運用FMEA提升手術室火災預防及應變能力

Using Failure Mode and Effect Analysis to Improve Fire Prevention and Adaptable Ability in the Operation Room

無論在哪個國家，醫院發生火災常會造成人員傷亡及財務損失，手術室服務的病人因麻醉或手術關係，無法自行離開火場，所以一旦發生火災意外，影響層面涵蓋甚廣。本文運用失效模式與效應分析（Failure Mode and Effect Analysis，FMEA）探討手術室火災潛在失效原因，提出可行之改善方案。本研究透過跨團隊合作檢視消防設備、火災流程，藉由手術室舉行實際消防演練、模擬桌演發現流程中的缺失，列出所有可能的失效模式及原因分析，配合風險優先係數（Risk Priority Number，RPN）及決策樹找出首當改善項目並給予其改善方法。經分析火災預防減災、火災緊急應變項目，整體RPN前測總分數為4,048分，介入改善措施後降至1,493分，整體下降成效達63.2%。FMEA是前瞻性風險分析方法，希望在火災尚未發生前便可因為流程改善而預防或降低傷害發生。火災的預防及應變能力的提升，必須不斷透過模擬桌演練及實際演練，來加深人員對火災的應變能力及反應，才能降低風險確保病人安全。

Objectives: Operating room fires rarely occur but may result in severe harm to the anesthetized patient. These events happen all over the world and may cause significant financial loss since many expensive and sophisticated equipment store there. This manuscipt uses Failure Mode and Effect Analysis (FMEA) to discuss the potential causes of fire in the operation room and to propose our efficient management methods. The purpose of this article is to view the indiscretion in the process of extinguishing a fire in operating rooms in order to make prevention and improvement.Methods: Application of inter-team cooperation to check fire-fighting equipment and the fire management process. By performing a fire drill in the operation room and oral practice, we listed all possible invalid modes and analyzed the reasons. Then we used the RPN (Risk Priority Number) and decision tree to identify the problems and offer better management.Result: By analyzing extension cords, fire-fighter equipment and staff management ability to be proactive to emergency incidents, the score of RPN pre-test was 4,048. After the intervention for improving management, the score of RPN post-test decreased to 1,493. Total efficiency increased by 63.2%.Conclusion: Failure Mode and Effect Analysis provides an excellent prospective risk analysis, which would prevent and decrease the damage in encountering an incident fire by prompt and accurate responses. Regular drills and continued education are necessary to maintain the capability to manage the fire incidents in order to ensure the patient.