• Title/Summary/Keyword: Westgard Multi-Rules

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Efficient Application of Westgard Multi-Rules and Quality Control Implementation Improvement (Westgard Multi-Rules의 효율적 적용과 조치사항의 개선)

  • Jung, Heung Soo;Oh, Youn Jung;Bae, Jin Soo;Baek, Jin Young;Hwang, Bo ra;Shin, Yong Hwan
    • The Korean Journal of Nuclear Medicine Technology
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    • v.21 no.1
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    • pp.60-64
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    • 2017
  • Purpose Westgard multi-rules application based on test quality improvement and commercialized international standard has been widely used in quality control. However, it is difficult to applicate the Westgard multi-rules in nuclear medicine in vitro tests due to the larger sample sizes and the simultaneous measurement of quality control material and patient sample. This study investigated the usefulness of Westgard multi-rules application in nuclear medicine in vitro tests. Materials and Methods A total of 282 systematic error multi-rules (22s, 101s) recorded in the samsung medical center computer system from January 2013 to June 2016 along with 117 cases of corrective measure record was analyzed. The Quality control implementation is recorded in Hospital information system were divided into 4 high-level areas including quality control material error, experimental procedural error, Kit lot number management error, and others. To prevent quality control material error, the existing method that each staff used their own method was changed. The staff who in charge of managing the quality control material was designated and daily consumption amount of every test was strictly controlled by one person. To prevent other errors, every test step was standardized so that the entire test procedures are identically implemented. Results The total quality control implementation was 117 cases; As a result, 62 quality control material errors were 62 cases, experimental process errors were 24 cases, Kit lot number control errors were 18 cases, and other errors were 13 cases. The quality control material error was corrected and could be used fresh materials within 2 days after thawing. The cases of systemic error were decreased to causes as quality control material error. The quality control materials were reduced above 10 vials to a monthly average. In addition, these errors of experimental processing and Kit lot number were improved by test standardization. Consequently, the cases of 101s and 22s in systematic error rules decreased at least 2 cases to a monthly average. Conclusion To confirm of systematic error through multi-rules application quickly, it is necessary to base on management of the QC material, target values and standard deviation. Moreover, in the event of a systematic error, it was found important to record measures based on test cause analysis. The experiment results are expected to contribute to internal quality control improvement and prompt and accurate result reporting through error recording and causal analysis based on Westgard multi-rules analysis.

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Application of Westgard Multi-Rules for Improving Nuclear Medicine Blood Test Quality Control (핵의학 검체검사 정도관리의 개선을 위한 Westgard Multi-Rules의 적용)

  • Jung, Heung-Soo;Bae, Jin-Soo;Shin, Yong-Hwan;Kim, Ji-Young;Seok, Jae-Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.16 no.1
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    • pp.115-118
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    • 2012
  • Purpose: The Levey-Jennings chart controlled measurement values that deviated from the tolerance value (mean ${\pm}2SD$ or ${\pm}3SD$). On the other hand, the upgraded Westgard Multi-Rules are actively recommended as a more efficient, specialized form of hospital certification in relation to Internal Quality Control. To apply Westgard Multi-Rules in quality control, credible quality control substance and target value are required. However, as physical examinations commonly use quality control substances provided within the test kit, there are many difficulties presented in the calculation of target value in relation to frequent changes in concentration value and insufficient credibility of quality control substance. This study attempts to improve the professionalism and credibility of quality control by applying Westgard Multi-Rules and calculating credible target value by using a commercialized quality control substance. Materials and Methods : This study used Immunoassay Plus Control Level 1, 2, 3 of Company B as the quality control substance of Total T3, which is the thyroid test implemented at the relevant hospital. Target value was established as the mean value of 295 cases collected for 1 month, excluding values that deviated from ${\pm}2SD$. The hospital quality control calculation program was used to enter target value. 12s, 22s, 13s, 2 of 32s, R4s, 41s, $10\bar{x}$, 7T of Westgard Multi-Rules were applied in the Total T3 experiment, which was conducted 194 times for 20 days in August. Based on the applied rules, this study classified data into random error and systemic error for analysis. Results: Quality control substances 1, 2, and 3 were each established as 84.2 ng/$dl$, 156.7 ng/$dl$, 242.4 ng/$dl$ for target values of Total T3, with the standard deviation established as 11.22 ng/$dl$, 14.52 ng/$dl$, 14.52 ng/$dl$ respectively. According to error type analysis achieved after applying Westgard Multi-Rules based on established target values, the following results were obtained for Random error, 12s was analyzed 48 times, 13s was analyzed 13 times, R4s was analyzed 6 times, for Systemic error, 22s was analyzed 10 times, 41s was analyzed 11 times, 2 of 32s was analyzed 17 times, $10\bar{x}$ was analyzed 10 times, and 7T was not applied. For uncontrollable Random error types, the entire experimental process was rechecked and greater emphasis was placed on re-testing. For controllable Systemic error types, this study searched the cause of error, recorded the relevant cause in the action form and reported the information to the Internal Quality Control committee if necessary. Conclusions : This study applied Westgard Multi-Rules by using commercialized substance as quality control substance and establishing target values. In result, precise analysis of Random error and Systemic error was achieved through the analysis of 12s, 22s, 13s, 2 of 32s, R4s, 41s, $10\bar{x}$, 7T rules. Furthermore, ideal quality control was achieved through analysis conducted on all data presented within the range of ${\pm}3SD$. In this regard, it can be said that the quality control method formed based on the systematic application of Westgard Multi-Rules is more effective than the Levey-Jennings chart and can maximize error detection.

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Availability of Statistical Quality Control of Nuclear Medicine Blood Test Using Population Distribution (모집단 분포를 이용한 핵의학 혈액검사의 통계적 품질관리의 유용성)

  • Cheon, Jun Hong;Cho, Eun Bit;Yoo, Seon Hee;Kim, Nyeon Ok
    • The Korean Journal of Nuclear Medicine Technology
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    • v.20 no.1
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    • pp.37-41
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    • 2016
  • Purpose The importance of quality control by the error to a minimum, which for the purpose of enhancing the reliability of the examination is not be emphasized excess. Currently, most nuclear medicine laboratory are conducting the internal and external quality control, and they are applying the Levey-Jennings or Westgard Multi-Rules by using the commercialized quality control materials. The reliability of the nuclear medicine blood test which affects the diagnosis of patients and the treatment policy is being secured through this quality control activity. Therefore, researchers will evaluate the utility of the statistic quality control using the population distribution of the nuclear medicine blood test conducted targeting the checkup examinees by the additional technique of the reliability improvement. Materials and Methods A statistic analysis was performed about 12 items of the nuclear medicine blood test targeting 41,341 peoples who used the health screening and promotion center in Asan Medical Center from January, 2014 to December, 2014. The results of 12 items of the nuclear medicine blood test was divided into the monthly percentage of three groups: within reference values, over reference, and under reference to analyze the average value of the population distribution, standard deviation, and standard deviation index (SDI). Results The standard deviation of the population distribution mostly showed a result within ${\pm}2SD$ in all groups. However, When the standard deviation of the population distribution represented a result over ${\pm}2SD$, it was confirmed SDI was showing a result of SDI > -2 or SDI > 2. As a result of analyzing the population distribution of 12 items(AFP, CEA, CA19-9, CA125, PSA, TSH, FT4, Anti-Tg-Ab, Anti-TPO-Ab, Calcitonin, 25-OH-VitD3, Insulin) of the nuclear medicine blood part basic test, when SDI of the monthly percentage which deviated from the reference values was over ${\pm}2.0$, CA19-9 September was 2.2, Anti-Tg-Ab may was 2.2, Insulin January was 2.3, Insulin March was 2.4. It was confirmed these cases were attributed to the abnormality of the test reagent (maximum combination rate of isotope reagent declined) and the decline of the test response time. Conclusion The population distribution includes the entire attribute which becomes the study object. It is expected the statistic quality management using the population distribution which was conducted targeting the checkup examinees by dividing into three groups: within reference values, over reference, and under reference by means of this characteristics will be able to play a role of complementing the internal quality control program which is being carried out in the laboratory.

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