運用醫療失效模式與效應分析提升危害性化學品管理符合率

Improving the Compliance Rate of Hazardous Chemical Management Using Healthcare Failure Mode and Effect Analysis

化學品災害事件有逐年成長趨勢，國內外評鑑重視危害性化學品的管理，以維護環境及使用者安全，個案醫院雖無傷害事件發生，但醫療照護環境變遷，服務量及照護人力亦趨增加，在充滿挑戰、緊張及忙碌，面臨程度不同的危害因子，故以HFMEA檢視流程，找出可能發生的問題，進而擬定行動方案改善，提供高品質工作環境及照護品質。本專案依HFMEA五步驟進行，執行日期2020/2/1至2020/8/31，依潛在失效原因進行危害指數計算與決策樹分析並擬定行動方案：一、校正品項建置資訊系統之分類；二、建置更換氧氣作業系統；三、建立系統領料通知；四、推動全面教育；五、制定認知及操作檢核表；六、建立分級管理；七、設計衛教單張；八、規劃資訊會辦及複查時間；九、制修查核表單；十、購置儲放所需設備；十一、設計分裝瓶標示格式；十二、固定大量化學品儲放櫃。結果原35個失效模式21個單一弱點共56項高風險因子降為0項，危害性化學品通報率，由改善前70.3％提升至98.9％，危害性化學品管理符合率，改善前24.3％提升至97.1％，達成專案之目的。近年因危害性化學品使用或儲存不當等，因教育、標示及健康及安全防護措施尚未建置完備暴露潛在風險造成的重大事件中，故健全管理制度及落實使用或儲存，以確保健康與安全的工作環境是職場安全衛生的重要議題，持續落實管理且精進是唯一路徑。（澄清醫護管理雜誌2022；18（2）：56-73）

Owing to the growing trend in incidences of chemical accidents in recent years, domestic and foreign hospitals attach great importance to the assessment of hazardous chemical management for ensuring the safety of the environment and users. Although no related injuries have occurred in individual hospitals thus far, the increasing number of services provided by medical care institutions as well as the higher number of caregivers and human activity therein poses various hazards, creating environments that are full of challenges and tension. Therefore, the purpose of this project was to inspect the service flow of a hospital using healthcare failure mode and effect analysis (HFMEA) in order to identify possible issues and formulate action plans for improvement, thereby providing high-quality work environments and care. This study was carried out in accordance with the five steps of HFMEA, from February 1 to August 31 of 2020. The hazard indices were calculated and a decision tree analysis of the potential failure causes was performed. Finally, an action plan was formulated as follows: (1) establish an information system for correcting classified items, (2) establish an operating system for oxygen replacement, (3) establish a system for notification of requisition, (4) promote comprehensive education, (5) develop knowledge and operational checklists, (6) establish hierarchical management,(7) design health education leaflets, (8) schedule information meetings and review time points, (9) develop repair check forms, (10) purchase storage equipment, (11) design bottle label formats, and (12) designate enough fixed chemical storage cabinets. Consequently, 56 high-risk factors (including 35 failure modes and 21 single-point weaknesses) were eliminated. The notification rate of hazardous chemicals improved from 70.3% to 98.9%. The compliance rate of hazardous chemical management increased from 24.3% to 97.1%, reaching the project goal. Given the many major chemical disasters in recent years resulting from the improper storage of hazardous chemicals, lack of education, incomplete labeling, incomplete health and safety protection measures, or exposure to potential risks, improving the management system and implementing proper usage and storage to ensure a healthy and safe working environment are the only ways to ensure workplace safety and hygiene. (Cheng Ching Medical Journal 2022; 18(2): 56-73)