某區域級教學醫院之檢驗試劑庫存管理精進實務研究

Test Reagent Inventory Management in a Regional Teaching Hospital

物資(materials)庫存將積壓可運用資金及其增加營運及管理成本，然而因醫療服務業之病患維繫生命需求或供應商之供輸限制，對於各醫藥用品及材料須有一定程度之庫存，尤其攸關協助醫師診斷需求之檢驗試劑甚之；因其檢驗試劑過多、短缺都將影響醫院成本及直接影響臨床醫師之診斷能力，故檢驗管理者應從實驗室試劑之種類、採購量和出入庫時間等管理手段，以確保醫療機構營運無虞。本研究發現個案醫院之檢驗試劑庫存管理錯誤卻達44.1%，始至積壓成本或短缺不足－－供需不穩定，進而影響其檢驗時效，醫療服務品質備受考驗。本研究於2009年7月成立專案小組，以Q.C.C手法，期降低檢驗試劑庫存管理不當率，2009年8月分析個案醫院之檢驗試劑庫存管理不當原因主要為（一）訂試劑人員不熟悉；（二）冰箱庫存數量不清楚；（三）試劑擺放無固定位置；（四）沒有訂試劑標準。經本研究1個月之專案改善措施，內容包括（一）請生化室人員每月訂藥；（二）依機器設定項目碼做分類；（三）製作試藥庫存表；（四）制定生化試藥安全庫存量。本研究執行結果顯示檢驗試劑庫存管理不當由44.1%降至4.78%，達成率為159.2%，進步率是89.2%，成效顯著可有效改善檢驗試劑庫存管理不當，不僅人員執行過程試劑無短缺、成本控制良好，確實可提升更完善的實驗室檢驗品質。

Materials inventory may tie up usable capital and increase operating and management costs; however, the medical service industry has to maintain a certain level of inventory of various medical/pharmaceutical products and material in order to meet patients’ needs or to comply with governmental regulations. Maintenance of the inventory of test reagents to meet diagnostic needs is particularly important because either an oversupply or shortage of test reagents will affect a hospital's operating costs and directly affect doctors’ diagnostic ability. Administrators should therefore monitor the categories of laboratory reagents, the amounts purchased, and the time of warehouse entry and exit in order to ensure smooth operation of the medical institution. This study found that the error rate for the inventory management of test reagents at the study site (hospital) was 44.1%, and the main cause was accumulation or shortage–an unstable supply. As a result, the effectiveness of tests was affected, and this might have undermined the quality of medical services. This study established an ad hoc group in July 2009, and used the Q.C.C. method to reduce the error rate in the inventory management of test reagents. Analysis at the study site in August 2009 showed that the main causes for the improper inventory management of test reagents were: (1) personnel ordering the reagents were unfamiliar with inventory management; (2) the quantity of inventory in the refrigerator was uncertain; (3) reagents were not placed at a fixed location; (4) storage criteria for reagents were not established. The one-month improvement project for inventory management included: (1) personnel in the biochemical laboratory were requested to order reagents every month; (2) the reagents were classified according to machine-labeled codes; (3) a reagent inventory list was produced; (4) a safe stock inventory of biochemical reagents was established. The results of project implementation showed that the error rate for inventory management of test reagents was reduced from 44.1% to 4.78%, the completion rate was 159.2%, and the progress rate was 89.2%. The inventory management of test reagents was significantly improved. During implementation of the project, there was no shortage of reagents, the cost was properly controlled, and the quality of laboratory testing improved.