降低某區域教學醫院手術室醫衛材計價漏帳之專案

Reducing Omission Rate for Charging Medical Materials:Case Study of a Regional Teaching Hospital

本專案目的在改善某手術室之醫衛材漏帳率，因單位漏帳率居全院之冠，漏帳率為 52.93%，漏帳金額一年達 103 萬元，經要因分析為人員忙碌忘記計價、醫衛材數量及代碼登錄錯誤、手術備物單內容不齊全、醫衛材代碼更換頻繁等。於 2011年 3 月 1 日至 12 月 31 日進行專案之改善，針對要因進行改善：新舊代碼統整、更新修改手術用物備物單、製作醫衛材代碼貼紙、添購材料盒及醫衛材置物籃、舉辦在職教育及制定雙重核對機制、並成立稽核小組進行稽核，改善後漏帳率為10.16%，漏帳金額為 15 萬元，目標達成率 101%。專案結果證實醫衛材管理及成本概念教育，可提升計價正確及手術的照護效能，亦可提升護理人員向心力及計價滿意度，並作為其他醫療機構之參考。

This study explored measures for reducing omission rate for charging medical materials. In one regional teaching hospital, the charging omission rate in the operation room was 52.93%, ranked highest in the hospital, and the amount of omission reached 1.03 million dollars per year. Analysis of critical factors revealed major reasons for omission including employees forgetting to input the charge, errors in entering quantity and codes of materials, incomplete list of materials used, or frequent modification of codes used for materials. To reduce charging omission, measures including code renewed in time upon replacement of materials, redesigning the sheet of materials used, making code stickers for items, providing on-job education, regulating double-checking, and establishing an audit team. These measures for improvement were implemented from March 1st to December 31st, 2011, with charging omission rate reduced to 10.16%, and the amount of omission reduced to 150 thousand dollars, 101% of goal achievement. The results indicated that education on material management and cost effectiveness can improve the accuracy of charging and efficacy of patient care, strengthen the solidarity among nurses, and increase job satisfaction. The present findings can also be used as references by other medical institutions.