[Keywords:] Clinical laboratory; Management; cultivate
At present, the laboratory departments of hospitals above the second level in China can be divided into several relatively independent professional laboratories, such as hematology, biochemistry, immunology, microbiology and body fluids. With the wide application of modern science and technology in the medical field, the instruments and equipment of various laboratories have been greatly improved and improved, and the inspection projects carried out have been fully automated or semi-automated, and a relatively complete technical system has been initially formed, which can cooperate with each other. With the implementation of the national "Management Measures for Clinical Laboratories in Medical Institutions", the author talks about the management methods of department directors in the construction and management of hospital laboratories under the new situation.
1. Technical personnel management
The quality level of hospital laboratory depends on the medical ethics and technical level of its staff, which requires inspectors to have the concept of "injury", rich and solid theoretical foundation, skilled operating skills and the ability to adapt to knowledge update actively.
1. 1 building a good medical ethics is an important part of building a hospital medical ethics, and building a good professional ethics is a code of conduct that every medical staff must have. The purpose of "serving patients" should not only stay in words, but also be implemented in action to meet the needs of patients as much as possible [1]. Establishing the morning shift system in department management, one of which is to carry out medical ethics education.
1.2 professional technical training Although the theoretical education level of inspectors before entering the department has been improved to a certain extent, the knowledge they have mastered has not kept up with the rapid development of medical laboratory technology. As technicians, they must be further trained. First, we should conduct pre-job rotation study according to the quality of personnel, be familiar with the business and job responsibilities of the department, and take the exam; Second, it is necessary to take purposeful and planned academic exchanges, study abroad, project training, study tours and other ways to cultivate some professional and technical backbones with stable professional thinking. At the same time, all departments rely on manufacturers to carry out new business training and encourage manufacturers to learn and master new technologies and methods.
2. Inspection quality management
Because the improvement and improvement of the quality of instruments and equipment can better avoid the interference of human factors, make the judgment more objective and scientific, and feed back the information and results to the clinic more and more quickly, a considerable number of technicians believe that as long as someone, instruments and reagents are available, they can issue inspection reports to the clinic. This understanding does not pay enough attention to the quality work of clinical laboratories, coupled with the urgent need to "speed up" inspection reports, and ignores the basic quality assurance measures necessary for issuing reports, such as instrument calibration, maintenance, repair, indoor quality control, standard operating procedures, records and other quality management of clinical laboratories. The core of clinical laboratory quality management is quality control. Quality control is not only internal quality control (IRC) and external quality assessment (EQA), but also includes many management contents such as personnel, quality system, facilities and environment, testing methods, records and samples. China Distance Education Holding Co., Ltd.
2. 1 set up a professional team and set up a quality management team with department leaders as the team leader and professional laboratory leaders (heads) as members. Formulate and supervise the implementation of various quality management systems, such as program documents, operation manuals, quality control records, error registration, etc. Regularly check and analyze the indoor and outdoor quality evaluation of each group, and correct the irregular behavior of the staff in technical operation in time; Collect the opinions and suggestions of clinical departments on undergraduate courses regularly, and put forward solutions.
2.2 The professional experimental group is responsible for the team leader, with a fixed team leader. The team leaders of various professional groups compete for posts and are elected by secret ballot after being studied by the Party branch committee of the branch. Establish a "three-level" inspection report audit system for operators, professional team leaders or competent technicians and department directors, and analyze the test results. If it is within the scope of quality control, you can issue a report, otherwise you should find out the reason and re-examine it if necessary. The special inspection report shall be reviewed by the department director, and other inspection reports shall be issued after being reviewed by the team leader.
2.3 Formulation of specimen collection and inspection system In order to ensure the effectiveness and reliability of the work of the clinical laboratory, a written specimen rejection standard is formulated, and the records of rejected specimens are kept, and the reasons for rejection are indicated on the application form. The used kits should be purchased on the principle of quality first, reasonable price and considerate service, and should be compared before selection, and an analysis report should be made. The instrument is calibrated with standard substance before use, and checked with indoor quality control substance according to the requirements of operating standard procedure documents after it is normal.
2.4 IRC and EQA IRC are the basis of laboratory inspection quality assurance, and EQA is the continuation and supplement of IRC, which plays a role in mutual correction of the accuracy of inspection results and supervision and promotion of laboratory quality control. EQA should evaluate the professional experimental group 1 time every month, and evaluate the department 1 time after the results of EQA are returned every time, so as to sum up experience.
3. Instrument and equipment management
The combination of computer and various automatic instruments has greatly improved the automation degree of inspection work. Many testing instruments have replaced manpower. As long as there is a machine, inspectors can operate according to the instructions, and then the computer directly outputs the inspection results, which greatly reduces the workload of inspectors and improves the work efficiency. Therefore, the management of instruments and equipment is another important part of laboratory management.
3. 1 The required certificate and the establishment of a complete instrument file must include: registration certificate, qualification certificate, sales certificate, operating procedures (specified by the laboratory), maintenance and use records (instrument status certificate), calibration and quality control procedures and records (accuracy and precision certificate), and compulsory inspection records of measuring equipment.
3.2 Evaluate the main performance parameters of the instrument, including precision, detection of normal and abnormal samples, linear range, comparability, anti-interference test, etc. , to ensure the normal use of equipment every day.
3.3 Reconstruction of standard curve The standard curve should be established before the routine sample is determined by the new instrument, and should be re-established after the new batch of reagents is replaced or the instrument is repaired.
3.4 Instrument Maintenance Establish an instrument maintenance and use system, assign a special person to be responsible for the daily maintenance, maintenance and calibration of various instruments, and make records. Find the problem, report it in time and contact maintenance.
3.5 Instrument comparison Instrument comparison is an important method to ensure the consistency of laboratory reports. At least 3 months 1 time, with detailed records. The method is as follows: firstly, choose an instrument whose technical performance is in our laboratory (calibrate it with a matching calibrator as far as possible) and compare other instruments with this instrument respectively.
4. Department management
4. 1 Safety Requirements Laboratories must establish and implement a "safety management system" to prevent physical, chemical, biochemical, electrical and biological injuries; Laboratories and offices are strictly distinguished, and polluted areas and non-polluted areas are strictly distinguished.
4.2 One of the purposes of formulating and perfecting rules and regulations, post responsibilities and reward and punishment system is to establish a set of effective management methods, and perfect rules and regulations are an important guarantee for improving quality. Clinical laboratory determines the "alarm" range of important analysis. When the test results suggest that there is an alarm range, the clinical laboratory must re-examine the specimens and report to the clinic immediately. If it is inconsistent with the clinical diagnosis, the measurement must be repeated and contacted with the clinic in time. At the same time, make detailed records, including date, time, person in charge of inspection, notifying personnel, experimental results, etc.
4.3 Strengthen personnel training, strengthen the access demonstration of new projects and on-the-job training of inspectors. On the one hand, train and improve all inspectors' understanding of basic knowledge and quality control theory; On the other hand, quality work is guaranteed by the behavior of all employees in each position. We must strengthen the quality consciousness of all staff, always regard the quality education of all staff as a basic work and make unremitting efforts.
4.4 Only by adhering to the system of regular and clinical coordination meeting can the test data be truly transformed into useful clinical information, which requires close cooperation between clinicians and laboratory doctors. It is necessary to establish a quality information feedback system, solicit opinions regularly, and deal with, report and correct relevant problems in a timely manner.
5. Supervision and evaluation management
5. 1 At the end, a disciplinary management team composed of department heads and professional team leaders shall be established to supervise, inspect and implement the implementation of various rules and regulations by department employees, record the problems found, criticize and point out in time at the morning meeting of the department and punish or reward them according to the reward and punishment method. The discipline management team conducts a comprehensive quantitative assessment on everyone every quarter, focusing on quality inspection, supplemented by style and discipline, scoring item by item and accumulating until the end of the year, and rewarding the excellent.
5.2 The person in charge of the two-way evaluation team (the person in charge of the laboratory) will score through the two-way evaluation. First, the general practitioner elects the team leader (laboratory director) by secret ballot; Second, the Committee of the Party branch of the department scores the group leader, and the sum of them is included in annual work summary as one of the basis for their assessment. In a word, the director is not only the administrative leader of the department, but also the leader of the professional discipline. The improvement of inspection quality, the cultivation of talents and the increase of economic benefits depend largely on the management ability and level of the factory director [2]. To do a good job in the management of hospital laboratories, it is necessary for department directors to keep learning, update their concepts in time, formulate and improve various management systems and assessment and reward and punishment systems of departments, and use systems to manage and restrain personnel.
References:
[1] Liu, Yan. On scientific management of clinical laboratory [M]. China Clinical Laboratory, 2002, 9 (3): 6.
[2] Cong Yulong, Qin Xiaoling. Several main problems and countermeasures in clinical laboratory management [J]. Chinese Journal of Laboratory Medicine, 2003, 1 1 (26): 649? 65 1.