检验前6项质量指标在全程检验质量管理中的作用探讨

关宝杰 潘丽艳 徐建华

[摘要] 目的 监测国家卫生计康委下发的6项检验前质量控制指标，并制定整改措施，提高标本及检验质量。方法 回顾整理该院2017年和2018年全年检验数据，统计分析检验前6项质量指标（标本类型错误率、容器错误率、采集量错误率、抗凝标本凝集率，溶血率、血培养污染率），并针对不合格原因制定改进措施。结果 2017全年标本数为581 990例，其中不合格标本820例，不合格率为14.1/万例，2018全年标本数为696 161例，不合格标本481例，不合格率为6.9/万例，不合格率明显降低，二者统计学差异有统计学意义（P<0.05），与2017年比较，检验前6项质量指标率均有下降，其中标本类型错误率、采集量错误率降低明显，两者差异有统计学意义（P<0.05）。结论 检验科通过检测质量指标并制定有效整改措施，使得检验标本不合格率明显降低，提升了检验标本质量，保证了检验结果的可靠性。

[关键词] 标本;检验前质量控制;质量指标;检验质量

[中图分类号] R446 [文献标识码] A [文章编号] 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

檢验标本的质量是影响检验结果准确性和可靠性的重要因素，不正确的检验结果可能导致医疗资源浪费甚至错误的治疗而威胁患者生命。检验标本质量主要取决于检验前多个环节的有效把控。检验前过程包括医生根据患者情况选择检验项目，患者检验前准备，医护人员采集样本，样本运送至检验科，检验前处理等多个环节，是临床检验全程质量控制中最关键性的环节，也是检验质量控制的难点和薄弱点。研究发现检验前差错占检验差错的46.0%～68.2%，甚至更高，有数据统计可高达71%[1-3]。能够识别并控制检验前风险，也是实验室提升检验质量管理的重要内容。该科室在2017年通过监测国家卫生健康委下发的质量指标，在年终对监测数据进行整理分析，并针对薄弱环节制定了相应的改进措施，结果显示2018年全年检验前6项质量指标不合格率明显降低，检验质量得到改善，现报道如下。