應用品質突破模式降低內科病房血液檢體異常退件率

Breakthrough Series Model in Reducing Rejection Rates of Clinical Laboratory Specimens-the Project of a Medicine Ward

10.3966/102673012016092703008

汪美玲(Mei-Ling Wang)；黃淑芬(Sue-Fen Huang)；林姿秀(Tzu-Hsiu Lin)

品質突破模式 ； 血液檢體 ； 退件率 ； breakthtough series model ； specimens ； rejection rate

長庚護理

27卷3期（2016 / 09 / 01）

391 - 402

繁體中文

本專案旨在降低內科病房血液檢體異常退件率。本病房自2011年1月至3月血液檢體異常退件率為0.49%，經現況分析發現缺乏在職教育、檢體試管血液混合輔助工具、檢體異常處理登錄未資訊化及護理人員血液檢體採檢正確率及認知正確率偏低，造成血液檢體異常退件率偏高。解決辦法為成立BTS小組，經團隊合作舉辦血液檢體採檢在職教育、製作「真空採血步驟參閱圖片」、設製「自動血液試管搖擺機」輔助器、拍攝「血液檢體採集流程」光碟及建構檢體異常登錄資訊化。經介入措施後，血液檢體異常退件率由0.49%降低到0.07%、護理人員抽血技術平均正確率由80.6%提升到98.6%及抽血認知正確率平均由78.9提升100.0%，達到專案目的。冀望護理部將此標準作業平行展開，進而確保病人安全及提升最佳醫療照護品質。

The project aims to reduce rejection rate of clinical laboratory blood specimens. The factors which are possibly contribute to the high rejection rate included lack of sufficient blood sampling training, lack of proper instrument to mix sample in order to lower the possible hemolytic specimens, and lack of database of abnormal specimens. Besides, inadequate accuracy of sampling technique and lack of knowledge about sampling were also the reasons for the high level of rejection rate. As the consequence, 0.49% of total blood specimens were rejected from the laboratory from January to March in 2011. The BTS team was then organized to lower rejection rate. By conducting clinical training programes, using rotators, creating blood sampling demonstration display, providing education CD-ROM and E-learning website, the rejection rate decreased to 0.07% from 0.49%, the accuracy of sampling technique and knowledge toward sampling increased to 98.6% and 100%, respectively. It is expected that the intervention used in the project can be generalized in the clinics to ensure better quality of nursing care.

1. Alexandre, C. G.,Marilei, W.,Maria, L. L.,Brisolara,Caroline, D.(2012).Causes of rejection of blood samples handled in the clinical laboratory of a university hospital in porto alegre.Clinical Biochemistry,45,123-126.
2. Ashavaid, T. F.,Dandekar, S. P.,Keny, B.(2008).Influence of blood specimen collection method on various preanalytical sample quality indicators.Indian Journal of Clin Biochem,23(1),4-9.
3. Incilay, S. L.,Aslı, P.,Filiz, A.(2014).Classification of reasons for rejection of biological specimens based on prepreanalytical processes to identify quality indicators at a university hospital clinical laboratory in Turkey.Clinical Biochemistry,47,1002-1005.
4. 吳麗蘭、潘淑儀、黃瓊儀(2008)。應用品質突破模式預防內科病房跌倒意外。北市醫學雜誌，5(6)，61-70。
5. 林金蓮、康秀雲、楊君菁(2011)。降低病房檢體異常之改善專案。長庚護理雜誌，22(1)，73-83。
6. 陳政惠、柯乃熒、李奉素、賴霈妤、李秀現、馬先芝(2011)。真空採血器降低護理人員針扎及減少檢體溶血率之成效。感染控制雜誌，21(4)，213-221。
7. 陳欽明、蘇美玉、鄭高珍、陳志金、董育珍、陳郁慧(2010)。以醫療品質改善突破手法來改善加護病房病人中心導管相關血流感染。醫療品質雜誌，4(3)，77-84。
8. 陳雅華、陳素里(2013)。急診室檢體錯誤率之改善方案。領導護理，25(4)，85-95。
9. 黃珮琪、莊靜娟、陳婉宜(2014)。降低肝臟移植病房檢體退件率之改善專案。長庚護理雜誌，25(4)，424-437。
10. 黃淑媛、李淑桂、曾月霞、曾淑梅(2009)。減少新生兒先天性代謝疾病篩檢檢體退件之改善方案。護理雜誌，56(4)，46-52。

1. 陳瑞芳,韋岭岄,胡素儒,林佳慧,吳麗娟,王郁華(2021)。降低健康管理中心檢體退檢率。源遠護理，15(1)，30-39。
2. 謝春蘭,陳麗貞,陳安婷,施美娟,邱嘉玲,王怡婷(2021)。降低急診血液檢體退件率。長庚護理，32(1)，65-76。