降低某內科病房檢體退件率之專案

A Project for Reducing Specimen Rejection Rates in the Medical Ward

10.6692/KJN-2011-28-1-3

李佳倫(Chia-Lun Lee)；蕭文琪(Wen-Chi Hsiao)；蔡雅齡(Yi-Ling Tsai)；孫麗珍(Li-Chen Sun)

檢體 ； 退件率 ； PDCA ； specimen ； rejection rate ； PDCA

高雄護理雜誌

28卷1期（2011 / 04 / 01）

23 - 34

繁體中文

臨床檢驗是醫療過程的重要項目，據檢驗部及資訊室統計，某內科病房自2007年7月到12月間每月平均檢體退件率為0.74%，分析原因為：1.護理人員對採集檢體之認知不足及行為不正確；2.未建立標準採檢作業流程及檢體採集流程未全面資訊化；3.缺乏適當的參考工具。單位同仁與檢驗部、資訊室人員利用決策矩陣分析擬定相關對策，依計畫(Plan)、執行(Do)、檢討(Check)、行動(Act)之PDCA步驟確實執行。於改善措施執行後，單位於執行期、檢討期及維持期之平均檢體退件率為0.28%~0.47%，目標達成率為135.3%，進步率為62.2%，平均每月因檢體退件造成的成本浪費由619.8 元降至227.0元；此改善專案除降低病房檢體退件率、減少醫療成本支出外，更提升單位護理人員採檢的正確知識及行為，簡化檢體採集及送檢流程。

The clinical laboratory is an important part of the medical process. According to the data collected by laboratory and information departments, the average specimen rejection rate was 0.74% from July to December 2007 in the medical ward. Analysis showed the reasons for this error were as follows: 1. professional knowledge and skills to collect specimens were not sufficient; 2. standard operating procedures for specimen collection were not set up and the process of specimen management was not computerized; and 3. proper reference tools were lacking. Following discussion with related departments, a panel including staff, political and facilities dimensions were established and performed by the Plan, Do, Check, Act (PDCA) process. After the interventions were implemented, the average specimen rejection rate could be maintained at 0.28%~0.47% in performance, check and maintainance periods. The rate of goal achievement was 135.3%, the rate of improvement was 62.2%, and the waste of specimen rejection was reduced from 619.8 NTD to 227.0 NTD. This project not only improved specimen reduction rate and waste, but also enhanced the knowledge and behavior of nursing staff. The process of specimen collection and transportation was ultimately simplified.