運用知識態度行為模式降低內科病房檢體退件率

Apply Knowledge, Attitude and Behavior Model to Reduce the Dismissal Rate of Specimens in Medical Wards

不正確檢體採集不僅會延遲醫師診斷、增加護理工作與醫療成本，嚴重甚至危及病人生命安全。專案介入前，本病房檢體退件率平均為 1.36%。經查核與分析後，確立檢體退件的主因為護理師對檢體採檢的知識不足。專案小組經文獻查證及創意策略，除以 Baranowski 等（2003）提出的知識態度行為模式，改善護理師對血液採檢的行為，另外還拍攝影片、製作採檢小卡，以及運用擬真情境「採血假手臂」等，來提升護理人員的專業知識與技能，進而影響其行為，正符合知識、態度、行為模式，結果使本病房檢體退件率由 1.36% 降為0.65%。本專案不僅提高本病房血液採檢正確性、減少醫療成本的浪費及提升護理師對血液採檢的知識，進而提升照護品質減少病人不必要的反覆被抽血。

 

Inaccurate specimen collection not only delays physician diagnosis, and increases nursing work and medical costs, but can seriously endanger the lives of patients. Before the advent of the project, the average return rate of specimens in this ward was 1.36%. Evaluation and analysis identified the problem: the lack of knowledge of nurses about inspection. The task force’s literature review and creative strategy, in addition to the knowledge, attitude and behavior model proposed by Baranowski et al. (2003), were used to improve the behavior of nurses vis-à-vis blood tests. The task force also organized on-the-job education, filming, and production of small-scale inspection cards. A realistic situation, i.e. a “blood collection dummy arm”, was used to improve the nursing staff’s professional knowledge and skills, thereby encouraging their behavior to fall line with their knowledge, attitude, and behavior patterns. The return rate subsequently dropped to 0.65%. This project improves the accuracy of ward blood screening, reduces the waste of medical costs, and enhances the knowledge of nurses about blood sampling, and, thus, ensures the quality of ward care and maintenance.