運用品管圈手法降低急診病人部份凝血活酶時間(APTT)假性偏低之比率

Reduce the False Rate of Short Activated Partial Thromboplastin Times (APTT) in an Emergency Department through the Quality Control Circle Activity

李景耀(Jing-Yao Li) ； 楊惠芬(Hui-Fen Yang) ； 葉依綾(Yi-Ling Yeh) ； 劉玉香(Yu-Hsiang Liou) ； 林素美(Su-Mei Lin) ； 蘇姵瑄(Pei-Shun Su) ； 鄭瑞楠(Jui-Nan Cheng) ； 施勇綸(Yung-Luen Shih) ； 陳東榮(Tong-Jong Chen)

《台灣醫學》 20卷6期 (2016/11) Pp. 625-633

https://doi.org/10.6320/FJM.2016.20(6).9

摘要

偏低的APTT( Active partial thromboplastin time, 部份凝血活酶時間）在傳統上被認為是有問題的抽血技術所造成的假性數臄。然而，近年來有證據顯示偏低的APTT反而是反映了人體內為容易凝血的狀態，可能與增加栓塞機率和不良的心血管事件有關。過去文獻指出一般血凝實驗室APTT偏低的比率約為6%-9%，本研究統計個案醫院2014年1月至4月門診、病房和急診室APTT偏低的比例數據，分別為7.8%、8.3%和22.4%，經過探討急診室比率較高的原因是因為抽血流程問題造成，並非是因為容易凝血狀態之病人較多。透過文獻查證以及跨部門團隊合作運用品管圈手法制訂改善策略，採取措施包括：使用真空抽血設備、將APTT藍頭抽血管直立擺放、製作提醒小卡提示採血管要上下混合、制定抽血標準作業流程和在職教育訓練。最後，急診室APTT偏低比率有明顯的改善，由原本改善前的24.3%下降至15.9%。

關鍵字

APTT ； 品管圈

並列摘要

Short activated partial thromboplastin times (APTTs) are generally considered to be a surrogate marker of inappropriate blood collections. However, recent evidence suggests that short APTT may reflect a hypercoagulable state, potentially associated with an increased thrombotic risk and adverse cardiovascular events. Earlier studies have showed the proportion of short APTT is about 6%-9% in the hemostasis laboratory. We prospectively computed the rate of short APTT in outpatient, inpatient and emergency (ER) from January to April, 2014, and the proportion were 7.8%, 8.3% and 22.4%, respectively. We assumed that higher proportion in ER might be due to the inappropriate blood collections not more patients in a hypercoagulable state. Through a literature review and in accordance with the improvement strategy, the following methods were taken: using vacuum extraction tube systems, putting sodium citrate tube upright, reminding cards for overturning the blood collection tube, creation of standard operating procedures, in-service training. In conclusion, there was a significant reduction in the proportion of short APTT in ER with a reduction from 24.3% to 15.9%.

並列關鍵字

APTT ； quality control circle activity

參考文獻

陳政惠、柯乃焚、李奉素等：使用真空採血器降低護理人員針扎及減少檢體溶血率之成效。感染控制雜誌 2011;21:213-21。[Chen CH, Ko NY, Lee FS, et al: Effects of implementing the vacutainer system on reducing needlestick injuries in nurses and hemolysis during blood collection. Infection Control Journal 2011;21: 213-21.]

陳雅華、陳素里：急診室檢體錯誤率之改善方案。領導護理 2013;14:85-95。[Chen YH, Chen SL: A project on reducing errors in specimen collection in the emergency department. Leadership Nursing 2013;14: 85-95.]

李佳芳、葉筱鳳、林琪馨：降低某醫學中心外科加護病房血液檢體退件率之改善案。澄清醫護管理雜誌 2015;11:54-65。[Li CF, Yeh SF, Lin CH: Improving the rejection rate of blood specimens from the ICU of a medical center. Cheng Ching Medical Journal 2015;11: 54-65.]

Johari V, Loke C: Brief overview of the coagulation cascade. Dis Mon 2012;58:421-3.

Panteleev MA, Dashkevich NM, Ataullakhanov FI: Hemostasis and thrombosis beyond biochemistry: roles of geometry, flow and diffusion. Thrombosis Research 2015;136: 699-711.