بررسی رضایت در کارکنان بیمارستان های عمومی درگیر در انتقال خون: پیاده سازی استاندارد ایزو 9001: 2000

As part of its policy of constant quality improvement, Etablissement Français du Sang (EFS) des Pays de la Loire (Pays de la Loire Regional blood transfusion institution) carried out a satisfaction survey among the hospital personnel involved in prescribing and using immuno-hematological tests and labile blood products. The polling tool selected by agreement between the hospital management and quality assurance department was a questionnaire that permitted item rating and free commentary. It addressed the personnel’s perception of the quality of erythrocyte immuno-hematological (EIH) testing and of the products administered, as well as their perception of the quality of communications with the local EFS. The questionnaire was sent to 26 physicians and 32 senior nurses in 15 hospital departments. The reply rate was 60% and expressed a 85% overall satisfaction level. Dissatisfaction causes were more specifically analysed, the main one involving labile blood product distribution in emergency situations. A joint undertaking by the EFS and the hospital led to the implementation of corrective measures, including the writing and implementation of a common standard operating procedure for emergency transfusion management. The results obtained demonstrated the feasibility of this type of survey and the interest, to a blood transfusion centre and the hospital personnel involved in transfusion, of assessing their very own perception of service quality.

Quality assurance (QA) has been imposed on French blood transfusion Centres (BTC) by the laws of 4 January 1993 on the safety of drugs and blood transfusion [1] and of 1 July 1998 on the reinforcement of the health vigilance and of the control of health safety of products destined for human use [2]. These laws are furthered by a binding regulation consisting of good transfusional practices [3], [4], [5], [6] and [7] whose application is regularly controlled through Afssaps inspections (Agence française de sécurité sanitaire des produits de santé, French Agency for the safety of health products). The approach can also refer to outside organisational references such as the ISO 9000 standards [8] and [9]. As early as 2000, Établissement français du sang pays de la Loire (EFS PL), one of the 18 BTC of the French Blood Institution, opted for the ISO 9001:2000 standard [10] and was granted that certification in July 2001 for all its activities and all its sites. To meet one of the requirements of the standard, EFS PL in 2001 assessed the satisfaction level of hospital personnel involved in transfusion (physicians and nurses) on one of its sites. This article reports and discusses the results from that survey.

The questionnaire return rate was 60% (N =36/58) after two telephone reminders done over six weeks. Each of the 15 prescribing departments, i.e. all those approached, returned at least one questionnaire. The replies came from physicians for 37% (N =13), from nursing personnel (senior or rank) for 51% (n = 18) and 8% (N =3) were common to physicians and nurses. Those mixed replies were eventually considered as coming from physicians (two replies from the biology laboratory, not involved in transfusion, were counted separately). In total, the response rate from physicians was 62% and 58% from nurses. Thirty-five replies included a filled-out questionnaire, i.e. 97% of useable replies. One out of 36 replies (coming from the HMC chairman) included only a free comment. Sixteen replies (44%) had a free commentary associated with the questionnaire. Those replies came from prescribing physicians for one half and from nursing staff for the other. As regards the immunohaematological laboratory, Fig. 1 shows that 89% of responders were satisfied (61%) or highly satisfied (28%) with the test result delivery times. These were considered as average or even poor by 11% of users (replies from Emergency-resuscitation and Gastro-enterology Departments). Test result quality was perceived as satisfactory (41%) or highly satisfactory (56%) in 97% of replies, one reporting quality as average (from the person in charge of the Biology Laboratory). Free commentaries on EIH testing essentially addressed the relative distance of the EFS site from departments (building outside of hospital; five remarks) and the disruptions caused by specimen identification problems (1 remark).About the LBP Dispatching Department, 87% of responders perceived delivery times as satisfactory (53%) or highly satisfactory (34%), and 13% perceived them as average or poor. The average or poor ratings came from Emergency-resuscitation, Anaesthesiology, Gastroenterology and Paediatrics Departments. Delivery compliance with demand was assessed as satisfactory or highly satisfactory by 88%, average to poor by 12% (Fig. 2). Unsatisfied departments were the Emergency-resuscitation Department and the Oncohaematology day Hospital. Product quality was assessed as satisfactory by 45% of responders and as highly satisfactory by 55%. It is worth noting that two physicians did not reply to that item and one raised the issue of the relevancy of quality assessment for products issued by the EFS.