降低急診血液檢體退件率

本單位2017年1至4月血液檢體異常退件率1.16%，超過本院目標值0.95%。在急診，血液檢體退件率的增加，可能會延誤治療並危及病人安全，進而造成急診醫療品質下降。專案小組經現況分析後發現單位採集檢體被退件的原因和護理師的認知不足以及採集的檢體發生溶血、凝固、檢體量不足等異常狀況有關。藉由修訂急診採集檢體標準流程及檢體採集輔助工具如：設置提醒計時器、注血試管順序提示卡、創新不倒翁檢體搖擺機及檢體量比對彩虹架等改善措施介入後，本單位急診檢體退件率由1.16%降低為0.7%；同時，單位護理師採集檢體認知正確率由76.3%提升為96.2%，採集檢體行為正確率由70.9%提升到96.7%，專案改善效果顯著。本專案藉由跨團隊合作，改善採集檢體品質，進而提升醫療判斷正確性，可做為相關單位之參考。

關鍵字

急診室；血液檢體；退件率

並列摘要

About 1.16% of blood specimens taken at the emergency ward from January to April 2017 were rejected, which exceeded the target value of 0.95%. Rejection of blood specimen can lead to delayed treatment and declined quality of emergency care. After analyzing, we found several causes of incorrect blood sampling, including hemolysis, coagulation, and insufficient sample volume. The task force of the improving project revised the standard procedure for blood sample collection at emergency department and designed sample collection aids, such as the timer reminder, the reminder card for injecting blood into test tubes, innovative tumbler body sample shaking machine, and rainbow volume indicative comparator, among others, to reduce the abnormal rejection rate. After implementation, the rejection rate decreased from 1.16% to 0.7%; meanwhile, the recognition increased from 76.3% to 96.2%, and the accuracy of sample collecting increased from 70.9% to 96.7%, reaching the goal of the improving project. This cross-functional team project successfully improved the quality of blood sample collection and emergency care.

並列關鍵字

emergency room ； blood sampling ； return rate

參考文獻

汪美玲、黃淑芬、林姿秀 (2016) 應用品質突破模式降低內科病房血液檢體異常退件率•長庚護理，27(3)，391-401。[Wang, M. L., Huang, S. F., Lin, T. H. (2016). Breakthrough series model in reducing rejection rates of clinical laboratory specimens-the project of a medicine ward. Chang Gung Nursing, 27(3), 391-401.]https://doi.org/10.3966/102673012016092703008

李衛華、李紹屏、陳惠芬、林美秀、賴芊孝(2016)•運用 PDA 系統降低急診檢體退件率之改善方案•領導護理，17(4)，71-83。[Lee, W. H., Lee, S. P., Chen, H. F., Lin, M. X., & Lai., C. H. (2016). An improvement project to reduce specimen errors with the use of the PDA barcode system. Leadership Care, 17(4), 71-83.] https://doi.org/10.29494/LN.201612_17(4).0007

林佳琦、李怡旻、吳家麗 (2018)•以電腦輔助系統提升加護病房護理人員血液採集檢體流程正確率•新臺北護理期刊，20 (1)，77-87。[Lin, C. C., Li, Y. M., Wu, K. L. (2018). Using computer-aid system to enhance ICU nursing staff the correct rate of phlebotomy workflow. New Taipei Nursing Journal, 20(1), 77-87.]https://doi.org/10.6540/NTJN.2018.1.007

胡寶雪、胡曉珍、黃惠如、趙慧玲、雷宜芳(2014)•運用失效模式與效應分析改善手術室病理檢體採集送檢流程及退件率•護理雜誌，61(2)，56-59。[Hu, P. H., Hu, H.C., Huang, H. J., Chao, H. L., & Lei, E. F. (2014). Applying healthcare failure mode and effect analysis to improve the surgical specimen transportation process and rejection rate. Journal of Nursing, 61(2), 56-59.] https://doi.org/10.6224/JN.61.2S.50

陳雅華、陳素里 (2013)•急診室檢體錯誤率之改善方案•領導護理，14(4)，85-95。[Chen, Y. H., Chen. S. L. (2013). A project on reducing errors in specimen collection in the emergency department. Leadership Care, 14(4), 85-95.]https://doi.org/10.29494/LN.201312_14(4).0009

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降低急診血液檢體退件率

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