結合人員採血認知、採血器具與資訊系統改善有效提升血液檢體品質：五年經驗分享

Improving the Quality of Blood Specimen: Integrating Phlebotomy Skills Cognition Equipment, and Information System

當依據風險管理分析評估資料顯示，檢驗前人員對採血的認知，檢驗中採血的方式與執行流程，檢驗後採血品質的追蹤與管理，為影響檢驗報告正確性之重要因素。本院2011-2013年之血液檢體品質風險評估結果顯示，檢體溶血與檢體凝固風險係數高達12高分。自2014-2016年針對各階段所評估之風險執行因應改善措施，制定標準作業流程與完整之人員教育訓練計畫，將人員正確採血認知率由43.5%提升為97.4%。以「Luer Adapter with holder」真空採血方式取代使用置入靜脈留置針同步採血的方法，確實將檢體溶血率自0.057%降至0.032%，檢體凝固率自0.07%大幅減少至0.0325%。整合資訊與網路通知系統管理檢體異常，使急診護理師對臨床檢驗滿意度由68.5%提升至94.5%，並且醫檢師對急診護理師滿意度由62%提升96.4%。藉由推行各種品質管理計畫成功使整體檢體錯誤率自2011-2013年的平均0.23%降低至0.10% 。本研究顯示藉由系統性品質管理以檢驗前、中、後分析採血作業流程中人員、設備與流程之風險，依風險擬訂品質管理計畫，可有效提升血液檢體，進而減少檢驗報告異常發生情形。

Sample rejection due to pre-analytical errors is very common in many medical laboratories worldwide. Specific rejection criteria are used to determine samples unsuitable for analysis. Increase amount of sample rejection impacting negatively the patient, staff, facility, and laboratory costs. Base on improving the pre-analytical process in order to ensure patient from being harmed by wrong medical decisions. We determined the sample rejection rate and clarified the reason. The average sample rejection rate was 0.21% in 2011-2013. The laboratory initiates pragmatic approach program to continue improve the problems, such as set up communication information platform, phlebotomy training and optimizing the collection devices. Through the cross sectoral cooperation, we successfully decline the sample rejection rate from 0.23% to 0.10%.