Abstract: Objective To investigate the effect of health failure mode and effect analysis (HFMEA) on optimizing management process of stress-induced hyperglycemia (SHG) in patients after cardiopulmonary bypass (CPB). Methods HFMEA was performed in the SHG management process in the cardiothoracic surgery intensive care unit. After the flowchart was drawn, and potential risk factors were analyzed, improvement measures such as refined SHG management process, SHG management process verification chart and other measures were developed and implemented. SHG management risk values, glycemic management, and patient prognosis before (October 2019 to December 2020) and after (January 2021 to March 2022) the implementation of HFMEA was compared. Results After the implementation of HFMEA, the risk of training without tier, inadequate cognition on necessity of blood glucose monitoring, being unaware of patients' preoperative blood glucose base and history of hyperglycemia, unreasonable management protocols and target blood glucose value, without SHG management protocols for enteral and intravenous nutrition, no standardized insulin preparation, and without timely blood glucose monitoring, medication nursing and management evaluation after insulin administration was decreased, indicating statistical significance (P<0.05); the blood glucose management and patient prognosis were significantly better after the implementation, and the differences between the monitoring indexes before and after implementation were statistically significant (P<0.05). Conclusion Optimized postoperative SHG management process after CPB by HFMEA can reduce SHG management risk, improve the effect of blood glucose management, and promote the clinical outcomes of the patients.

Key words: stress-induced hyperglycemia, healthcare failure mode and effect analysis, HFMEA, cardiopulmonary bypass, process optimization