检验护理品管圈在降低血液样本异常率中的应用研究

An Application Research of Quality Control Circle in Both Laboratory Medicine Department and Nursing Department in Reducing Abnormal Blood Specimen Rate

目的运用QCC手法降低血液样本异常率,以减少分析前错误对检验结果的影响。方法对近2年的异常血液样本进行统计分析,对比检验科与护理部组建品管圈(QCC)前后的异常指标的改善,验证QCC手法及改善措施的有效性。结果 820844支血液样本中异常样本为2581支,按血液样本异常原因占比从高到低排序,前五位为:溶血(37.27%)、凝固(33.90%)、样本量不足(13.29%)、容器错误(5. 97%)、脂血(4.49%),其次为样本类型错误(2. 17%)、输液同侧采血(0. 81%)、条码错误(0. 70%)及其他错误(1. 40%);血液样本异常率按来源从高到低排序,依次为:新生儿科(2. 83%,3.5 sigma)、急诊科(0.64%,4.0 sigma)、ICU(0.51%,4.1 sigma),外科(0.48%,4.1 sigma)、妇产科(0.44%,4.2 sigma)、内科(0.39%,4.2 sigma)、体检中心(0.20%,4. 4 sigma)、门诊部(0.06%,4. 8 sigma); QCC实施前血液样本异常率为0.40%(4.2 sigma),实施后下降到0.26%(4.3 sigma),改善幅度为35%。结论 人为因素是引起血液样本异常的主要因素,运用QCC手法,检验与护理进行跨部门协作可有效降低血液样本异常率。

Objective To decrease abnormal blood specimen rate by quality control circle method,so to reduce the adverse effect of pre- analytical specimen errors on results. Methods The statistical analysis of abnormal blood specimens for recent 2 years was conducted and then estimated the abnormal blood specimens improvement before and after the establishment of Quality Control Circle (QCC)in both laboratory medicine department and nursing department,so to validate the effectiveness of QCC method for improvement. Results 2581 abnormal samples were found in 820844 blood samples,in which the proportion of top five causes of abnormal blood specimens ranking from high to low were: hemolysis (37.27%),coagulation (33.90%),insufficient volume (13.29%),container errors (5.97%),and lipemia (4.49%),followed by sample type errors (2.17%),transfusion contamination (0.81%),barcode errors (0.70%)and other errors (1.40%).The source for abnormal blood specimen rate ranking from high to low were as follows: department of pediatrics (2.83%,3.5 sigma),emergency department (0.64%,4.0 sigma),ICU (0.51%,4.1 sigma),surgery department (0.48%,4.2 sigma),obstetrics and gynecology department (0.44%,4.2 sigma),internal medicine department (0.39%,4.2 sigma),physical examination center (0.20%,4.4 sigma),and outpatient department (0.06%,4.8 sigma);The abnormal blood specimens rate was 0.40%(4.2 sigma)before QCC,and decreased to 0.26%(4.3 sigma)after QCC,with an improvement rate of 35%. Conclusion Human mistakes are the main factors causing abnormal blood specimen.Making good use of QCC method and promoting collaboration between laboratory medicine department and nursing department can effectively reduce the abnormal rate of blood samples.