縮短新鮮冷凍血漿出庫時間改善專案

A Project to Develop a Timesaving Technique for Preparing Outgoing Fresh Frozen Plasma

新鮮冷凍血漿是全血採血後8小時內所分離而成之血漿，經急速冷凍而成；使用前連同血袋於30-37℃下搖盪解凍。本院新鮮冷凍血漿原本由各病房自行溶解，在考量溶解品質以及病人安全前提下，改由檢驗室統一溶解後再交由各單位進行輸血作業。當新鮮冷凍血漿檢體量太多時、新鮮冷凍血漿於水中的浮力、以及水浴箱的溫度種種問題，而導致各病房護理人員反應等待新鮮冷凍血漿的時間太長；檢驗室單位人員希望透過專案的執行找出能夠縮短溶解新鮮冷凍血漿的時間來進行改善。為使醫檢人員有標準的作業流程且也符合臨床需要，並確保新鮮冷凍血漿品質，本單位於2007年7月1日至7月31日，利用資訊系統收集一個月所有新鮮冷凍血漿溶解時間，在每一個新鮮冷凍血漿出庫流程程序圖上，利用ECRS(Eliminate、Combine、Rearrange、Simplify)的原則統計了各步驟需要的時間。進行步驟包含等待3次（3960秒）、作業1次（60秒）、檢驗2次（62秒）、搬運1次（58秒），共計需要4140秒的時間完成7個步驟。在分析中發現等待是最為耗時，因此改善重點以剔除及合併的方式將流程縮為3個步驟，共節省了2580秒（43分鐘）。本案藉由品管圈手法來簡化作業流程，縮短作業時間，維持新鮮冷凍血漿品質，以增進醫療照護效能。

Fresh frozen plasma (FFP) is obtained by a separation and instant freezing technique within eight hours of whole blood collection. The entire blood bag containing the plasma needs to be shaken at temperature of 30-37°C to unfreeze before use. Previously, fresh frozen plasma needed by staff on a hospital ward was unfrozen on the ward as the plasma was needed; this policy was changed based on considerations involving quality control and patient safety. The new policy requires that the hospital laboratory be responsible for thawing the frozen plasma before a transfusion is administered by another department. A number of problems have arisen when there are too many fresh frozen plasma needed at one time; these include the buoyancy of the fresh frozen plasma in the water bath and the temperature of the water bath. One result has been a longer wait time for the nursing staff on the wards who need the fresh frozen plasma. Laboratory staff needed to resolve this issue and identify a timesaving technique that allows the fresh frozen plasma to be thawed safely, more quickly and without problems. Such a standard procedure needed to fulfill the requirements of the medical laboratory workers, the clinical needs of the patients and also preserve the quality of fresh frozen plasma. Therefore, between July 1 and July 31 2007, data was collected on the methodology and time requirements when thawing fresh frozen plasma. A statistical analysis was conducted using the ECRS (eliminate, combine, rearrange, simplify) approach to calculate the time needed for every step in the procedure that provides outgoing fresh frozen plasma. The steps included waiting thrice (3960 sec), operating once (60 sec), laboratory testing twice (62 sec), and moving once (58 sec). The seven steps were completed over 4140 seconds. After analysis, it was revealed that the waiting time was the most time-consuming procedure. To improve efficiency, the process was shortened to three steps by omission and combination of some procedures; this saved a total of 2580 sec (43 min). The project thus simplified the operational procedures and shortened the time needed for the process by the use of a quality control circle. In the process, the quality of fresh frozen plasma was maintained while improving the effectiveness of medical care.