24小時尿液檢體收集改善方案

An Improved Program of 24-hour Urine Specimen Collection

本專案旨在提高24小時尿液檢體一天內完成之比率。調查本病房此項檢查完成所需之天數，平均2.5天，且一天內完成之比率僅21%。護理人員常因忘記交班、做法不統一，流程自隔日清晨六點開始、病人單位標示不明顯、病人意識不清，無法合作、家屬不清楚收集時間及方法等因素，造成延遲24小時尿液收集，常引起醫師責難、家屬抱怨。為此成立專案小組，與同仁共同檢討缺失，找尋解決辦法及著手相關文獻查證。制訂出標準作業流程，並將每步驟拍照，配合書面資料及物料之改善(如集尿桶、攪拌棒等)再向全體同仁說明及示範，以達作業一致性。實施期共5個月，平均24小時尿液檢體一天內完成之比率由原先之21%提高至96%。品質改善率為357%，目標達成率為127%。除使收集天數縮短，減少醫師、家屬責難及抱怨。同時材料成本由原先平均每次42元降為1.4元，在目前健保給付拮据的情形下，此方案可為醫院減少成本開支，是可推展之方案。

This special case study aimed at promoting the effectiveness of “24-hour Urine Specimen Collection" in one day. Before this program, it would take two and half days to complete the urine collection; the total rate was 21% on the first day. The causes of this low total rate are: nursing staff forgot to hand over the test; inconsistent collection method; collection procedure started at six in the morning; unclear marking in the patient unit; patient's poor consciousness without cooperation; and the family didn't know well about the collection timing and method. All the above factors caused the 24-hour urine specimen collection to delay and resulted in physician's annoyance and family's complaints. To improve the effectiveness, our team members discussed and reviewed the defects to find out the solutions. We designed a reminder card containing instructions of urine specimen collection. A standard operating procedure was established, and each step was photographed and accompanied with improved written data and materials. The entire procedure was demonstrated to the staff and they were asked to follow the standard operating procedure. After 5 months of implementing this special program, the total rate of 24-hour urine specimen collection in one day was improved from 21% to 96%. The targeted success rates was 127%, and the quality improvement rate was 357%. In addition to shortened collection period and fewer complains form physician and families, the material cost was reduced from NT$42 to NT$1.4 per collection as well. Under the condition of payment shortage from the National Health Insurance, this program is feasible and can be extended to the entire hospital.