北京市属医院输血质量控制现状调查研究与改进对策

Investigation and improvement on the present situation of blood transfusion quality control in municipal hospitals in Beijing

目的通过对北京市19家市属医院输血质量控制现状调查,发现输血环节中存在的漏洞和不足,从而提出有建设性的意见和建议,逐步完善输血质量控制体系。方法采用文献研究、现场调研、问卷调查及电话随访的方式对19家医院的输血科、临床用血相关科室、行政主管部门及信息管理部门进行调研,调研数据采用SPSS17.0统计软件进行汇总及分析。结果 19家医院的调研结果显示,人员构成分布中学历构成(博士、硕士、本科、大专、中专)在三级专科医院占比分别为1.7%、6.9%、12.2%、19.2%、1.7%,而在三级综合医院占比分别为1.7%、11.6%、30.8%、13.4%、0.6%,本科以上学历人员较专科医院多(P<0.05);在职业类别构成中,三级综合医院医师占比5.8%、三级专科医院占比2.3%,而医师在19家医院总比例为8.1%,技师占比87.3%,差异显著(P<0.05);在实验室检测项目开展情况比较中,不规则抗体鉴定试验和Rh五型抗原检测试验在三级专科医院中占比分别为21.1%和5.3%,在三级综合医院占比分别为47.4%和31.5%(P<0.05);在输血信息管理系统建设中,只有患者信息提取功能、输血不良反应上报功能和用血数据统计功能实现占比超过50%(分别为73.7%、73.7%、52.6%),其它功能模块未应用或应用不全。结论在输血科人员配置、实验室能力与输血信息管理系统(TMS)的建设等几个方面北京市19家市属医院存在着较大的差距和不足。输血质量控制必须将行之有效的措施纳入输血管理体系来指导临床输血实际工作,才能提高临床输血质量、确保临床用血安全。

Objective To investigate the quality control of blood transfusion in 19 municipal hospitals in Beijing and find out the loopholes and shortcomings in the process of blood transfusion,so as to put forward constructive opinions and suggestions and gradually improve the quality control system of blood transfusion.Methods By means of literature research,field investigation,questionnaire survey and telephone follow-up,the transfusion departments,clinical blood related departments,administrative departments and information management departments of 19 hospitals were investigated.The data were collected and analyzed by SPSS17.0 statistical software.Results The survey results of 19 hospitals showed that the proportion of graduates(doctor,master,undergraduate,junior college and secondary school)in the three-level specialized hospitals was 1.7%,6.9%,12.2%,19.2%and 1.7%respectively,while that in the three-level general hospitals was 1.7%,11.6%,30.8%,13.4%and 0.6%,respectively.The number of graduates with bachelor′s degree or above in general hospitals was more than that in specialized hospitals,and the difference was significant(P<0.05).The proportion of physicians in tertiary general hospitals was 5.8%and that of tertiary specialized hospitals was 2.3%,while the proportion of physicians in 19 hospitals was 8.1%and that of technicians was 87.3%,with significant differences(P<0.05).In the comparison of laboratory testing projects,the proportion of irregular antibody identification test and five blood groups of Rh antigen detection test in tertiary specialized hospitals was 21.1%and 5.3%,respectively,and that in tertiary general hospitals was 47.4%and 31.5%respectively,with significant difference(P<0.05);in the construction of transfusion information management system,only such three functions as extraction function of patients′information,reporting function of transfusion adverse reactions and statistical function of blood data accounted for more than 50%(73.7%,73.7%,52.6%,respectively),while other functional modules were not applied or incomplete.Conclusion There are great gaps and deficiencies in personnel allocation of blood transfusion department,laboratory capacity and construction of blood transfusion information management system(TMS)in 19 municipal hospitals in Beijing.In order to improve the quality of clinical blood transfusion and ensure the safety of clinical blood transfusion,effective measures must be incorporated into the management system of blood transfusion to guide the actual work of clinical blood transfusion.