降低肝臟移植病房檢體退件率之改善專案

A Project to Reduce the Specimen Returning Rate in Liver Transplant Ward

不正確的採集過程是影響血液品質不佳的主要原因，檢體退件不但造成病人診斷與治療時間的延誤，也可能因重複採集檢體導致病人不適及增加護理人員的工作負擔。自2011 年5-9 月本單位送檢檢體退件率高達0.63%，引發專案小組改善動機，目的在降低肝臟移植病房病人檢體退件率低於全院設定0.22% 之閾值。根據現況分析發現問題為：缺乏採集移植檢體參考資料、條碼設 備不完善、護理人員對檢體採集作業認知及技能不足、未落實執行檢體採集前後條碼辨識操作、缺乏肝臟移植病人檢體採集監測機制。經文獻查證及團隊討論後，擬定解決辦法包括：1. 制定肝臟移植病房檢體採集參閱本、設計採血工具、改善條碼設備系統；2. 舉辦在職教育訓練；3. 進行情境模擬演練；4. 定期稽核機制。結果顯示：檢體退件率由0.63% 降至0.13%，護理人員對檢體採集作業認知正確率由改善前的69.1% 提升至96.5%，檢體採集作業正確率由72.6% 提升至94.8%。此專案實施有效降低檢體退件率，強化護理人員執行檢體採集正確性，提高病人的安全及照護品質。

The main reason of poor blood sample quality is incorrect process of blood collection. Returning specimens leads to delay of both diagnosis and treatment. Other results include increased discomfort of patients and increased workloads for nurses. The specimen returning rate in our department was 0.63% between May and September 2011. Therefore, the purpose of this project was to reduce the specimen returning rate in liver transplant ward to 0.22%. We analyzed and found out the problems as follows: 1. Lack of references for collecting specimens of liver transplant, 2. Barcode equipment was inadequate, 3. Nursing staffs were not familiar with specimens collection, 4. Staffs failed to double check barcodes before and after specimens collection, and 5. The organization failed to monitor specimens collection procedure. After references investigation and team discussion, the projects included: 1. Planning a guide book for collecting specimens in liver transplant ward, designing an equipment for collecting blood and improving barcode equipment system, 2. Holding in-service training sections, 3. Performing simulating rehearsal, and 4. Auditing regularly. The results were as follows: The specimen returning rate decreased from 0.63% to 0.13%. Nursing staffs’ knowledge improved from 69.1% to 96.5%. Accuracy of collecting specimens improved from 72.6% to 94.8%. Our project reduced the specimen returning rate and decreased re-collecting specimens, significantly reducing the workload and medical cost. It helped nursing staffs to correctly collect specimens and improved quality of care. In conclusion, our project could be a reference for reducing the specimen returning rate in the other units.