檢驗前6項質量指標在全程檢驗質量管理中的作用探討

關寶杰 潘麗艷 徐建華

[摘要] 目的 監測國家衛生計康委下發的6項檢驗前質量控制指標，并制定整改措施，提高標本及檢驗質量。方法 回顧整理該院2017年和2018年全年檢驗數據，統計分析檢驗前6項質量指標（標本類型錯誤率、容器錯誤率、采集量錯誤率、抗凝標本凝集率，溶血率、血培養污染率），并針對不合格原因制定改進措施。結果 2017全年標本數為581 990例，其中不合格標本820例，不合格率為14.1/萬例，2018全年標本數為696 161例，不合格標本481例，不合格率為6.9/萬例，不合格率明顯降低，二者統計學差異有統計學意義（P<0.05），與2017年比較，檢驗前6項質量指標率均有下降，其中標本類型錯誤率、采集量錯誤率降低明顯，兩者差異有統計學意義（P<0.05）。結論 檢驗科通過檢測質量指標并制定有效整改措施，使得檢驗標本不合格率明顯降低，提升了檢驗標本質量，保證了檢驗結果的可靠性。

[關鍵詞] 標本;檢驗前質量控制;質量指標;檢驗質量

[中圖分類號] R446 [文獻標識碼] A [文章編號] 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

檢驗標本的質量是影響檢驗結果準確性和可靠性的重要因素，不正確的檢驗結果可能導致醫療資源浪費甚至錯誤的治療而威脅患者生命。檢驗標本質量主要取決于檢驗前多個環節的有效把控。檢驗前過程包括醫生根據患者情況選擇檢驗項目，患者檢驗前準備，醫護人員采集樣本，樣本運送至檢驗科，檢驗前處理等多個環節，是臨床檢驗全程質量控制中最關鍵性的環節，也是檢驗質量控制的難點和薄弱點。研究發現檢驗前差錯占檢驗差錯的46.0%～68.2%，甚至更高，有數據統計可高達71%[1-3]。能夠識別并控制檢驗前風險，也是實驗室提升檢驗質量管理的重要內容。該科室在2017年通過監測國家衛生健康委下發的質量指標，在年終對監測數據進行整理分析，并針對薄弱環節制定了相應的改進措施，結果顯示2018年全年檢驗前6項質量指標不合格率明顯降低，檢驗質量得到改善，現報道如下。