減少全膝關節置換術前備血過當之實用方案

Reducing Blood Preparation for Total Knee Arthroplasty: A Practical Approach

方玉瓊(Yu-Chiung Fang) ； 陳依甄(Yi-Chen Chen) ； 王靜枝(Jing-Jy Wang) ； 楊俊佑(Chyun-Yu Yang) ； 林啟禎(Chii-Jeng Lin) ； 張志偉(Chih-Wei Chang)

《護理雜誌》 59卷2期 (2012/04) Pp. 72-79

https://doi.org/10.6224/JN.59.2.71

摘要

背景　過去本醫療部門對接受全膝關節置換的病人，採常規術前備血，備血率高達100%，但大部分備血並未使用而被浪費。目的　為減少全膝關節置換術前非必要備血，節省相關資源，包括人力、物力、時間和成本等。解決方案　結合醫療團隊各專業，確認問題關鍵，如對術中緊急輸血需求的憂慮、術前高風險患者評估不足與過時的臨床路徑等；研擬採取對應措施，包括：援引相關實證，重新界定輸血標準；徵求決策者支持，並建立醫療團隊執行共識；檢視過去資料，確認輸血需求相關因子，建構更完整、健全術前備血需求評估；提出對此手術新的備、輸血作業標準，將配套措施納入新臨床路徑。結果　實施後，除術前備血自100%大幅下降至10.2%外，備血後之實際輸血執行率也從原來23.8%有效提昇至76.2%，成效遠超過預期。結論　此專案結合醫療團隊各專業，共同檢討所擬改善措施，切近臨床需求，獲得同儕支持並順利推行。我們建議應用此模式於各照護單位，兼顧病人安全與醫療成本，發展更有效、安全的輸血策略。

關鍵字

備血 ； 全膝關節置換術 ； 輸血 ； 評估

並列摘要

Background & Problems: The rate of allogenic blood preparation for an elective total knee arthroplasty (TKA) has been as high as 100% at our institute. However, most (76.2%) of these preparations were wasted.Purpose: This project worked to reduce unnecessary blood preparations for this elective procedure and reduce resource expenditures.Resolutions: Key issues identified as requiring resolution included: Uncertainty regarding urgent transfusion need, insufficient preoperative evaluation of high risk patients, and the use of outdated clinical pathways. Measures taken to overcome these issues included redefining transfusion triggers using relevant empirical data as conclusive evidence and building a general consensus within the medical team while acquiring practical support from decision makers. A more comprehensive assessment process for identifying risk factors was developed by reviewing and assessing the prior experiences of inpatients; new standard procedures for blood preparation and transfusion were issued; and related clinical pathways were updated with supplementary measures.Results: After project implementation, the blood preparation rate declined significantly from 100% to 10.2%. The rate of effective transfusion rate rose from 23.8% to 76.2%.Conclusions: This project combined various medical professions to propose practical improvements that effectively access peer support. We recommend applying this model in all care units to ensure patient safety and lower medical costs while developing a more effective policy for blood transfusion.

並列關鍵字

blood preparation ； total knee arthroplasty ； transfusion ； assessment