馬偕紀念醫院血庫品管指標執行成果分析探討

Performance of Blood Bank Quality Control Indices in the Mackay Memorial Hospital

蕭麗君(Li-Chun Hsiao) ； 王敦仁(Tun-Jen Wang) ； 何信重(Hsin-Chung Ho)

《Journal of Biomedical & Laboratory Sciences》 22卷1期 (2010/03) Pp. 40-47

https://doi.org/10.30046/JBLS.201003.0005

摘要

為了有效提升醫療品質，馬偕紀念醫院醫事檢驗科於2006年申請通過ISO認證，並依規範訂定品保作業程序，以品管指標來監控醫療品質。為了瞭解品管指標執行成效，本研究就醫事檢驗科血庫組的「緊急輸血達成率」、「輸血反應率」、「血品報廢率」及「血球血漿用量比」四項品管指標，分析比較2006~2008年馬偕紀念醫院台北院區及淡水院區血庫組的達成率，並探討影響指標達成率之原因。分析結果顯示台北、淡水兩院區緊急輸血的達成率三年均為100%。輸血反應率台北院區為0.87~1.22%；淡水院區為0.85~1.90%；均低於3%閾值。血品報廢率台北院區為0.15~0.51%，2007、2008年超過0.2%閾值；淡水院區則為0.11~0.17%，三年均為合格。血球血漿用量比台北院區為0.91~1.07，2006年未符＞1.0標準；淡水院區則為0.89~0.92，三年均不合格。2006~2008年之輸血反應率明顯較2000~2002年平均2.25~2.28%為低，未來輸血反應率之閾值應再降低。台北院區血品報廢率較高之原因為心臟手術須大量備血，效期短的血小板報廢率因此增加，建議適度放寬該院區血品報廢率之閾值。為降低血球血漿用量比偏高現象，未來應針對用量比較高的科別加強督導。

關鍵字

血庫 ； 品管指標 ； 閾值

並列摘要

To improve medical service quality, Department of Laboratory Medicine of the Mackay Memorial Hospital applied for ISO certification in 2006, and proposed a series of quality control indices for monitoring medical service quality. To evaluate the effectiveness of the quality control indices, this study selected four indices for blood banking quality control to compare the performance between Taipei branch and Tamsui branch of the Mackay Memorial Hospital during 2006 and 2008. The four indices include fulfillment of emergency blood transfusion, reaction rate of blood transfusion, obsolescence of blood products, and ratio of packed cell and plasma usage (RBC/FFP ratio). Analysis results show that the fulfillment of emergency blood transfusion was 100% in each year in both branches. The reaction rates of blood transfusion ranged from 0.87 to 1.22% in the Taipei branch, and 0.85 to 1.90% in the Tamsui branch; both met the ＜3% requirement. The obsolescence rates of blood products ranged from 0.15 to 0.51% in the Taipei branch; exceeded the 0.2% threshold both in 2007 and 2008. In contrast, the obsolescence rates of blood products ranged from 0.11 to 0.17% in the Taipei branch; met the requirement in all three years. The RBC/FFP ratios in the Taipei branch ranged from 0.91 to 1.07; did not meet the ＞1.0 standard in 2006. In the Tamsui branch, the ratios ranged from 0.89 to 0.92; failed to meet the requirement in all three years. In comparison, the reaction rates of blood transfusion during 2006 and 2008 were significantly lower than the average rates (2.25 to 2.28%) during 2000 and 2002. Therefore, a more stringent threshold in the future is proposed. The Taipei branch had higher blood obsolescence rates because heart surgeries were performed in the hospital. Heart surgeries usually require mass amount of blood reserves, and hence increase the obsolescence rates of the platelets. Therefore, the threshold of blood obsolescence rate should be adjusted to account for the circumstances in the Taipei branch. Finally, in order to lower the RBC/FFP ratios, closer supervision should be continued on departments having high RBC/FFP ratios.

並列關鍵字

blood bank ； quality control indices ； threshold