降低急診檢體退件率之改善專案

An Improvement Project to Reduce the Rate of Specimens Rejection in Emergency Room

10.6530/YYN.202211_16(3).0007

李柏菁(Pai-Ching Lee)；曾雯琦(Wen-Chii Tzeng)；王蔚芸(Wei-Yun Wang)

急診 ； 檢體採集 ； 退件率 ； emergency room ； specimen collection ； rejection rate

源遠護理

16卷3期（2022 / 11 / 01）

50 - 57

繁體中文;英文

急診檢體採集品質對病人診斷及治療方向影響甚鉅，然而急診採集檢體眾多，採檢容器及方式各有不同，且急診病人來診量多，增加急診檢體退件率。本機構急診檢體退件率與全院相比，高出近50倍，主因為護理師對急診檢體採集認知不足、缺乏急診適用之檢體採集作業流程、特殊檢體採集之提醒資訊不足、缺乏定期稽核制度、缺少冰桶即時使用等，故專案目的為提升護理師檢體採集認知及執行檢體採集流程正確率，進而降低急診檢體退件率。改善方案包含：（1）新增檢體採集學習教案及作業流程；（2）舉辦檢體採集在職教育；（3）發展口號、強化記憶；（4）增加檢體容器選用之海報說明圖；（5）以特別符號標示特殊檢驗項目；（6）新增檢體採集為品管稽核項目；及（7）檢體收集車增放冰桶等策略。結果護理師檢體採集認知正確率由64.3％提升至98.7％；檢體採集流程正確率由80.9％提升至96.1％；急診檢體退件率由2.4％下降至0.02％。本專案藉由執行各項策略，增進護理師檢體採集流程之正確性，降低急診檢體退件率，提升醫療品質。

The quality of emergency specimen collection has a huge impact on the patient diagnosis and treatment. However, the rejection rate of specimen collected in the emergency room was high due to high number of patients, high specimen volume, and variety of specimen containers and collection methods. The rejection rate of emergency room specimens in this institution was nearly 50 times higher than the rest of the hospital. Main reasons included lack of the knowledge among nurses, lack of the standard procedure on specimens' collection, lack of remind information for specific specimens, a regular audit program, and lack of ice container for storage and transportation of specimens. The purpose of this project was to improve nursing staffs' knowledge and skills on proper specimen collection to reduce the rejection rate of emergency specimens. Intervention included: (1) designed training plan and standard procedures on specimens collection, (2) conducted group in-service training, (3) developed slogan to enhance the nurses' memory, (4) used poster to illustrate proper container selection, (5) used unique symbols to indicate specific test items, (6) conducted audits, and (7) added ice bottle on the trolley. The results showed that the nurses' knowledge on specimen collection improved from 64.3% to 98.7%, the accuracy of specimen collection procedures increased from 80.9% to 96.1%, and the rejection rate of emergency specimens reduced from 2.4% to 0.02%. This project successfully increased the accuracy of knowledge and execution procedure related to specimens collection and reduce the rejection rate of emergency specimens.

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