運用醫療照護失效模式與效應分析改善急診血液檢體送檢流程

Applying Healthcare Failure Mode and Effect Analysis to Improve the Blood Specimen Transportation Process in the Emergency Room

蔡玟純(Wen-Chun Tsai) ； 施郁雯(Yu -Wen Shih) ； 周玉華(Yu-Hua Chou) ； 劉欣宜(Hsin-Yi Liu)

《醫務管理期刊》 17卷2期 (2016/06) Pp. 131-149

https://doi.org/10.6174/JHM2016.17(2).131

摘要

目的：採用醫療照護失效模式與效應分析進行跨部門的風險管理方案，以改善新北市某教學醫院急診的血液檢體送檢流程，並降低退件率。方法：依據HFMEA 模式的五大步驟進行現況分析，包括組成團隊小組、繪製流程圖、確認潛在失效模式／原因、執行危害分析、提出改善方案及結果評量。結果：回溯2011 年急診血液檢體退件事件，篩選出23 項潛在失效原因，執行標準作業流程、規劃教育訓練、增設檢體辨識與警示工具、定期執行稽核等策略之推動。實施後，失效潛在原因由23 項下降至2 項，年退件率由0.6% 降至0.28%。結論：應用HFMEA 進行品質改善計畫，確實能有效改善急診的送檢流程，未來仍應持續進行系統性監控，以提供病人安全的就醫環境。

關鍵字

醫療照護失效模式與效應分析 ； 血液檢體 ； 檢體送檢流程

並列摘要

Objectives: To conduct a healthcare failure mode and effect analysis (HFMEA) to improve the process of specimen collection and transportation as well as lower the specimen rejection rate at a teaching hospital emergency room in New Taipei City. Methods: The five steps of HFMEA include assembling a multidisciplinary team, verifying a flow process diagram, identifying potential failures in individual components and subsystems, conducting a hazard analysis, and determining actions and outcome measures. Results: The team retrospectively reviewed the records and causes of blood specimen rejection in the emergency room for the year 2011. Twenty-three potential failure modes were identified during process analysis. The strategies for improvement included establishing standard operating procedures for blood specimen collection and transportation in the emergency room, planning training, adding additional specimen identification and warning tools, conducting regular audits, and increasing incentives to motivate personnel. Implementation of these strategies reduced the number of potential failure modes from 23 to 2, and the specimen rejection rate declined from 0.6% to 0.28%. Conclusions: The project utilized the HFMEA tool to provide continuous quality improvement based on quality indicators. As a result, it enhanced the effectiveness of the process of specimen collection and transportation and the quality of medical care. In the future, there should be ongoing systematic monitoring in order to provide a safe medical environment for the public.

並列關鍵字

healthcare failure mode and effect analysis ； blood specimen ； transportation process

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