上海市某区输血质控督察分析与思考

Blood transfusion quality supervision in a district of Shanghai

目的 通过对上海市某区有用血计划的19家医疗机构两年间临床用血全覆盖督察,以期发现各级医疗机构在输血环节中存在的问题,提出有建设性的意见和建议进行针对性的分级整改,从而推动区各级医疗机构临床用血管理水平的持续改进。方法 依据《医疗机构临床用血管理办法》、《临床输血技术规范》、《上海市医疗质量督查评分统计表》,对19家医疗机构进行实地督察,督察内容包括硬件设施、管理水平、专业技术水平及现场血型定型检测,并对数据进行整理分析。结果 各医疗机构基本能较规范地开展临床输血工作,但存在明显的差异性,主要表现在:三级医疗机构总体较好,但需要加强医疗输血文书管理;二级医疗机构有待提升,主要问题在输血科(血库)建设欠缺、关键设备管理及维护不到位、医疗输血文书书写不规范;而民营医疗机构(因大部分是挂靠医院)各督察内容均存在较大问题,需要加强临床用血管理。结论 加强二级以上医疗机构医疗输血文书规范化书写,加大二级医疗机构输血科(血库)建设,而民营医疗机构尤其是挂靠医院则需要进一步加强临床用血管理,建议拟出与之用血流程相适应的考核细则进行督察与约束,并建立严格的准入和退出机制,从而整体提高区各级医疗机构临床用血管理水平,保障临床用血安全。

Objective To supervise the clinical blood use of 19 hospitals, covering a district of Shanghai, during two years, and discover the problems in the process of blood transfusion, so as to put forward suggestions for corrective methods in grades and promote continuous improvement of clinical transfusion management.Methods A total of 19 hospitals were supervised in terms of hardware facilities, management level, professional and technical level, and blood typing test on the site, according to the Administrative Blood Management Measures for Medical Institutions,Technical Specification for Clinical Transfusion and Shanghai Medical Quality Supervision Score Statistical Table.All data were analyzed.Results These hospitals can properly perform clinical blood transfusion, but there were obvious differences.Tertiary hospitals were relatively better, yet need to strengthen the management of medical documents.Secondary hospitals remained to be improved, mainly in insufficient construction of Blood Transfusion Department(blood bank),the lack of management and maintenance of key equipment and the lack of standardization in medical documents writing.However, flaws in the supervision were general in private hospitals(most of which were affiliated hospitals),so the management of clinical blood use should be further strengthened.Conclusion For secondary hospitals or above, routinized writing of medical documents and promoted construction of Blood Transfusion Department(blood bank) should be strengthened.For private hospitals, especially affiliated hospitals, the management of clinical blood use should be further improved, including the examination rules corresponding to the blood use process and strict access and exit mechanism, so as to improve the overall management level of clinical blood use and ensure the safety of clinical blood use.