervene the ventilator-associated pneumonia(VAP) by using the method of healthcare failure mode and effect analysis (HFMEA) ,so as to reduce the infection rate .METHODS During the monitoring of VAP ,a professional team of FMEA was formed and the operating standards and procedures of VAP were developed .Then the reasons resulting in infected patients were analyzed to find out the potential failure modes of each step . The risk priority number (RPN ) value and preferred intervention factors were calculated . Corresponding improvement measures were taken and implemented for the high risk factors .RESULTS After the implementation of FMEA ,RPN value declined obviously from 1615 to 476 ,and the difference was significant (P<0 .05) ,with the average decrease of 70 .5% .The VAP infection rates significantly declined from the initial rate of 39 .55‰ to 16 .62‰ .CONCLUSIONS FMEA method can control the occurrence of VAP and reduce the VAP rate .

目的探讨失效模式和护理对策模式在骨科静脉留置中应用。方法2013年1至6月将骨科使用静脉留置针患者100例纳入研究，将2013年1至3月份实施常规使用留置针的50例患者作为对照组，将2013年4至6月份使用失效模式和护理对策模式后的50例患者作为观察组。应用失效模式和护理对策分析方法对骨科静脉留置针使用过程中可能出现的失效模式原因、结果进行查找，计算出 rPn 值，针对影响留置针的高危因素，实施相应的整改措施，比较两组静脉留置针输液患者导管堵塞、液体外渗、敷贴卷边/脱管、静脉炎的 rPn 值和留置天数。结果实施失效模式和护理对策后观察组与对照组比较导管阻塞，液体外渗，敷贴卷边/脱管，静脉炎、安全质量方面明显提高。结论失效模式和护理对策应用有利于提升骨科静脉留置针的风险管理，保障输液安全，减少并发症，延长留置时间，取得明显效果，值得骨科推广应用。

Objective to study the failure mode and the nursing countermeasures in orthopaedic venous indwelling applications. Methods from January 2013 to June orthopaedic patients using intravenous indwelling needle 100 cases included in the study, will be in 1 ~ 3 2013 implementation of routine use of indwelling needle 50 cases as control group, will be used from april to June in 2013 after the failure mode and nursing countermeasures of 50 patients as observation group. failure mode and the nursing countermeasure analysis method for the orthopaedic venous indwelling needle possible failure modes in use process is find the reason and result, calculate the RPN values, aiming at the high risk factors influencing the indwelling needle, implement the corresponding rectification measures, compared two groups of patients with venous indwelling needle infusion catheter jam, liquid leakage, sticking edge/tube, rPn value of phlebitis and lien days. Results after the implementation of failure mode and nu

介绍了故障树分析法（ FTA）和故障模式、机理影响分析法（ FMMEA）。运用FTA建立了某型导弹发动机失效模型，并根据定性分析结果，对发动机点火药进行FMMEA分析，确定故障模式和故障机理，找出故障发生的根本原因，提出改进措施以符合初始风险优先数（ RPN ）要求，输出FMMEA表格。这一分析方法对导弹其他部件潜在故障的分析具有借鉴意义。

Fault tree analysis(FTA) method and failure mode, mechanisms and effects analysis(FM-MEA)method are introduced.Using FTA,the model of failure analysis on missile engine is established, and using the qualitative analysis results, the ignition powder of engine is analyzed by FMMEA, then the failure mode and mechanisms are determined, the fundamental reasons are found out.Improvement meas-ures are put forward so that the risk priority number( RPN) is suited for the merits, and FMMEA table is outputted.This method is useful when analyzing the potential failures of the other parts of the missile.

盾构始发与到达施工是盾构法建造区间隧道的关键工序,也是施工频繁的常见工序。一旦发生事故,将造成较大人员伤亡和经济损失。将失效模式与效应分析(FMEA)法引入地铁盾构始发与到达施工风险评估。通过对该施工工序特点剖析,识别失效模式,制定风险评估标准;通过专家问卷调研,按FMEA法计算风险优先指数(RPN),并对各类风险进行灾害严重性定级;最后,通过对国内地铁施工典型事故案例分析,验证FMEA法评估风险的有效性。

The construction at TBM launching & break through area is a critical and frequent common process of tunneling construction. The accident will result in severe casualties and economic losses. This paper presents construction risk identification and evaluation at TBM launching & break through area based on Failure Mode and Effect Analysis (FMEA). Firstly tunneling construction process features are analyzed, failure modes are identified, and risk evaluation criterions are formulated. Secondly Risk Priority Number (RPN) is calculated according to expert questionnaires, risk-disastrous severity is classified. Lastly the validity of risk evaluation is verified through case analysis of typical metro accidents at TBM launching&break through area.