台灣地區勞工醫院如何建立輸血檢驗標準作業之要求

The Requirement of Transfusion Standard Operation Procedure in Taiwan Labor Hospitals

劉淑惠(Sui-Hui Liu) ； 張錦標(Jin-Biou Chang)

《中華職業醫學雜誌》 20卷2期 (2013/04) Pp. 119-126

摘要

臨床輸血為侵襲性治療之一，輸血過程在醫院被視為高風險的醫療作業，輸血錯誤被美國醫院評鑑機構（JCAHO）視為是嚴重的警訊事件。在輸血過程中可能發生錯誤的風險包括：備血檢驗、血品選擇與輸血執行，尤其以備血檢驗的錯誤為最危險，人為疏失已證實是引發輸血錯誤的主要原因。醫學檢驗室認證規範為檢驗品質之基本要求，目前國內法規並沒有規定檢驗室要通過認證才能執行檢驗業務，只需要接受醫策會醫院評鑑或當地衛生局督導訪查。在台灣地區勞工醫院應建立輸血檢驗標準作業以符合認證之要求，通過認證是檢驗科血庫所追求的目標與未來之趨勢，其要求應包括：(1)制定輸血檢驗標準作業手冊。(2)輸血檢驗試劑品質要求與管理。(3)交叉試驗的執行。(4)正確的血品選擇。(5)輸血反應的處理。(6)合格的能力試驗等。檢驗科建立輸血檢驗標準作業可降低臨床輸血異常事件發生，以提升輸血檢驗作業之品質與病人安全之照護。

關鍵字

輸血 ； 認證 ； 輸血檢驗

並列摘要

Blood transfusion is one of the invasive treatments in clinical practice. In addition, it is also regarded as a high risk procedure during the blood transfusion. Transfusion error is defined as a serious warning event in Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Transfusion error may happen during the pre-transfusion compatibility procedures, incorrect administration of blood component and procedures of transfusion. Among all of the errors, pre-transfusion compatibility procedure is the most dangerous event, and human action has been proofed to be the major cause. Medical laboratory certification is the basic requirement of laboratory quality control. However, there are no regulations for the laboratory certification requirement to perform the laboratory tests in our country. Instead, laboratories qualified if they accept the Medical Institute for Hospital Accreditation (Taiwan Joint Commission for Hospital Accreditation; TJCHA) or local health bureau supervisory visits. Certification should be the goal of the laboratory blood bank and it will be the future trends in Taiwan. Therefore, all the hospitals have to establish standard operating procedures of transfusion to meet the certificate criteria. The criteria should include (1) Establish standard operating procedures (2) Validation and qualification (3) Pre-transfusion compatibility procedure (4) Correct administration of blood components (5) Investigation and management of acute transfusion reactions (6) Qualified proficiency test. It will be lower the risk of transfusion errors, promote the quality control and patients safety care after the establishment of standard operating procedures by all the medical laboratories.

並列關鍵字

blood transfusion ； accreditation ； transfusion examination