降低血液檢體凝固之改善專案

Improvement Project of Reducing Blood Specimen Clotting

陳郁芬(Yu-Feng Chen) ； 吳美玲(Mei-Lin Wu) ； 王筱珮(Shiao-Pei Wang)

《台灣醫學》 23卷2期 (2019/03) Pp. 242-253

https://doi.org/10.6320/FJM.201903_23(2).0012

摘要

血液採檢是常見的醫療處置，不正確的血液採檢將導致不必要的檢查或不當的處置，讓病人暴露於傷害的風險增加，不僅影響醫院名聲，對醫療照護失去信心，也會因此增加住院天數及費用。根據檢驗醫學部的統計，本單位急診後送病房血液檢體因凝固退件數占全院之冠，平均每月退件數為11.8件，經過認知及採檢行為之調查，歸納問題之導因包括：不知採血管内之添加劑會影響血液注入試管之順序、採檢後未適當搖勻檢體、不知檢體已凝固、病人血管特性差時容易緊張、口耳相傳方式學習未有抽血相關在職教育、不知自己操作不正確等。此品管改善專案之目的，期望藉有效之改善對策，將檢體因凝固退件數由平均每月11.8件下降為4.13件。解決方案包括：（1）擬定採血相關流程，其中也納入困難抽血時之介入措施；（2）依檢驗醫學部之建議，製作注入血液試管順序圖，方便同仁隨時參考；（3）製作抽血流程教育宣導影片，做為醫護人員教育訓練所用；（4）前述之流程列入新進護理師訓練計畫表中，務必每一細節都能落實；（5）請檢驗醫學部提供檢體凝固之樣態，讓同仁知道此檢體已凝固無法送出檢測；（6）使用檢驗醫學部自行研發的試管搖勻機器，確保採檢後檢體有適當搖勻；（7）單位內進行數次在職教育；（8）建立技術評核及稽查制度等。改善專案之成效，成功降低了平均每月檢體退件數為3.3件，達到專案目的，不僅減少醫護同仁重新採檢之頻率，病人的檢驗報告也能盡早得知，並採取進一步治療措施，提升了照護的時效性、品質及病人安全。

關鍵字

檢體 ； 退件率 ； 凝固

並列摘要

One of the commonly treatments in medical care is Blood Sampling. An incorrect treatment of blood sampling will lead to an unnecessary inspection procedure or improper handling, which will put the patients in a highly risk and a highly injury occurrence. These occasions will not only affect hospital's reputation, but lose confidence of medical treatment; furthermore the days and costs of hospitalized treatment will be increased too. According to the statistics of the Department of Laboratory Medicine, the specimen samples' rejection rate of our unit is the highest amount the hospitals, which the rejection number reached 11.8 pieces per month in average. After some investigations and analysis of blood sampling cognition had been introduced, the causes of these occasions include: not knowing the additives will affect the order of blood infusion into the test tube, not shaking test tube properly, not knowing the blood sample clot already, easy to be nervous while patients, blood vessel condition was not easy to approach, no blood sampling education just by word of mouth, not knowing the technique is incorrect. The purpose of this quality control program aims to decrease the blood specimen rejection rate, using effective strategies, from 11.8 pieces per month to 4.13 pieces per month. Improvement strategies include: drafting the blood collection process which included the strategies facing difficult blood drawing, the sequence map of blood injection into tubes according to the recommendation of the Department of Laboratory Medicine, producing blood drawing educational film for nursing staffs and putting into new staffs training program, showing clotted specimen to nurses and let them know which cannot be sent out for testing, using shaking machine after blood drawing and ensuring that the sample is properly shaken. Other strategies also included on-site education and establishment of skill audit. After introduce these improvement strategies, successfully decreased the average rejection number to 3.3 per month, and reached the goal of this project. These achievements decreased the frequency of re-sampling which need to be performed by hospital's colleagues, and the patients' report can quickly be delivered as well. This project not only performs treatment procedures promptly, and increases the quality of time management, treatment procedures and patients' safety.

並列關鍵字

specimens ； rejection rate ； clot