台灣地區衛生所臨床檢驗品質保證之研究

目的：探討各衛生所臨床檢驗之品質現況並促進臨床血液、生化及尿液檢驗之品質保證。材料及方法：行政院衛生署委託中華民國醫事檢驗學會，負責執行八十七年度台灣地區衛生所臨床檢驗品質測試，執行期限為民國八十六年七月一日至民國八十七年六月三十日。總計有211家衛生所參與。內容包括：(一)舉辦輔導作業說明會，以利輔導原則、方法及技巧之傳授。(二)舉辦人員持續教育，以利檢驗品質之提升。(三)舉辦精練度測試，以瞭解各單位之品質現況。結果：尿液化學檢查、尿液HCG驗孕檢查、血液組及生化組檢查之回收率分別為73.0%、60.2%、56.9%及85.3%。各組及格成績的標準為80分，及格率分別為尿液化學檢查92.2%、尿液HCG驗孕檢查95.2%、血液組55.9%及生化組66.7%。尿沈渣檢查結果普遍不理想，僅供參考用，未列入結果之評定。血液組的成績不佳，部份儀器測得的結果不甚理想，低於60分者佔30.8%。生化組之成績亦不理想，其中cholesterol及urea nitrogen的及格率只有43.0%及53.9%。結論：由整體評估看來，衛生所尿沈渣、血液及生化檢驗能力之改善及提升為當務之急。由臨床檢驗精練度測試可看出各單位之檢驗能力，因此精練度測試及人員再教育之持續舉辦，應有必要。如此將可提升衛生所檢驗品質，促使品保績效較差的單位有所改善，以確保民眾之健康福祉。

關鍵字

品質保證；持續教育；精練度測試；及格率

並列摘要

Objective: To investigate the quality of clinical laboratory assessments and to promote quality assurance (QA) in the fields of clinical hematology, clinical chemistry and urinalysis. Materials and Methods: The National Health Administration, Taiwan ROC, assigned the execution of a QA survey program for clinical laboratories of the Bureau of Public Health in Taiwan to the Association of Laboratory Medicine from July 1997 to June 1998. A total of 211 clinical laboratories were included in the program. A meeting was held to help the directors understand the principles, methods and techniques of guidance. Two symposiums for continuing education on QA were held before the proficiency testing. Results: The response rates for proficiency testing for urine chemical tests, urine HCG pregnancy test, clinical hematology and clinical chemistry were 73.0%, 60.2%, 56.9% and 85.3%, respectively. The criteria for acceptance for urine chemical tests, urine HCG pregnancy test, clinical hematology and clinical chemistry were all set as a score above 80 and the acceptable rates in these fields were 92.2%, 95.2%, 55.9% and 66.7%, respectively. Due to wide distribution of data, the results of urine sediment tests were not evaluated. The scores for proficiency testing for clinical hematology were poor. Scores below 60 were recorded in 30.8% of clinical laboratories. Proficiency testing scores for clinical chemistry were also poor. The acceptable rates for cholesterol and urea nitrogen were only 43.0% and 53.9%. Conclusion: The results of this study show that the level of QA in urine sediment tests, clinical hematology and clinical chemistry must be improved immediately. Laboratories with poor QA performance need to identify problems quickly and enhance technical training to improve their quality. A QA program may be used to assess laboratories’ ability to perform tests competently. Therefore, it will be worthwhile to continue proficiency testing schemes and reeducation.

並列關鍵字

quality assurance ； continuing education ； proficiency testing ； acceptable rate

國際替代計量

台灣地區衛生所臨床檢驗品質保證之研究

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