以電腦輔助系統提升加護病房護理人員血液採檢流程正確率

Using Computer-aid System to Enhance ICU Nursing Staff the Correct Rate of Phlebotomy Workflow

血液採檢是病人常見的醫療處置，然採檢流程複雜且需要經過多重核對，方能避免採檢錯誤而造成檢驗值誤判、診斷或治療偏誤等嚴重後果，故正確血液採檢是確保病人安全與醫療品質的重要課題。有鑑於2012年1月單位血液採檢流程正確率僅76.9％，探究退件原因發現，超過七成為核對錯誤（含檢體姓名與檢驗單不符、檢體無黏貼姓名標籤及有檢驗單無檢體等），故成立專案小組，尋求解決對策以提升血液採檢流程的正確性並降低檢體退件率，進而改善醫療照護品質。解決對策包括實施：1、電腦輔助系統－個人數位助理（Personal Digital Assistant, PDA）進行採檢作業流程，以PDA讀取病人手圈及檢驗單以核對身份，PDA核對兩者皆正確無誤後，同時列印出標籤並黏貼於試管；2、人員教育訓練，內容為採檢知識、PDA技術；3、固定臨床教學講師，將單位新人的採檢流程及檢體容器介紹之教育訓練皆由固定主講者擔任，進行統一教學；4、制定檢體採集稽核制度，由專案人員觀察護理人員血液採檢之流程，並由護理長每月由電腦管理平台檢視成效，包含血液採檢數量、退件數量、退件原因等解決辦法後，於2012年12月血液採檢流程正確率提升至97.9％，正確率約提升21.0％。本專案不僅提升血液採檢正確率，更能有效的降低因核對錯誤造成之退件率，使醫療團隊獲得有效率的檢驗值，並提供病人安全與醫療照護品質。

Phlebotomy is one of the common medical treatments. However, the procedure may be associated with adverse complications. A major clinical concern is the abnormal laboratory values received due to inappropriate phlebotomy, which may mislead the clinicians to make wrongful treatment decisions. Therefore, executing an accurate phlebotomy procedure is a very important issue in regards to improving patient safety and quality of medical treatments. The rate of correct phlebotomy preformed in January of 2012 was 76.9%. All the incorrect phlebotomy identified based on our checklist revealed that over 70% of the inappropriately performed items included the following: wrongful information of the patient sticker, mismatch of inspection sheet, absence of sticker on the test tube, and the lack of blood specimen. As a result, a project committee was established with the objectives to search for solutions and to implement methods with the goal to prevent negligence associated with incorrect phlebotomy. A four-aspect solution was carried out. The first was to obtain a double check system on patient identity by using a computer-aid system (Personal Digital Assistant, PDA) to read the patient's wristband and laboratory inspection sheet prior to conducting phlebotomy. Once the identification code from both sources matched, the nurse could then print out the number of ID labels and stick them onto the test tubes for the specimens. The second was to strengthen the knowledge of correct phlebotomy by educating and training the nursing personnel, which included the re-emphasis on the importance of correct phlebotomy and the implementation of hands-on skills necessary for operating the PDA. The third was to assign a special clinical training instructor among our senior nursing staff, whose role was specifically focused on overseeing the new personnel so that the implementation and execution of correct phlebotomy could be unified. The last was to set up an auditing system by assigning project specialists to monitor the process of phlebotomy performed by nursing personnel. The surveillance items included the number of phlebotomy, the number of rejected cases, and the reason for rejection, all of which were then checked monthly by the head nurse. After implementation of the four-aspect solution, the rate of correct phlebotomy performed achieved 97.9% by December of 2012, a correction rate of improvement nearly 21% with the number of erroneous items reduced to only two events (9.6%). By enhancing the rate of correct phlebotomy performed, this project successfully achieved our initial intent to provide the medical team accurate and reliable test values, thereby improving patient safety and refining quality of medical treatments.