檢驗(yàn)前6項(xiàng)質(zhì)量指標(biāo)在全程檢驗(yàn)質(zhì)量管理中的作用探討

關(guān)寶杰 潘麗艷 徐建華

[摘要] 目的 監(jiān)測(cè)國(guó)家衛(wèi)生計(jì)康委下發(fā)的6項(xiàng)檢驗(yàn)前質(zhì)量控制指標(biāo)，并制定整改措施，提高標(biāo)本及檢驗(yàn)質(zhì)量。方法 回顧整理該院2017年和2018年全年檢驗(yàn)數(shù)據(jù)，統(tǒng)計(jì)分析檢驗(yàn)前6項(xiàng)質(zhì)量指標(biāo)（標(biāo)本類型錯(cuò)誤率、容器錯(cuò)誤率、采集量錯(cuò)誤率、抗凝標(biāo)本凝集率，溶血率、血培養(yǎng)污染率），并針對(duì)不合格原因制定改進(jìn)措施。結(jié)果 2017全年標(biāo)本數(shù)為581 990例，其中不合格標(biāo)本820例，不合格率為14.1/萬(wàn)例，2018全年標(biāo)本數(shù)為696 161例，不合格標(biāo)本481例，不合格率為6.9/萬(wàn)例，不合格率明顯降低，二者統(tǒng)計(jì)學(xué)差異有統(tǒng)計(jì)學(xué)意義（P<0.05），與2017年比較，檢驗(yàn)前6項(xiàng)質(zhì)量指標(biāo)率均有下降，其中標(biāo)本類型錯(cuò)誤率、采集量錯(cuò)誤率降低明顯，兩者差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 檢驗(yàn)科通過(guò)檢測(cè)質(zhì)量指標(biāo)并制定有效整改措施，使得檢驗(yàn)標(biāo)本不合格率明顯降低，提升了檢驗(yàn)標(biāo)本質(zhì)量，保證了檢驗(yàn)結(jié)果的可靠性。

[關(guān)鍵詞] 標(biāo)本;檢驗(yàn)前質(zhì)量控制;質(zhì)量指標(biāo);檢驗(yàn)質(zhì)量

[中圖分類號(hào)] R446 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1672-5654（2019）12（a）-0003-03

Discussion on the Role of the First Six Quality Indicators in the Quality Inspection of the Whole Process Inspection

GUAN Bao-jie， PAN Li-yan， XU Jian-hua

Department of Clinical Laboratory， General Hospital of FAW， Changchun， Jilin Province， 130012 China

[Abstract] Objective To monitor the six pre-inspection quality control indicators issued by the National Health and Family Planning Commission， and to formulate rectification measures to improve the quality of specimens and inspections. Methods Review and review the annual test data of the hospital in 2017 and 2018， and statistically analyze the first six test quality indicators （sample type error rate， container error rate， collection error rate， anticoagulation specimen agglutination rate， hemolysis rate， blood culture pollution rate） and develop improvement measures for the reasons for non-conformity. Results The number of specimens in 2017 was 581 990 cases， of which 820 were unqualified specimens， the unqualified rate was 14.1/10，000， the number of specimens in 2018 was 696 161， and 481 were unqualified specimens. The unqualified rate was 6.9/10，000. For example， the rate of disqualification was significantly reduced， and the statistical difference between the two was significant（P<0.05）. Compared with 2017， the rate of the six quality indicators before the test decreased， and the error rate of the sample type and the error rate of the collected amount decreased significantly. The difference between the two was statistically significant（P<0.05）. Conclusion By testing the quality indicators and formulating effective rectification measures， the laboratory has significantly reduced the unqualified rate of the test specimens， improved the quality of the test specimens， and ensured the reliability of the test results.

[Key words] Specimen; Pre-test quality control; Quality indicators; Inspection quality

檢驗(yàn)標(biāo)本的質(zhì)量是影響檢驗(yàn)結(jié)果準(zhǔn)確性和可靠性的重要因素，不正確的檢驗(yàn)結(jié)果可能導(dǎo)致醫(yī)療資源浪費(fèi)甚至錯(cuò)誤的治療而威脅患者生命。檢驗(yàn)標(biāo)本質(zhì)量主要取決于檢驗(yàn)前多個(gè)環(huán)節(jié)的有效把控。檢驗(yàn)前過(guò)程包括醫(yī)生根據(jù)患者情況選擇檢驗(yàn)項(xiàng)目，患者檢驗(yàn)前準(zhǔn)備，醫(yī)護(hù)人員采集樣本，樣本運(yùn)送至檢驗(yàn)科，檢驗(yàn)前處理等多個(gè)環(huán)節(jié)，是臨床檢驗(yàn)全程質(zhì)量控制中最關(guān)鍵性的環(huán)節(jié)，也是檢驗(yàn)質(zhì)量控制的難點(diǎn)和薄弱點(diǎn)。研究發(fā)現(xiàn)檢驗(yàn)前差錯(cuò)占檢驗(yàn)差錯(cuò)的46.0%～68.2%，甚至更高，有數(shù)據(jù)統(tǒng)計(jì)可高達(dá)71%[1-3]。能夠識(shí)別并控制檢驗(yàn)前風(fēng)險(xiǎn)，也是實(shí)驗(yàn)室提升檢驗(yàn)質(zhì)量管理的重要內(nèi)容。該科室在2017年通過(guò)監(jiān)測(cè)國(guó)家衛(wèi)生健康委下發(fā)的質(zhì)量指標(biāo)，在年終對(duì)監(jiān)測(cè)數(shù)據(jù)進(jìn)行整理分析，并針對(duì)薄弱環(huán)節(jié)制定了相應(yīng)的改進(jìn)措施，結(jié)果顯示2018年全年檢驗(yàn)前6項(xiàng)質(zhì)量指標(biāo)不合格率明顯降低，檢驗(yàn)質(zhì)量得到改善，現(xiàn)報(bào)道如下。