抗凝血液标本不合格原因分析及应对措施

Reasons for unqualified anticoagulant samples and countermeasures

目的 动态分析血液组2016-2018年标本不合格率及产生原因,降低不合格率,保证分析前质量控制,为制订改进措施提供依据。方法 统计该实验室血液组2016-2018年不合格抗凝血液标本总数,并进行原因分析,动态观察3年来在实验室采取分析前标本质量管理措施下不合格率的变化。结果 2016年不合格标本共3 484份,不合格率为7.45‰;2017年不合格标本共3 007份,不合格率为6.30‰,较2016年降低 1.15 ‰;2018年不合格标本共2 839份,不合格率为5.55 ‰,较2017年降低0.75‰。连续3年标本不合格原因分布前3位均为标本凝血、采血量不足和条码未执行,临床科室不合格率占前3位的均为新生儿科、重症监护病房、心外科,其中新生儿科连续3年标本不合格率比较,差异有统计学意义(χ 2=50.917, P =0.000)。结论 实验室应建立控制标本不合格率的制度,不断与临床医护人员沟通,对医护人员及送服人员进行岗前培训,确保分析前标本质量控制。

Objective To dynamically analyze the unqualified rate and causes of blood samples from 2016 to 2018,to reduce the unqualified rate,to ensure the quality control before analysis,and to provide the basis for formulating improvement measures. Methods The total number of unqualified anticoagulant samples in the blood group of the laboratory from 2016 to 2018 was counted,and the causes were analyzed.The change of unqualified rate under the quality control measures of samples before analysis was observed dynamically in the laboratory in the past three years. Results In 2016,there were 3 484 unqualified specimens,the unqualified rate was 7.45‰.There were 3 007 unqualified specimens in 2017,the unqualified rate was 6.30‰,which was 1.15‰ lower than that in 2016.There were 2 839 unqualified specimens in 2018,the unqualified rate was 5.55‰,which was 0.75‰ lower than that in 2017.The top three reasons for the unqualified samples were coagulation,insufficient blood collection and non-execution of barcode.The top three unqualified samples in clinical departments were neonatal department,intensive care unit and cardiac surgery.There was significant difference in the unqualified samples in neonatal department for three consecutive years (χ 2=50.917, P = 0.000 ). Conclusion Laboratories should set up a system to control the unqualified rate of specimens,communicate with clinical doctors and nurses constantly,train medical staff and service personnel before work,and ensure the quality control of pre-analysis specimens.