tracking hematology qc with a concise visual display.
The normal magnetic scheduling board integrates the test results together and keeps them in a clearly visible position for easy evaluation.
Coordinating and comparing the quality control of multiple CBCanalyzer is not an easy task.
There are three such analyzers in our large university hospitals, located in regular, Stat, and outpatient clinics, respectively.
The combined QC program generates a lot of data.
Although a large amount of paperwork is necessary for documentation, it cannot be managed.
If there is no operation, most of this available material cannot be used at all.
Our blood department has been doing quality control work.
We developed procedures for all the tests and implemented a formal training program for new employees.
We looked into the unusual results and formed a top team.
Trouble Shooting procedures for Gap instruments.
The QC program produces accurate and repeatable results, but we cannot process the data efficiently.
Most of the data collected dust and barely accelerated the pace of the dayto-day routine.
What we need is a quality control plan that is effective for us, not a plan that is bad for us.
It is particularly difficult to explain CBC quality control data.
Lack of standards;
The same is true for any extended stability of commercial controls.
Some laboratories favor commercial whole blood control verifiers for quality control.
Other moving averages (Bell\' salgorithm-XB)
The RBC Index of consecutive patients was monitored.
Somelabs periodically retested patient specimens and used them as a second control to check the accuracy and accuracy of the day.
There are also some people on international relations.
Instrument comparison or reference method for checking instrument performance.
It is not uncommon to use two or more methods. A three-level check (
Normal, abnormal high, abnormal low)on aneight-parameter CBC (
Monitoring of white blood cells, red blood cells, HGB, HCT, MCV, maternal and child health care, maternal and child health hospital)
A total of 24 inspections per analyzer.
Since we recently introduced our thirdanalyzer, the current statistics are 72 QC checks.
The automatically generated XB analysis on a larger machine adds three to six checks.
Depending on the number of parameters being monitored, the comparison between instruments increases at least five inspections of the analyzer.
Frustration and wasted time ultimately power the system.
Whenever we have QC questions or questions, I will extract the necessary reports, look carefully at the results, and prepare detailed charts to track the performance of the analyzer.
In a particularly difficult week, I may repeat the process two or three times and repeat the previous work.
However, there seems to be no easy way to draw these charts-
Selected from computers and various manual records-
Keep up with the times without creating more paper and work.
Recalibrating requires checking the data in several QC logs, scanning the 30 to 40 pages of the QC computer print out, and reviewing the one to two weeks of the XB print out.
It is very irritating to invest over and over again.
The notes and charts I seem to be doing forever inspire me to find a way to summarize the \"sqc data\" section on a regular basis.
The trick is to find a system that allows me to study the results of all QC methods for all our CBC instruments at the same time.
The solution is in front of me. -
At least for now: An magnetic dispatching board.
I got a 24x36-
Inch plate with 1-
Inch square of four vertical parts-
QC data on each cbc analyzer and one
I write on a magnetic chip with a washable marker and release new data on a regular basis.
Chips of various shapes and colors visually distinguish the type of data recorded.
The type and frequency of information I posted are recorded in Table 1.
Details from the Hematology QC summary board are shown in Figure 1.
Title COUP, FAST, and STP are the computer code names we use in the three CBC analyzers.
We publish data in chronological order using dark-
The blue square marked \"Start\" indicates an expired post.
When a column reaches the bottom of the board, we go back to the top of that column.
Since some columns are filled faster than others, we use the \"start\" magnet to zero in our recent results.
I also skipped a line to provide a demarcation point for fault safety.
A circular magnet represents a time frame for publishing data. We uselight-
The green squares and circles of the data of XB;
The pale blue weeklyFAST is compared to the blind repetition of the coup;
Light pink for STPvs every week.
Comparison of fast blind weight;
White rectangle and circle for commercial control data.
There is also a post: dark-
A pink magnet representing the instrument\'s re-calibration (Recal).
Because the recalibration of any instrument can affect the protocol between quality control data or blind samples, it must be recorded.
Today\'s CBC analyzer is re-calibrated every quarter.
The board is ready to remind us of any development trends that may indicate the need for recalibration.
* One size fits all.
We can easily determine the value to be released by using a weekly computer print output, including the calculated mean of our qc results and the manufacturer\'s analytical mean and acceptable range, we enter the computer for the control of each new batch number.
Below is a summary of the data shown in Figure 1.
The first post in the coup area was business control data for the week of July 4 by the laboratory department. 11, 1989. (
We released the findings on Tuesday. )
Average white blood cells in the control group (L)
Exactly match the manufacturer\'s analytical average (L = 0).
Our average (N)was 0.
1 higher than the analysis average (N = +0. 1).
A high level of means (H)was 0.
Assaymean, manufacturer of month ratio (H = +0. 7)--
The white blood cell count at this level is about 28,000.
The XB data is the second post in the coup section.
This shows an average difference between the mean of several parameters in the 400 patient sample and the target value. (
We call these 20 batches of 20 samples \"20-20 report. \")
When the specimen No. 20 (
20 batches in a row)
Through the analyzer, the computer screen flashes a signal indicating the technician to print the report, including all calculations for the batch and the first 19 batches.
Since the analyzer does not provide cumulative data, we calculated by hand 20-
About 20 reports in five minutes.
We processed 400 samples in two or three days and at 20-
There are 20 reports on hand.
Anything the manufacturer thinks is less than 3 different from the target value is acceptable.
However, based on our experience, troubleshoot--
And possibly recalibrated-
When more than two consecutive targets exceed 1 to 2, 20-20batches.
A simple calculation of the mchc xb data converts the percentage difference in the target value to the actual average MCHC.
This switch to a closely monitored index adds a bit of reality.
Although the analyzer provides data for this RBC index, I have not released the XB data table just because of the lack of space.
I did check 20-
However, it is still necessary to report and file it.
The data under FAST and STP presents the same type of information, although the way we handle the data of the STP is slightly different.
Since the CBC workload in the clinic is still somewhat low, it will take two weeks to accumulate 20 batches of the necessary 20 samples.
To keep the data as up-to-date as possible, we generated a report on Friday (
Many batches have been processed, however)
The circular magnet under STP displays the date of the release of theXB and specifies the number of batches.
Maybe a week (N =10); the next, (N = 13).
Note that the COUP, FAST, and STP data are independent.
Nevertheless, we found that comparing the commercial control data for the same time period helps us to evaluate the instrument calibration.
The second release under STP records the recalibration completed by HGB on the 11 th of the month (7/11).
This is just a good question.
The hemoglobin parameters are adjusted according to slightly lower XB and commercial control values.
Indeed, the variation is only 0. 1--
The analyzer in the clinic is almost branded. new--
But we would like to see agreement on these instruments.
The first article under comparison gives the blind repeated comparison results of our two CBC analyzers-
In the coup of the main laboratory of Stat labs ---
From 89 on July 3-19.
The information of the comparison comes directly from the computer quality control report.
The QC function in our computer will define blind duplicate data files by using patient samples as a \"control.
\"Because the computer compares only two instruments at a time, it is necessary to evaluate all the analyzers to run separate blind copiers and compare them themselves.
So we chose the random patient sample that was originally tested on COUP, re-tested on FAST, and compared the results.
From Monday to Friday, we took three samples at the Stat lab and sent them to the fast analyzer for mainlab.
The technician re-tested the specimen and filed the results.
Next Monday, I calculated the average difference of 15 control samples for each parameter and posted my findings on the blackboard.
As shown in the white blood cell column under the comparison in figure 1, FASTanalyzer has an average of 0. 1(K)
Blind repeat samples initially tested in the coup were low.
The average difference in RBC is-0. 03M.
I chose the CBC analyzer of the main laboratory as a reference instrument at will.
Therefore, the difference is represented by FASTanalyzer.
Although posting shows a fast average of 0.
This is all just an explanation for RBC, since the mean value of RBC is also 0.
03 metres faster.
To save space, instead of posting two values, I post the difference in the values.
Comparison of platelet count--The last column--
All other blind repeat values are represented by absolute numbers.
The flexibility of our computers allows us to do this.
Since the platelet count may reach 1 million or more, it is unrealistic to expect the results of the random sample to be agreed within 10.
A percentage gives us a better idea of what\'s really happening.
The second article under comparison compares the blind duplexers tested on STP and fast analyzers.
Use two magnets of different colors
The comparison of instruments makes it easier to view the data.
The position of the starting magnet in the comparison section illustrates the way we wrap the data on the board to maintain the chronological order of the results.
I posted a recalibrate (
\"Recal\" on the magnet \")
In this column and in the section that represents the value of the analytical procedure being evaluated.
This duplication makes it easier and faster to view information.
Otherwise, I have to scan the previous column for possible recalibrations before I evaluate the contrast correctly.
Of course, this article must determine which analyzers have been recalibrated. * Not a cure-all.
Although my summary board saves a lot of time, it is not a solution for QC.
All: it cannot make effective quality control decisions by itself.
However, it does help me to make my own decisions more effectively.
I have been using it for more than four years and I like it.
In fact, when we started building the lin lab, one of my first official actions was to order a larger magnetic board to accommodate data from the third CBC analyzer.
That was a few months ago, and the board accepted the addition with little fuss.
This is the advantage of this system: you can add another column at any time if you need it-
If you have enough space to buy a ragplate
Maintenance is minimal once the board is established ---
But you must be diligent.
I update the board at least three times a week.
View new data and publish data for no more than 10 minutes.
It must have been a good time.
The Board of Directors provides continuous, upwardto-
The increase of CBC monitoring was greatly reduced.
As far as I am concerned, I like to make it clear at a glance by simply raising my head from my desk to allow a large amount of previously unmanageable data.
I call the board \"armchair quality control\" and expect it to decorate my office for a long time. [
Omitted table data