锦州血站紧急采供血质量保证方案设计与应用研究
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摘要
本文运用项目质量管理相关理论,对锦州血站应对突发事件紧急采供血质量保证方案进行设计,探讨了解决突发事件发生时血液来源的充足性、及时性、安全性以及保证供给临床用血的血液质量等紧急采供血问题。
通过对锦州地区突发事件用血需求与采供血不足原因的深层次分析,从社会营销调研及策略(市场细分、消费者调查、产品概念开发和测试)等角度对紧急采供血质量保证方案进行了设计。同时,运用项目全面质量管理(PDCA循环)、项目质量控制、项目质量改进、质量管理体系、针对性交流、便利设施、鼓励手段和交换理论等管理理论和方法,对解决突发事件时血液来源及血液质量两方面的关键问题进行了应用。最后,通过建立紧急采供血设计方案评价体系,对紧急采供血过程进行监控,使锦州血站应对突发事件紧急采供血质量保证方案得以有效运行并持续改进。
Since the transfusion technique is clinical applied, it has rescued countless people already, especially plays an important role in the treatment of casualty emergencies, such as "9.11" incident, transit bombings in London, and Wenchuan earthquake incident. Due to the sudden increase of the ill and injured patients, the demand for temporary blood is more obvious. How to deal with these incidents, and collect and supply blood in the shortest time has attracted attention of our government departments at all levels, and the emergency response plan already on the agenda. Many incidents have occurred in Jinzhou area, such as the small plant explosion in 2005, and super storms in 2006, causing temporary blood increased. It is necessary and timely for Jinzhou blood station to establish emergency quality assurance plan to response the emergencies.
In Jinzhou district, there are 3080,000 people and more than 20 medical institutions, including two 3A general hospitals, three provincial general hospitals and a troop general hospital. As the central city of the western region, the ability of medical treatment is the first, with over 6 tons of blood a year. The blood used in Jinzhou is all from the Jinzhou blood station, as the only one blood collecting and supplying specialized institution, the Jinzhou blood station is responsible for blood donors mobilization and recruitment, blood collecting, preservation, inspection, the preparation of separation, and blood supply. Incidents are associated with clinical use and are effective for clinical blood flow, blood donor blood flow, blood collecting progress, and blood transport. The blood flow in Jinzhou district is smoothly, increasing by 10% each year. The 25,000 people blood collecting and 1,000 people platelets collecting, basically can meet the needs of daily use, but cannot satisfy the sudden blood demand in short time. The clinical impact source for emergency rescue by the timeliness and platelet needs daily is not the same.
The blood is a precious resource from human body, and there is no appropriate artificial replacement yet. Several components of blood, such as red blood cell, blood platelet, blood plasma and leukocyte collected from the body, cannot be permanent preserved. The blood station tests the blood after collecting the blood and blood components from donors’bodies used one-off blood bags, and keeps the qualified blood after separation and preparation. The red blood cell is kept in 2-6℃refrigerator, and platelet is kept in 22℃vibrating box. With current existing technical skills and techniques, red blood cell is kept at most 35 days, and platelet is at most 5 days. Once pass the retention period, the cells loose will physiological activity and be scraped. Therefore, sufficient number of blood donors must be called up in a short time Secondly, in recent years the country has issued a series of laws and regulations, inspecting the blood collecting and supplying behavior. According to the standards of the World Health Organization, the blood must be collected from low-risk gratis blood donors to ensure the quality and the source of the blood. Therefore, the donors must be strictly selected never allow blood transmission of HIV spread disease. Thirdly, donor groups have undergone tremendous changes since the implementation of the Blood Donation Law of People's Republic of China in 1998. The blood donation behavior is gratis and volunteering donors sell blood transform gratis blood, blood is spontaneous actions voluntary, with no purpose, so they cannot be forced to donate or not, and how much they donate. They concern much about their bodies, safety, and donating service. Cultivating loyal gratis blood donors is very difficult. Fourthly, during the blood collecting and supplying process, some problems appeared in the blood, inspection, separation, packaging, transportation links, affecting blood quality, their reasons are the problems appeared in one factor of "people, machines, materials, methods, links".
It is necessary to design quality assurance plan of blood collecting and supplying to response the emergency. The quality management theories are in favor of the establishment, implement and continuous improvement of quality system of the blood station. Apply marketing research and strategy to recruit donors and retain. Social marketing refers to the use of marketing skills and principle advocating a social movement, concept and behavior. Social marketing applies market segmentation, surveys of consumers, the concept of product development and testing facilities, encourage exchanges, and exchange theory to pursue the goal of the recipient reaction. Secondly, to establish three teams. One is the establishment of the emergent blood donors team, and its members are the gratis donors come from many enterprises and institutions for organ donors. The other one is the establishment of selected donors team, publicizing and donating by the way of blood donors. The last one is the establishment of fixed donors team, and each blood type has a certain amount of loyalty. All of these to achieve blood source for low-risk donors. Thirdly, the process of the blood collecting and supplying is the whole progress from blood collecting extend to the clinical hospital application, including blood collecting process, the blood test process, the blood preparation and storing composition process, and blood extend process. The process quality guarantee needs to hold a series of key points above, to ensure safety of blood donors, ensure the quality of blood. Fourthly, the Jinzhou blood station establishes the process quality management system to realize the comprehensive quality management, implement a standard request, according to PDCA cycle to establish quality management system, and aware the quality consciousness of the leadership and the general staff. Each link need to be regulated by documents, write down what you should do, and do what you have written, then check that you have done, further improvement., to improve quality and service.
The preparation of the plan implementation is the establishment of the leadership group, establishing the system documentation team, and recruiting and quality management divisions. Through the internal audit and management review quality assurance plan for emergency blood collecting and supplying assessment, make continuous improvement. In the blood products garage of the blood station, the minimum cordon will be set, according to the severity of the incident. Then start preventive measures, staff in the blood-serving room notices the recruiting division and organizes the blood donors enter the station, mobilizing various departments and personnel to start the blood collecting work. The application of emergent blood collecting and supplying plan greatly alleviate the sudden blood in demand, but the aspects of laboratory testing, maintaining of the balance of supply and demand, promoting reasonable blood transfusion still should be further strengthened in and perfected.
通过对锦州地区突发事件用血需求与采供血不足原因的深层次分析,从社会营销调研及策略(市场细分、消费者调查、产品概念开发和测试)等角度对紧急采供血质量保证方案进行了设计。同时,运用项目全面质量管理(PDCA循环)、项目质量控制、项目质量改进、质量管理体系、针对性交流、便利设施、鼓励手段和交换理论等管理理论和方法,对解决突发事件时血液来源及血液质量两方面的关键问题进行了应用。最后,通过建立紧急采供血设计方案评价体系,对紧急采供血过程进行监控,使锦州血站应对突发事件紧急采供血质量保证方案得以有效运行并持续改进。
Since the transfusion technique is clinical applied, it has rescued countless people already, especially plays an important role in the treatment of casualty emergencies, such as "9.11" incident, transit bombings in London, and Wenchuan earthquake incident. Due to the sudden increase of the ill and injured patients, the demand for temporary blood is more obvious. How to deal with these incidents, and collect and supply blood in the shortest time has attracted attention of our government departments at all levels, and the emergency response plan already on the agenda. Many incidents have occurred in Jinzhou area, such as the small plant explosion in 2005, and super storms in 2006, causing temporary blood increased. It is necessary and timely for Jinzhou blood station to establish emergency quality assurance plan to response the emergencies.
In Jinzhou district, there are 3080,000 people and more than 20 medical institutions, including two 3A general hospitals, three provincial general hospitals and a troop general hospital. As the central city of the western region, the ability of medical treatment is the first, with over 6 tons of blood a year. The blood used in Jinzhou is all from the Jinzhou blood station, as the only one blood collecting and supplying specialized institution, the Jinzhou blood station is responsible for blood donors mobilization and recruitment, blood collecting, preservation, inspection, the preparation of separation, and blood supply. Incidents are associated with clinical use and are effective for clinical blood flow, blood donor blood flow, blood collecting progress, and blood transport. The blood flow in Jinzhou district is smoothly, increasing by 10% each year. The 25,000 people blood collecting and 1,000 people platelets collecting, basically can meet the needs of daily use, but cannot satisfy the sudden blood demand in short time. The clinical impact source for emergency rescue by the timeliness and platelet needs daily is not the same.
The blood is a precious resource from human body, and there is no appropriate artificial replacement yet. Several components of blood, such as red blood cell, blood platelet, blood plasma and leukocyte collected from the body, cannot be permanent preserved. The blood station tests the blood after collecting the blood and blood components from donors’bodies used one-off blood bags, and keeps the qualified blood after separation and preparation. The red blood cell is kept in 2-6℃refrigerator, and platelet is kept in 22℃vibrating box. With current existing technical skills and techniques, red blood cell is kept at most 35 days, and platelet is at most 5 days. Once pass the retention period, the cells loose will physiological activity and be scraped. Therefore, sufficient number of blood donors must be called up in a short time Secondly, in recent years the country has issued a series of laws and regulations, inspecting the blood collecting and supplying behavior. According to the standards of the World Health Organization, the blood must be collected from low-risk gratis blood donors to ensure the quality and the source of the blood. Therefore, the donors must be strictly selected never allow blood transmission of HIV spread disease. Thirdly, donor groups have undergone tremendous changes since the implementation of the Blood Donation Law of People's Republic of China in 1998. The blood donation behavior is gratis and volunteering donors sell blood transform gratis blood, blood is spontaneous actions voluntary, with no purpose, so they cannot be forced to donate or not, and how much they donate. They concern much about their bodies, safety, and donating service. Cultivating loyal gratis blood donors is very difficult. Fourthly, during the blood collecting and supplying process, some problems appeared in the blood, inspection, separation, packaging, transportation links, affecting blood quality, their reasons are the problems appeared in one factor of "people, machines, materials, methods, links".
It is necessary to design quality assurance plan of blood collecting and supplying to response the emergency. The quality management theories are in favor of the establishment, implement and continuous improvement of quality system of the blood station. Apply marketing research and strategy to recruit donors and retain. Social marketing refers to the use of marketing skills and principle advocating a social movement, concept and behavior. Social marketing applies market segmentation, surveys of consumers, the concept of product development and testing facilities, encourage exchanges, and exchange theory to pursue the goal of the recipient reaction. Secondly, to establish three teams. One is the establishment of the emergent blood donors team, and its members are the gratis donors come from many enterprises and institutions for organ donors. The other one is the establishment of selected donors team, publicizing and donating by the way of blood donors. The last one is the establishment of fixed donors team, and each blood type has a certain amount of loyalty. All of these to achieve blood source for low-risk donors. Thirdly, the process of the blood collecting and supplying is the whole progress from blood collecting extend to the clinical hospital application, including blood collecting process, the blood test process, the blood preparation and storing composition process, and blood extend process. The process quality guarantee needs to hold a series of key points above, to ensure safety of blood donors, ensure the quality of blood. Fourthly, the Jinzhou blood station establishes the process quality management system to realize the comprehensive quality management, implement a standard request, according to PDCA cycle to establish quality management system, and aware the quality consciousness of the leadership and the general staff. Each link need to be regulated by documents, write down what you should do, and do what you have written, then check that you have done, further improvement., to improve quality and service.
The preparation of the plan implementation is the establishment of the leadership group, establishing the system documentation team, and recruiting and quality management divisions. Through the internal audit and management review quality assurance plan for emergency blood collecting and supplying assessment, make continuous improvement. In the blood products garage of the blood station, the minimum cordon will be set, according to the severity of the incident. Then start preventive measures, staff in the blood-serving room notices the recruiting division and organizes the blood donors enter the station, mobilizing various departments and personnel to start the blood collecting work. The application of emergent blood collecting and supplying plan greatly alleviate the sudden blood in demand, but the aspects of laboratory testing, maintaining of the balance of supply and demand, promoting reasonable blood transfusion still should be further strengthened in and perfected.
引文
[1]徐国星.采供血机构应急预案建立的初步探讨[J].中国输血杂志,2007,20(2):163-164.
[2]高东英,梁万年,高国静,史唯唯.社会营销是无偿献血工作的理论基础和工作方法[J].中国输血杂志,2006,19(6):511-512.
[3]卫生部医政司.2006年全国血液工作会议资料汇编:郑州.2006,35-176[4]菲利普·科特勒,埃迪尤阿多·罗伯特著.社会营销——变革公共行为的方略[M].俞利军,邹丽译.北京:华夏出版社,2003,4-5.
[4]沈行峰主编.ISO 9000与血站质量管理.上海科学技术出版社,2002,30-32.
[5]毕星,翟丽.项目管理[M].上海:复旦大学出版社,2006.
[6]朱士俊.医疗质量管理发展现状及展望[J].解放军医院管理,2003,(3):204-206.
[7]吴卫星,金华.重大灾难救援和反恐怖袭击时的输血安全对策[J].中国输血杂志, 2003, 16(3):212.
[8]田兆嵩主编.临床输血学[M].北京:人民卫生出版社,1998.
[9]世界卫生组织日内瓦输血服务机构质量管理培训教员工具书[M].2002.
[10]世界卫生组织全球艾滋病项目.日内瓦安全血液和血液制品[M].1996.
[11]林俊杰主编.血站质量管理体系内部审核案例分析[M].2006.
[12]杜晓明,严振有.血站质量管理中存在的问题及相应对策[J].中国输血杂志,2004, (06):63-64.
[13]吴凯,钱开诚.对血站质量管理体系建立的几点体会[J].中国输血杂志, 2001,14(5):331.
[14]刘巧,吕运来,郭建社.做好献血者保健促进无偿献血工作[J].中国输血杂志, 2004, (5):90.
[15]陈平,邹昌新,何秉洪,陈小岭,黄小燕.血站的全面质量管理及意义的探讨[J].中国输血杂志, 2001,14(4):263.
[16]陈啸宏.继续推进无偿献血,全面加强血液管理,努力开创我国血液管理工作的新局面[J].卫生政务通报,2006,5:1-12.
[17]卫生部医政司WHO质量管理项目组.WHO输血服务机构质量管理项目培训在我国的实施及启示[J].中国输血杂志,2006,19(增刊):53-55.
[18] Therapeutic Goods Administration.The Australian code of good manufacturing practice human blood and tissues[S]. Canberra: TGA,2000.
[19]吴国桥.ISO 9000质量管理体系在血站中的应用体会[J].中国卫生经济,2004,23(4):72-73.
[20]后平钦,洪鹰,彭继红,等.建立质量监督管理体系中的难点问题与对策研究[J].中国卫生质量管理,2004,11(3):59-60.
[21]闫皓,程彦,王淑荣,王群,刘建云.突发事件应急供血的对策[J].中国输血杂志, 2006, 19(1):93.
[22]曹晓莉,李风琴,李皓.采供血机构成分制备易忽视的质量问题及相应对策[J].临床输血与检验, 2006, 8(4):341.
[23]黄菲,朱国标.重大自然灾害救援时影响输血安全的原因分析与对策[J].西部医学, 2008, 20(6):1333.
[24]郭永建,王鸿捷.更新理念,真抓实干,坚持不懈,实现血站质量管理新跨越[J].中国输血杂志, 2007, 20(6):554.
[25]赵丙全,张永善,孙艳,王玉国.无偿献血者对机采血小板献血认知、态度和行为的调查[J].中国输血杂志, 2008, 21(11):881.
[26]张新平,邱心境,孙碧玉.无偿献血的积极动机分析[J].国外医学·社会医学分册, 2002, 19(1):28-31.
[27]张清,周延风,高东英.献血者招募:从社会营销中获益[J].中国输血杂志, 2007, 20(3):179.
[28]高东英.无偿献血社会营销管理的核心理念和方法[J].中国输血杂志, 2007, 20(3):180.
[29]赵莉华,葛红卫,彭慧花,孙晓红,杨凤霞.采供血机构质量体系中可预防差错的来源分析及应对处理[J].中国输血杂志, 2003, 16(3):214.
[30]曹俊萍.血标本质量保证的重要性[J].中国输血杂志, 2004, 17(6):464.
[31]赵金光,王珍生.血液标本采集与处理是血站实验室质控的重要环节[J]. 中国输血杂志, 2003, 16(4):295.
[2]高东英,梁万年,高国静,史唯唯.社会营销是无偿献血工作的理论基础和工作方法[J].中国输血杂志,2006,19(6):511-512.
[3]卫生部医政司.2006年全国血液工作会议资料汇编:郑州.2006,35-176[4]菲利普·科特勒,埃迪尤阿多·罗伯特著.社会营销——变革公共行为的方略[M].俞利军,邹丽译.北京:华夏出版社,2003,4-5.
[4]沈行峰主编.ISO 9000与血站质量管理.上海科学技术出版社,2002,30-32.
[5]毕星,翟丽.项目管理[M].上海:复旦大学出版社,2006.
[6]朱士俊.医疗质量管理发展现状及展望[J].解放军医院管理,2003,(3):204-206.
[7]吴卫星,金华.重大灾难救援和反恐怖袭击时的输血安全对策[J].中国输血杂志, 2003, 16(3):212.
[8]田兆嵩主编.临床输血学[M].北京:人民卫生出版社,1998.
[9]世界卫生组织日内瓦输血服务机构质量管理培训教员工具书[M].2002.
[10]世界卫生组织全球艾滋病项目.日内瓦安全血液和血液制品[M].1996.
[11]林俊杰主编.血站质量管理体系内部审核案例分析[M].2006.
[12]杜晓明,严振有.血站质量管理中存在的问题及相应对策[J].中国输血杂志,2004, (06):63-64.
[13]吴凯,钱开诚.对血站质量管理体系建立的几点体会[J].中国输血杂志, 2001,14(5):331.
[14]刘巧,吕运来,郭建社.做好献血者保健促进无偿献血工作[J].中国输血杂志, 2004, (5):90.
[15]陈平,邹昌新,何秉洪,陈小岭,黄小燕.血站的全面质量管理及意义的探讨[J].中国输血杂志, 2001,14(4):263.
[16]陈啸宏.继续推进无偿献血,全面加强血液管理,努力开创我国血液管理工作的新局面[J].卫生政务通报,2006,5:1-12.
[17]卫生部医政司WHO质量管理项目组.WHO输血服务机构质量管理项目培训在我国的实施及启示[J].中国输血杂志,2006,19(增刊):53-55.
[18] Therapeutic Goods Administration.The Australian code of good manufacturing practice human blood and tissues[S]. Canberra: TGA,2000.
[19]吴国桥.ISO 9000质量管理体系在血站中的应用体会[J].中国卫生经济,2004,23(4):72-73.
[20]后平钦,洪鹰,彭继红,等.建立质量监督管理体系中的难点问题与对策研究[J].中国卫生质量管理,2004,11(3):59-60.
[21]闫皓,程彦,王淑荣,王群,刘建云.突发事件应急供血的对策[J].中国输血杂志, 2006, 19(1):93.
[22]曹晓莉,李风琴,李皓.采供血机构成分制备易忽视的质量问题及相应对策[J].临床输血与检验, 2006, 8(4):341.
[23]黄菲,朱国标.重大自然灾害救援时影响输血安全的原因分析与对策[J].西部医学, 2008, 20(6):1333.
[24]郭永建,王鸿捷.更新理念,真抓实干,坚持不懈,实现血站质量管理新跨越[J].中国输血杂志, 2007, 20(6):554.
[25]赵丙全,张永善,孙艳,王玉国.无偿献血者对机采血小板献血认知、态度和行为的调查[J].中国输血杂志, 2008, 21(11):881.
[26]张新平,邱心境,孙碧玉.无偿献血的积极动机分析[J].国外医学·社会医学分册, 2002, 19(1):28-31.
[27]张清,周延风,高东英.献血者招募:从社会营销中获益[J].中国输血杂志, 2007, 20(3):179.
[28]高东英.无偿献血社会营销管理的核心理念和方法[J].中国输血杂志, 2007, 20(3):180.
[29]赵莉华,葛红卫,彭慧花,孙晓红,杨凤霞.采供血机构质量体系中可预防差错的来源分析及应对处理[J].中国输血杂志, 2003, 16(3):214.
[30]曹俊萍.血标本质量保证的重要性[J].中国输血杂志, 2004, 17(6):464.
[31]赵金光,王珍生.血液标本采集与处理是血站实验室质控的重要环节[J]. 中国输血杂志, 2003, 16(4):295.
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