Abstract:

Objective

To explore the application effect of tracking methodology combined with Failure Mode and Effects Analysis （FMEA） in patients undergoing bladder infusion chemotherapy.

Methods

A total of 5436 patients who underwent transurethral resection of bladder tumors in the First Affiliated Hospital of Navy Military Medical University from May 2020 to May 2021 and subsequently received bladder instillation chemotherapy in the outpatient department were included. The intervention method is to conduct nursing risk assessment of patients through the application of tracking methodology combined with FMEA，and establish plans and implement improvement measures. This study used convenience sampling method to select 646 patients who implemented improvement measures （observation group） and 531 patients who did not implement measures （control group）. By comparing the risk priority index （RPN），satisfaction with nursing quality indicators，and annual incidence of adverse events between two groups of patients，evaluate whether the nursing plan benefits patients undergoing bladder infusion chemotherapy.

Results

Compared with patients without intervention，the application of tracking methodology combined with FMEA mode resulted in varying degrees of decrease in RPN scores before，during，and after bladder infusion therapy. The difference between the implementation group and the control group was statistically significant （P＜0.001）； Pre operation education，patient privacy protection，nurse service attitude，operating room conditions，proficiency in operating techniques，post operation condition observation，ability to handle adverse reactions，out of hospital guidance，patient satisfaction with the entire operation process，and treatment effectiveness all showed significant improvements compared to the control group （P＜0.001）； The incidence of adverse events decreased from 3.58% （not implemented） to 0.77% （implemented），and the incidence of adverse reactions was significantly lower than that of the control group，with statistical significance （P=0.001）.

Conclusions

The combination of tracking methodology and FMEA mode can effectively improve the weak links in the process of bladder perfusion chemotherapy，ensure the safety of bladder perfusion chemotherapy，reduce the incidence of adverse events，and improve the satisfaction of nursing indicators. It is a beneficial nursing attempt that is worth learning and promoting.

Key words: Tracking methodology, Failure mode and effect analysis, Intravesical chemotherapy, Bladder cancer, Transurethral resection of bladder tumors