检验医学 ›› 2017, Vol. 32 ›› Issue (11): 958-961.DOI: 10.3969/j.issn.1673-8640.2017.011.004

• 泌尿系统疾病实验诊断项目风险管理专题 • 上一篇    下一篇

慢性肾脏疾病生化检测项目的风险评估

王璐, 李汉华, 张敏, 赵美芸, 蔡慧萍, 李智, 钱朵朵, 吴亚洲   

  1. 同济大学附属杨浦医院检验科,上海 200090
  • 收稿日期:2016-08-02 出版日期:2017-11-30 发布日期:2017-12-07
  • 作者简介:null

    作者简介:王 璐,男,1979年生,硕士,主管技师,主要从事临床生化检验工作。

  • 基金资助:
    同济大学附属杨浦医院院级课题(Se1201524)

Risk assessment of biochemical determinations for chronic kidney diseases

WANG Lu, LI Hanhua, ZHANG Min, ZHAO Meiyun, CAI Huiping, LI Zhi, QIAN Duoduo, WU Yazhou   

  1. Department of Clinical Laboratory,Yangpu Hospital,Tongji University,Shanghai 200090,China
  • Received:2016-08-02 Online:2017-11-30 Published:2017-12-07

摘要:

目的 降低影响慢性肾脏疾病生化项目[血清肌酐(Cr)、尿素氮(BUN)、尿酸(UA)、胱抑素C(Cys C)]检测质量的风险,保证检验结果的准确性。方法 采用故障模式影响分析(FMEA)方法识别风险点,由4名有5年以上临床化学检验工作经验的资深检验工作人员与4名在职生化组工作人员完成,采用品管圈的方法,找出造成风险的主要原因并拟定对策进行整改,最后进行效果确认。结果 影响Cr、BUN、UA检测结果准确性的风险主要为患者准备不当,影响血清Cys C检测结果准确性的风险主要为检测方法。针对此2点风险通过品管圈方法找出要因并拟定对策,加强对患者的宣教和医护人员检验分析前注意事项的培训,同时更换性能更优的Cys C检测试剂。肾内科患者肾功能生化检测项目复检率由整改前的0.98%下降至整改后的0.13%。结论 对慢性肾脏疾病生化检测项目实施风险评估可以识别影响检验质量的潜在风险,拟定相应的对策可以降低医疗事故发生的概率,提高检验结果的准确性。

关键词: 慢性肾脏疾病, 故障模式与影响分析, 品管圈

Abstract:

Objective To decrease the risks of biochemical determinations [serum creatinine(Cr),blood urea nitrogen(BUN),uric acid(UA) and cystatin C(Cys C)] for chronic kidney diseases,in order to maintain the accuracy of determinations. Methods Failure mode and effect analysis(FMEA) was used to identify risk points,and 4 staffs and 4 experienced staffs(above 5-year experience) estimated these identified risk points. Quality control circle was used to analyze the main factors for these risk points and take related measures. Results The main cause for serum Cr,BUN and UA was inappropriate preparation of patients. However,for Cys C,the main cause was determination method. By quality control circle,strengthening communication with patients,selecting Cys C reagents with optimal performance and emphasizing the standard operating procedure of pre-analytical process for staffs were 3 strategies for improvement. The review rate of biochemical determinations for chronic kidney diseases decreased from 0.98% to 0.13%. Conclusions The application of risk assessment could identify the potential risks for determination quality. The relevant strategies could decrease the probability of malpractice. Meanwhile,it could increase the accuracy of determinations.

Key words: Chronic kidney diseases, Failure mode and effect analysis, Quality control circle

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