應用品質突破模式降低內科病房血液檢體異常退件率

Breakthrough Series Model in Reducing Rejection Rates of Clinical Laboratory Specimens- the Project of a Medicine Ward

本專案旨在降低內科病房血液檢體異常退件率。本病房自2011年1月至3月血液檢體異常退件率為0.49%，經現況分析發現缺乏在職教育、檢體試管血液混合輔助工具、檢體異常處理登錄未資訊化及護理人員血液檢體採檢正確率及認知正確率偏低，造成血液檢體異常退件率偏高。解決辦法為成立BTS小組，經團隊合作舉辦血液檢體採檢在職教育、製作「真空採血步驟參閱圖片」、設製「自動血液試管搖擺機」輔助器、拍攝「血液檢體採集流程」光碟及建構檢體異常登錄資訊化。經介入措施後，血液檢體異常退件率由0.49%降低到0.07%、護理人員抽血技術平均正確率由80.6%提升到98.6%及抽血認知正確率平均由78.9提升100.0%，達到專案目的。冀望護理部將此標準作業平行展開，進而確保病人安全及提升最佳醫療照護品質。

The project aims to reduce rejection rate of clinical laboratory blood specimens. The factors which are possibly contribute to the high rejection rate included lack of sufficient blood sampling training, lack of proper instrument to mix sample in order to lower the possible hemolytic specimens, and lack of database of abnormal specimens. Besides, inadequate accuracy of sampling technique and lack of knowledge about sampling were also the reasons for the high level of rejection rate. As the consequence, 0.49% of total blood specimens were rejected from the laboratory from January to March in 2011. The BTS team was then organized to lower rejection rate. By conducting clinical training programes, using rotators, creating blood sampling demonstration display, providing education CD-ROM and E-learning website, the rejection rate decreased to 0.07% from 0.49%, the accuracy of sampling technique and knowledge toward sampling increased to 98.6% and 100%, respectively. It is expected that the intervention used in the project can be generalized in the clinics to ensure better quality of nursing care.