Corl Dawn E, Yin Tom S, Hoofnagle Andrew N, Whitney Joanne D, Hirsch Irl B, Wisse Brent E
Harborview Medical Center.
J Healthc Qual. 2012 Jul-Aug;34(4):24-32. doi: 10.1111/j.1945-1474.2012.00149.x.
Analyze the effectiveness of mandated point-of-care (POC) blood glucose (BG) meter quality control (QC) testing. All POC BG QC tests were analyzed to evaluate operator and strip/meter error rates and institutional cost. POC BG QC test failure (17/103,580 over 24 months) was low and no meters failed subsequent linearity testing. Examining individual QC measures shows that operator error occurs frequently and total error rate is related to QC familiarity (>50 QC tests/month, 2.4%; <50 QC tests/month, 3.8%, p < .001). Even among the most competent operators, strip/meter error (1.2 ± 0.3%) accounted for 50% of total error. Compared with manufacturer-recommended QC testing, Joint Commission mandated POC BG QC testing during 2008/2009 incurred excess costs of approximately US$127,000. POC BG meter failure within current guidelines is rare and does not justify the cost of daily QC testing. Frequent QC testing can identify operators needing retraining in POC testing. Strip/meter QC errors are common, are not prevented by current QC testing standards, and may contribute to clinical errors.
分析强制即时(POC)血糖仪质量控制(QC)检测的有效性。对所有POC血糖质量控制检测进行分析,以评估操作人员和试纸/血糖仪的错误率以及机构成本。POC血糖质量控制检测失败率较低(24个月内17/103,580),且没有血糖仪在后续线性测试中失败。对各项质量控制指标的检查表明,操作人员失误频繁发生,总错误率与质量控制的熟悉程度有关(每月>50次质量控制检测,2.4%;每月<50次质量控制检测,3.8%,p<0.001)。即使在最有能力的操作人员中,试纸/血糖仪错误(1.2±0.3%)也占总错误的50%。与制造商推荐的质量控制检测相比,联合委员会在2008/2009年强制进行的POC血糖质量控制检测产生了约12.7万美元的额外成本。在当前指南范围内,POC血糖仪出现故障的情况很少见,每日质量控制检测的成本并不合理。频繁的质量控制检测可以识别需要接受POC检测再培训的操作人员。试纸/血糖仪的质量控制错误很常见,当前的质量控制检测标准无法预防,且可能导致临床错误。