降低檢驗報告修改率改善專案

A Program to Reduce the Revision Rate for Test Reports

檢驗室的報告多運用於疾病的診斷以及治療後的追蹤，檢驗報告的不正確，可能造成醫師誤判而危害病人的安全。因此，能提供正確檢驗報告的檢驗室才有能力確保病患安全，進而保障其就醫的權益。檢驗報告可分為血液報告、生化報告、血清免疫報告、細菌、病毒培養報告及尿液糞便報告等，本院急做生化項目包括肝臟、腎臟、心臟功能、電解質、血糖及血液氣體分析等檢測，急做全血液檢驗包括白血球、紅血球、血色素及血小板等報告。造成檢驗報告修改的原因有可能是人員方面問題，如未核對資料即上機或是人員輸入電腦的錯誤造成錯誤的報告，有些是檢體因特殊狀況須做特殊處理如去脂、回溫、推片⋯⋯等，而人員無確實執行sop造成報告的修改。在血液氣體分析方面，因採集到靜脈血為由造成重新採檢，報告亦得重新輸入而修改。我們利用資訊系統收集2008年7月1日至7月31日檢驗報告修改分析數據，顯示生化報告修改率占63%、尿液報告占19%、血液占報告15 %。本科考量人力、物力的耗損及提昇報告可信賴度跟工作默契藉由提醒小標籤的設計、落實3讀2對、警示系統設定以及對懷疑的報告在發報告前再確認等對策來降低本科室檢驗報告之修改率。

Laboratory reports are used to diagnose disease and track changes after medical treatment, so inaccurate test reports may result in misjudgments by doctors and potential harm to patients. Thus, only the provision of correct test reports can ensure the safety of patients. Reports can be divided into categories such as blood tests, biochemical tests r, serum immunity assays, bacterial and virus cultures and urine and stool tests. The biochemical tests in this hospital include liver, kidney and heart functions, electrolytes, blood sugar and blood gas analysis. Blood test reports cover leucocyte, erythrocyte, hemoglobin and blood platelet counts. The need for revision of test reports may due to human error, such as not checking the data or inputting errors, which generate erroneous reports, or failure to follow the standard operating procedures for specimens that require special treatment such as fat removal, temperature return, or smear. Blood gas analysis may be retested if the blood collected was venous blood. This department utilized the information system to collect the analysis data for revised test reports from July 1 to July 31, 2008. Results indicated that the revision rate for biochemical test reports was 63%, for urine test reports it was19%, and for blood test reports it was 15%. Considering the amount of manpower and material consumed, this department adopted strategies such as reminders, 3-reading 2-comparisons, warning system settings, and reconfirmation of suspicious reports, in order to reduce the rate of test report revisions.