篇名 | 運用品管圈手法降低急診病人部份凝血活酶時間 (APTT)假性偏低之比率 |
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卷期 | 20:6 |
並列篇名 | Reduce the False Rate of Short Activated Partial Thromboplastin Times (APTT) in an Emergency Department through the Quality Control Circle Activity |
作者 | 李景耀 、 楊惠芬 、 葉依綾 、 劉玉香 、 林素美 、 蘇姵瑄 、 鄭瑞楠 、 施勇綸 、 陳東榮 |
頁次 | 625-633 |
關鍵字 | APTT 、 品管圏 、 APTT 、 quality control circle activity 、 TSCI |
出刊日期 | 201611 |
DOI | 10.6320/FJM.2016.20(6).9 |
偏低的APTT(Active partial thromboplastin time,部份凝血活酶時間)在傳統上被認為是有問題的抽 血技術所造成的假性數據。然而,近年來有證據顯示偏低的APTT反而是反映了人體内為容易凝血的狀 態,可能與增加栓塞機率和不良的心血管事件有關。過去文獻指出一般血凝實驗室APTT偏低的比率約 為6%-9°%,本研究統計個案醫院2014年1月至4月門診、病房和急診室APTT偏低的比例數據,分別為 7.8°%、8.3°%和22.4°%,經過探討急診室比率較高的原因是因為抽血流程問題造成,並非是因為容易凝血 狀態之病人較多。透過文獻查證以及跨部門團隊合作運用品管圏手法制訂改善策略,採取措施包括:使 用真空抽血設備、將APTT藍頭抽血管直立擺放、製作提醒小卡提示採血管要上下混合、制定抽血標準 作業流程和在職教育訓練。最後,急診室APTT偏低比率有明顯的改善,由原本改善前的24.3%下降至 15.9%。
Short activated partial thromboplastin times (APTTs) are generally considered to be a surrogate marker of inappropriate blood collections. However, recent evidence suggests that short APTT may reflect a hypercoagulable state, potentially associated with an increased thrombotic risk and adverse cardiovascular events. Earlier studies have showed the proportion of short APTT is about 6%-9% in the hemostasis laboratory. We prospectively computed the rate of short APTT in outpatient, inpatient and emergency (ER) from January to April, 2014, and the proportion were 7.8%, 8.3% and 22.4%, respectively. We assumed that higher proportion in ER might be due to the inappropriate blood collections not more patients in a hypercoagulable state. Through a literature review and in accordance with the improvement strategy, the following methods were taken: using vacuum extraction tube systems, putting sodium citrate tube upright, reminding cards for overturning the blood collection tube, creation of standard operating procedures, in-service training. In conclusion, there was a significant reduction in the proportion of short APTT in ER with a reduction from 24.3% to 15.9%.