降低某醫學中心外科加護病房血液檢體退件率之改善案

Improving the Rejection Rate of Blood Specimens from the ICU of A Medical Center

李佳芳(Chia-Fang Li) ； 葉筱鳳(Shiad-Feng Yeh) ； 林琪馨(Chi-Hsin Lin)

《澄清醫護管理雜誌》 11卷3期 (2015/07) Pp. 54-65

摘要

目的血液採集對病人是常見的處置項目，當發生錯誤時，都將影響治療的時效性甚至病人安全，本單位於2013年5月至10月血液檢體退件率為3.42%，引發專案小組改善的動機。經現況分析發現問題為：人員對檢體採集認知不足、缺乏教育訓練、稽核制度、檢體置放盒、真空採血設備不足與未建立採血技術規範流程所致，故本專案主旨在降低加護病房血液檢體退件率至1.85%以下。方法經由文獻查證與改善策略透過：安排跨團隊在職教育、制定抽血標準作業流程、採血稽核表、另類記憶圖表、採血叮嚀小卡、製作檢體置放容器盒與增設採血用物。結果有效改善血液檢體退件率由3.42%降至1.65%，護理人員抽血認知也由67.42分提升為94.47分達成專案目的。結論希望藉此專案的分享能降低臨床血液檢體退件率，進而提升重症病人的照護品質與安全。

關鍵字

加護病房 ； 血液檢體 ； 退件率

並列摘要

Purposes Blood collection is a common procedure in patient handling and any errors during the process can affect the timeliness of treatment or even patient safety. This unit had a blood specimen rejection rate of 3.42% during the period between May and October, 2013, which prompted this improvement project. Current state assessment revealed the following causes of the problem: lack of staff awareness, training and an audit system pertaining to specimen collection, insufficient specimen containers and vacuum blood collection apparatus, and the absence of technical specifications and standard procedures for blood collection, The objective of this project is to reduce the rejection rate for the ICU to below 1.85%. Methods Through a literature review and in accordance with the improvement strategy, the following measures were taken: organization of cross-team in-service training; creation of standard operating procedures, audit checklist, unconventional memorization charts and reminder cards for blood collection; the preparation of specimen containers and blood collection tools. Results There was a drastic improvement in the rejection rate of blood specimens with a reduction from 3.42% to 1.65%. In addition, the blood cognition of nursing staff was promoted from 67.42 points to 94.47 points and reached project goals. Conclusions Sharing the results of the reduction in the rejection rate of clinical blood specimens achieved by this project is intended to improve care quality and safety for critically ill patients.

並列關鍵字

ICU ； Blood specimen ； Rejection rate