# Presentation: 547715

## Quality Control:Monitoring QC Data

- Pawan Angra MS
- Division of Laboratory Systems
- Public Health Practice Program Office
- Centers for Disease Control and Prevention

## Levey-Jennings Chart

## Levey-Jennings Chart 

**Mean**

**1 SD**

**2 SD**

**3 SD**

**1 SD**

**2 SD**

**3 SD**

## Monitoring QC Data

- Meet pre-established limits, usually 95% confidence interval
- Plot Levey-Jennings each day, make decision regarding acceptability
- Monitoring over time provides information about the precision and long-term accuracy of measurement
- Review charts at defined intervals

## Control Values and Decision

- Consider using Westgard Control Rules
- Use premise that 95.5% of control values should fall within ±2SD
- Commonly applied when two levels of control are used
- Use in a sequential fashion

## Westgard Rules

- 1 2s rule
- 1 3s rule
- 2 2s rule
- R-4s rule
- 4 1s rule
- 10x rule

## Westgard – 1 2s Rule

- “warning rule”
- One of two control results falls outside ±2SD
- Alerts tech to possible problems
- Not cause for rejecting a run
- Must then evaluate the 1 3S rule

## 12S Rule = A warning to trigger careful inspection of the control data

- Mean

- Day

- +1SD

- +2SD

- +3SD

- -1SD

- -2SD

- -3SD

- 12S rule violation

## Westgard – 1 3s Rule

- If either of the two control results falls outside of ± 3SD, rule is violated
- Run must be rejected
- If 1 3s not violated, check 2 2s

## 13S Rule = Reject the run when a single control measurement exceeds the +3SD or -3SD control limit

- Mean

- Day

- +1SD

- +2SD

- +3SD

- -1SD

- -2SD

- -3SD

- 13S rule violation

## Westgard – 2 2s Rule

- 2 consecutive control values for the same level fall outside of ±2SD in the same direction, or
- Both controls in the same run exceed ±2SD
- Patient results cannot be reported
- Requires corrective action

## 22S Rule = Reject the run when 2 consecutive control measurements exceed the same +2SD or -2SD control limit

- Mean

- Day

- +1SD

- +2SD

- +3SD

- -1SD

- -2SD

- -3SD

- 22S rule violation

## Westgard – R-4s Rule

- One control exceeds the mean by –2SD, and the other control exceeds the mean by +2SD
- The range between the two results will therefore exceed 4 SD
- Random error has occurred, test run must be rejected

## R4S Rule = Reject the run when 1 control measurement exceed the +2SD and the other exceeds the -2SD control limit

- Mean

- Day

- +1SD

- +2SD

- +3SD

- -1SD

- -2SD

- -3SD

- R4S rule violation

## Westgard – 4 1s Rule

- Requires control data from previous runs
- Four consecutive QC results for one level of control are outside ±1SD, or
- Both levels of control have consecutive results that are outside ±1SD

## Slide 16

## Westgard – 10X Rule

- Requires control data from previous runs
- Ten consecutive QC results for one level of control are on one side of the mean, or
- Both levels of control have five consecutive results that are on the same side of the mean

## 10x Rule = Reject the run when 10 consecutive control measurements fall on one side of the mean

- Mean

- Day

- +1SD

- +2SD

- +3SD

- -1SD

- -2SD

- -3SD

- 10x rule violation

## What to do when Control Value is out of limit?

- “out of control”
- Stop testing
- Identify and correct problem
- Repeat testing on patient samples and controls
- Do not report patient results until problem is solved and controls indicate proper performance

## Analysis of QC Data Over Time

- Levey-Jennings control charts
- 	-Gives information about precision, accuracy
- 	-Ideally have control values clustered about the mean with little variation in the upward or 	downward direction
- Need to review and document

## Findings Over Time

- Imprecision – large amount of scatter about the mean.  Usually caused by errors in technique
- Inaccuracy – may see as a trend or a shift, usually caused by change in the testing process, deterioration of reagents etc.
- Random error – no pattern. Usually poor technique, malfunctioning equipment

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

**1 2s Rule: “Warning”**

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

**1 3s Rule: “Reject Run”**

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

**1 2s Rule: “Warning”**

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

**2 2s Rule: “Reject Run”**

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

**2 2s Rule: “Reject Run”**

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

**R-4s Rule: “Reject Run”**

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

**4 1s Rule: “Reject Run”**

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

**4 1s Rule: “Reject Run”**

##           Urea: mg/ dl	

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

-     +1SD      33.66

- +2SD      35.32

** ****-**1SD      30.34

** ****-**2SD      28.68

** **-3SD      27.02

**Mean      32.00**

**          ****Urea: mg/ dl**

- Level 1

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

|  |
| --- |
|  |
|  |
|  |
|  |
|  |
|  |
|  |

- 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25

- +3SD      36.98

- +3SD     54.56

- +2SD     53.04

- +1SD     51.52

**Mean     50.00**

** ****-**1SD     48.48

** ****-**2SD     46.96

** **-3SD     45.44

- Level 2

## Westgard Multirule QC