減少新生兒先天性代謝疾病篩檢檢體退件之改善方案

A Project to Reduce Rejection of Newborn Screening Blood Specimens for Congenital Metabolic Diseases

新生兒先天性代謝疾病篩檢檢體如有不良，除了檢體被退件外，也需要再次執行新生兒的足跟穿刺，也會造成延誤診斷及家屬的抱怨。本專案旨在改善新生兒先天性代謝疾病篩檢檢體不良被退件情形，執行期為2006年3月1日至2007年2月28日。專案小組經實地觀察、文件查閱並進行檢體採集知識測驗，以確認造成檢體不良原因，發現原因包括不正確之檢體採血作業、缺乏在職教育以及採血工作台凌亂。提出五項改善措施：(1)制定新生兒先天性代謝疾病篩檢採血標準作業流程及Q&A集，(2)規劃護理人員篩檢檢體採集在職課程，(3)製作檢體收集錯誤一覽表，(4)專人整理採血工作台，及(5)每月月底從篩檢檢體送出月報表計算退件件數。於改善措施執行後，檢體不良退件率由原來平均每月19.5%降為3.8%，且護理人員檢體採集知識得分由68分上升至92分，達成專案的目的。建議日後將新生兒代謝篩檢採血做為新進人員職前訓練之必備課程，並定期舉辦在職教育，以確保檢體採集之正確性。

Defective blood specimens used to screen congenital metabolic diseases in newborns cause specimens to be rejected and necessitate that a heel stick be performed again. Such results in delayed diagnoses and family complaints. The purpose of this project was to reduce the incidence of blood specimen rejection. The project was carried out from March 1, 2006 to February 28, 2007. Project team members identified the causes of specimen problems using onsite observation, document review and quizzes on specimen collection knowledge. Three causes were found, including incorrect blood collection procedures, lack of pre-job training and continuing education, and disorganized blood collection work station. Five strategies were proposed to reduce the rejection of blood specimens: (1) establish standard operating procedures for blood specimen collection done to screen for congenital metabolic diseases; (2) design blood specimen collection training courses; (3) make a list of common errors encountered in blood specimen collection; (4) designate a specific person to organize the work station and (5) maintain an accurate monthly record of specimens rejected. After the completion of the project, the objective was achieved. The percentage of the rejected specimens fell from 19.5% to 3.8% per month and nurse scores on specimen collection knowledge increased from 68 to 92. In order to ensure the correctness of blood specimen collection, appropriate pre-job training and periodical on-job training courses for staff are further suggested.