Testing Times Newsletter Jan pub Read Only by MikeJenny


									                                                             North Devon Pathology Department
June 2009
Edition No. 3

Pathology Department
North Devon District
                                      Testing Times
Hospital                              Newsletter for ALL Pathology Users
Raleigh Park
EX31 4JB

Inside this issue:
                                   NICE Results: eGFR and HbA1c
Complying with NICE               To comply with the National      must be read. Since the Labo-
Guidelines—eGFR &          1                                                                             What is eGFR?
                                  Institute for Clinical Excel-    ratory does not know the
                                  lence (NICE) guidelines, the     ethnicity of the Patients, re-
What happens to results           Biochemistry department has      sults for both Afro-Caribbean     eGFR (estimated
when we don’t know where   1      made some changes to the         Patients and for non-Afro-        glomerular filtration
to send them?                     way some tests are reported      Caribbean Patients are            rate) are simple indices
                                  and have recently introduced     quoted. The requester must        to detect early changes
Antibiotic Therapy for     2      some new tests.                  determine which is the appro-     in kidney function. A
Cellulitis                                                         priate figure to use.
                                  Urine Total Protein to                                             normal result means
Rejected Pathology         2      Creatinine Ratio is now          Low Density Lipoprotein           that kidney disease is
Specimens                         available to be requested. It    (LDL) Calculation has been        less likely while a low
                                  will also be performed auto-     re-introduced. When a full        value suggests that
Immediate Issue of Blood   3
                                  matically on any request for     lipid profile has been re-        some kidney damage
Point of Care Testing News 3      Urine Albumin to Creatinine      quested on a fasting patient,     has occurred.
                                  ratio when the urinary Albu-     the LDL calculation will be       Creatinine Clearance
Control Freaks?            3      min is greater than 250 mg/l.    added automatically. The          results are usually
                                  Estimated Glomerular Fil-        Freidewald formula for this       evaluated in the same
Where is Phlebotomy at     3
NDDH?                             tration Rate (eGFR) is now       calculation breaks down when      way.
                                  being reported on all requests   the serum Triglyceride is
Contact Details            4                                       greater than 4.5 mmol/l and       cations Trial (DCCT) and the
                                  for Urea and Electrolytes                                          International Federation of
                                  when the patient is over 18      no result will be generated in
       How to Access                                               this case.                        Clinical Chemistry (IFCC)
                                  years of age. The Laboratory                                       standardisations. This dual
 Pathology on Tarkanet            Comment which details cave-      Glycated HbA1c results are        reporting will run for two
Most NDHT PCs have a link to      ats on interpretation of the     now reported against both the     years after which time only
Tarkanet on the desktop. Also,    results are very important and   Diabetes Control and Compli-      the IFCC result will be issued.
clicking on the internet ex-
plorer icon should open Tar-
kanet. NDHT I.T. Services Dept
(01271 322697) tell us that all
                                  Pathology Reports - Some Going Nowhere?
GP Practices should also have     The majority of pathology        system or national database       to ascertain who the request-
a link to Tarkanet—please
contact them if this is not the
                                  reports are correctly sent to    which tells us where to send      ing practitioner is and where
case.                             the requesting practitioner at   these results. We also do not     to send the results.
From the Tarkanet home page:
                                  the correct location. However,   have the resources to look-up     All results are available on the
                                  there are a significant number   the locations to send the 20-     pathology computer and can
Click the blue ’Documentation’
                                  where the requesting practi-     40 reports a day where this       be resent to any location upon
                                  tioner or location information   happens, as a result, these       request. Please ensure the
Click on the word ’Manuals’ in
                                  is not recorded on the request   reports are not issued on pa-     requester and location is pre-
the list shown.
                                  form. Unfortunately, we do       per.                              sent on request forms to en-
Click on the word ’Pathology
                                  not have an automatic com-       Where results are significantly   sure results are delivered to
Handbook’ from the list of
manuals.                          puter link to the hospital PAS   abnormal, an attempt is made      the correct location.
Page 2                              Testing Times—Pathology News                                                       Edition No. 3

   Icon Alert!
                                   Antibiotic Therapy for Cellulitis
                                   A cellulitis pathway has been       1 gram four times a day, al-       clinical presentation and
                                   developed by a clinical working     though unlicensed for the          weight of patient it may be
                                   group as part of the ‘re-           treatment of cellulitis, is a      appropriate to give a higher
                                   designing emergency care’ pro-      recognized treatment for cel-      dose.
 Accessing the pathol-             ject. Its purpose is to standard-   lulitis and has been common        If you wish to discuss any
                                   ise the assessment and treat-       practice amongst microbiolo-       aspect of the cellulitis path-
 ogy computer system
                                   ment of cellulitis throughout       gists for many years so to this    way or you require advice on
 Users who login to the            North Devon and prevent the         end is supported by a robust       microbiological aspects of
 pathology computer to             unnecessary admission of pa-        body of evidence. Flucloxacil-     individual cases, please do not
 access patient results            tients to hospital. This pathway    lin up to 8 grams daily in three   hesitate to contact either Dr
 can no longer use the             has been ratified by both           to four divided doses is li-       Gail Speirs or Dr David Rich-
                                   Devon PCT Prescribing Inter-        censed for osteomyelitis and       ards via the Microbiology
  icons shown above.
                                   face Group (North Devon)            endocarditis whereas the li-       Department ( 01271 349199).
Instead, the icon shown            and Northern Devon Health-          censed dose for the treatment
  below must be used.              care NHS Trust Drug and             of cellulitis is Flucloxacillin    If you feel your patient re-
                                   Therapeutics Group. The path-       500 mg four times daily. This      quires assessment please con-
 If you do not have this
                                   way has been distributed to all     is considered to be the lowest     tact Nigel Warner, Charge
  icon, contact I.T. Ser-                                                                                 Nurse—MAU Clinic, on
                                   general practitioners via prac-     effective dose by local micro-
              vices on                                                                                    bleep 187 via switchboard.
                                   tice managers and is hyper-         biologists and depending on
              ext. 2697            linked to the GP formulary.
                                   (Copy and paste –or type-
      “...it appears that the      link into your browser ad-
             early cases were      dress bar if it does not work)
               receiving what
                                   The pathway is for those pa-
  microbiologists consider
 to be inadequate doses of
                                   tients whose cellulitis has not
 oral antibiotic therapy... “
                                   responded to first line oral
                                   therapy and may require hospi-
                                   tal assessment.
                                   Approximately twenty patients
 Specimen Acceptance               have been managed to date                         Cellulitis of the lower extremities
        Policy                     using the pathway and al-
                                   though the cases have not been
Specimens must be labelled         formally audited, it appears
with 2 key patient identifiers
                                   that the early cases were receiv-
                                                                       Rejected Pathology Specimens
(transfusion specimens need
                                   ing what microbiologists con-
                                                                       In the last quarter (January -     patient stuck onto a different
                                   sider to be inadequate doses of
Request Forms must be la-          oral antibiotic therapy.            March 2009) figures show           patient’s specimens.
belled with 3 key identifiers                                          that 181 (0.34%) pathology
                                   The guidance on appropriate                                            With the holiday season in full
Key patient identifiers are:                                           requests were rejected from        swing we would like to re-
                                   antibiotic therapy was reviewed
Full name (not initials or pre-                                        NDHT locations and 406             mind GP practices to ensure
                                   earlier this year and updated in
ferred names), DOB, and            the GP formulary.                   (0.54%) from PCT locations.        T/R is visible on request
unique number (hospital,                                               More detailed figures are cir-     forms from temporary resi-
NHS, A/E, FP or GUM)               Cellulitis is most commonly         culated to NDHT and PCT
                                   caused by Staphylococcus                                               dents. This will avoid speci-
Specimen and request form                                              governance managers.               men rejection, where an NHS
information must match and be      aureus and/ or haemolytic
correct. Transfusion forms must    streptococci (A, C and G            The most common causes of          number is unavailable in these
be signed.                         groups). The formulary recom-       rejections are missing hospital    cases.
For more details or a copy of
                                   mends Flucloxacillin 500 mg         or NHS numbers, completely
                                   four times daily for patients                                          The department reviews re-
the full policy, contact the Pa-                                       unlabelled specimens, badly        jected specimens on a regular
thology Quality Manager—see        not allergic to penicillin for a    printed or aligned patient ID
back cover for contact number.     period of 7 – 10 days. In-                                             basis to spot trends which can
                                                                       labels and ID labels for one       then be addressed.
                                   creased doses of Flucloxacillin,
Testing Times—Pathology News                                                        Edition No. 3                         Page 3

Immediate Issue of Blood (“At last”, I hear you say)                                                    Cover Photograph
Maggi Webb, Blood Transfusion Manager
                                                                                                       The photograph under
The Blood Transfusion Labo-       It is important that patients      botomy at the patient’s side      the ‘Testing Times’ title
ratory is to introduce immedi-    for elective surgery are bled      confirming the details with       is of a Grocott silver
ate issue of blood from July      both at pre-op assessment          the patient. The sample must      stain for fungal ele-
1st. This means that most         clinic and again on admission      be labelled with the Surname,     ments. The stain has
patients will not have a cross-   to ensure that we have a con-      Forename, Date of Birth and       been performed on a
match performed and blood         firmed group and a current         Patient ID number. The per-       paraffin section of skin.
will be immediately available     sample. This will mean there       son undertaking phlebotomy        The fungal elements
upon request. There are cer-      will be no need to have blood      should sign and date both the
                                                                                                       appear as long fila-
tain conditions which need to     on stand-by for any patients.      sample and the request form
be fulfilled:                                                        thus confirming that they         ments (when seen in
                                  For medical day case patients,                                       longitudinal section) or
There must be a current           best practice will be to have      have followed procedure.
                                                                                                       as small buds in cross
Group and Save sample in the      the Group and Save sample          Samples which do not con-
                                                                                                       section. This type of
laboratory (i.e. less than 7      taken by the GP practice the       form to these specifications
days old)                         day before.                        will be rejected with an inevi-   fungus is known as
                                                                     table delay in the provision of   Candida albicans and
The patient must have a con-      May I take this opportunity to
                                                                     blood.                            can be found in 40 to
firmed blood group, i.e. the      remind everyone concerned
patient has been grouped          of the strict requirements for     Thank you                         80% of normal human
twice on two separate samples     labelling a sample for blood       for your co-                      beings, for example, in
(This can include the current     transfusion? The sample must       operation.                        athletes foot infections.
G&S sample as above)              be labelled by hand (no sticky
The patient must not have any     labels) immediately after phle-
irregular antibodies either
currently or historically.
The patient must not have                       Control Freaks?
had a solid organ transplant
within the previous 3 months.     To ensure the automated re-        specimens from accredited
The patient must not have         sults we report are of high        sources (NEQAS, WEQAS,
had an allogeneic bone mar-       quality and reflect the true       Heath Control etc). We ana-
row transplant.                   value, the blood science de-       lyse these samples regularly
                                  partments frequently test con-     and our anonymised results         “blood will be
The patient must not have
auto-immune haemolytic            trol specimens of known val-       are compared against all other     immediately
anaemia.                          ues. If a control test result is   participants in the scheme.
                                                                                                        available upon
                                  greater than two standard          Any anomalies or deviations
Provided all the above criteria                                                                         request.”
                                  deviations from the mean           can then be addressed.
are fulfilled then the blood
will be immediately available.    value, analysis is halted whilst   Together, this helps to ensure     Immediate issue of
We anticipate that cross-         corrective actions are carried     the automated results you          blood
matching will be reduced to       out. In addition to daily inter-   receive are both precise. and
20% of the current level.         nal control checks, the labora-    accurate.
                                  tory is sent external control                                        Phlebotomy—Where is
                                                                                                         it in the N.D.D.H?

Point of Care Testing (PoCT)                                                                           A number of patients still
                                                                                                       turn up at the Pathology
News                                                                                                   department looking for
                                                                                                       the Phlebotomy Service.
The Trust has made Blood          for help and advice when                                             Many years ago it was
Glucose Monitoring training       looking at new/reviewing                                             located next to Pathol-
mandatory, as it is one of the    ward based Pathology testing                                         ogy, but it can now be
core skills. This training can    equipment. (The contact de-                                          found on Level 2 within
be booked via Development         tails for the PoCT team are on
                                                                                                       the OPD. Please inform
and Learning department on        page 4.)
01271 322396 (internal exten-                                                                          patients of the location if
                                  NDHT policy is such that all                           Point of      they ask as currently,
sion 2396), and is provided in    new purchases of PoCT
both the community and at                                                                Care          Phlebotomy is not in-
                                  equipment, including from
NDDH.                             charitable funds, must involve                         Testing       cluded on the blue signs
Please contact the PoCT team      the PoCT team.                                                       in the hospital foyer.
 North Devon Pathology Department                                        Laboratory Opening Times
                       Contact Details
General Manager, Diagnostic Directorate:                                 The laboratory is fully staffed from 09:00 to 17:30 Monday to
Mr. Neil Schofield                                 Tel: 2761 (322761)
                                                                         Friday and on Saturday between 09:00 and 12:30 for all depart-
                                                                         ments except:-
Biochemistry Department
Dr John O’Connor, Consultant Clinical Biochemist   Tel: 01392 402944     Cellular Pathology—08:30 to 17:00 Mon-Fri only
Mr Philip Parker, Head Biomedical Scientist        Tel: 2345 (322345)    Mortuary/Bereavement—08:30 to 16:00 Mon-Fri only
General Biochemistry Laboratory Enquiries          Tel 2345 (322345)
                                                                         Outside of these times there is an on-call service in operation
                                                                         for Biochemistry, Haematology, Microbiology and the Mortu-
Haematology & Blood Transfusion Department                               ary departments. Contact the on-call staff via the N.D.D.H.
Duty Consultant Haematologist                      Tel: 3198 (349198)
                                                                         Switchboard on ext. 0 (or 01271 322577 externally) - see below
Mrs. Sally Williams, Haematology Secretary         Tel: 3198 (349198)
                                                                         for more details on how to contact the on-call biomedical team.
Melanie Bowyer, Haematology CNS                    Tel: 3198 (349198)
Mr. Tim Watts, Head Biomedical Scientist           Tel: 3232 (370232)    There is also a doorbell outside the main Pathology entrance .
Mrs. Maggi Webb, Blood Transfusion Manager         Tel: 2327 (322327)
Kathleen Wedgeworth I.V. Fluids/Transfusion CNS    Tel: 2440 (322440)
General Haematology Laboratory Enquiries           Tel 2329 (322329)
General Transfusion Laboratory Enquiries           Tel 2327 (322327)
                                                                         ‘How do I get Clinical or
Microbiology Department                                                  General Advice ‘Out of Hours?’
Dr Gail Speirs, Consultant Microbiologist          Tel: 2798 (322798)
Dr David Richards Consultant Microbiologist        Tel: 2320 (322320)
Angela Mills, Microbiology Secretary               Tel: 3199 (349199)    CLINICAL ADVICE:-                 Biochemistry & Haematol-
Mr. Colin Parkin, Head Biomedical Scientist        Tel: 3278 (370278)                                      ogy: By bleep, either directly
                                                                         Biochemistry & Haematol-
General Microbiology Laboratory Enquiries          Tel 2347 (322347)                                       (see below), or asking
                                                                         ogy & Microbiology
                                                                                                           switchboard to bleep the bio-
Cellular Pathology Department                                            Clinical Advice from a Pathol-    medical staff required.
Dr Nicolas Ward, Consultant Histopathologist       Tel: 3197 (349197)    ogy Consultant can be ob-
                                                                         tained outside of normal          Microbiology:
Dr Jason Davies, Consultant Histopathologist       Tel: 3197 (349197)
Dr Andrew Bull, Consultant Histopathologist        Tel: 3197 (349197)    hours by contacting the           Through Switchboard only.
Nicola Martin, Histopathology Secretary            Tel: 3197 (349197)    N.D.D.H. switchboard—dial         How To Contact a Pathol-
Mr. Lee Luscombe, Head Biomedical Scientist        Tel: 3754 (311754)    0 from inside the hospital or     ogy Bleep Holder
General Cell. Path. Laboratory Enquiries           Tel 2340 (322340)     01271 322577 and ask for the
Mr. Michael Elton, Mortuary Manager                Tel: 2302 (322302)    consultant you require.           Haematology Bleep: 045
Bereavement Support Office                         Tel: 2404 (322404)                                      Biochemistry Bleep: 031
                                                                         GENERAL ADVICE
Pathology Computer Manager                                               There are three on-call bio-      1. Obtain a dialing tone
Mr. Julian Bishop                                  Tel 2324 (322324)     medical scientists (one each      2. Dial 74 and the 3 digit
                                                                         for the biochemistry, haema-      bleep number (above)
                                                                         tology and microbiology de-
Pathology Quality Manager                                                                                  3. Input the extension number
                                                                         partments) .
Mr. Bruce Seymour                                  Tel 2324 (322324)                                       you wish the bleep holder to
                                                                         The on-call staff request that    contact
Point of Care Manager                                                    you do not directly phone the
                                                                                                           4. Wait for the confirmation
Mr. David O’Neill                                  Tel : 3114 (349114)   laboratory during on-call peri-
                                                                                                           tone ( series of long beeps)
                                                                         ods as they are frequently
                                                                                                           and replace/switch off the
Pathology Office Manager                                                 unable to take calls due to
Mrs. Ruth Teague                                   Tel: 2796 (322796)    being in other parts of the
                                                                         laboratory, collecting speci-     For example, to contact bleep
                                                                         mens for example.                 045 dial 74 045 (your ext. no.)
Pathology Supplies/Consumables
                                                                                                           and wait for the confirmatory
Debbie Martinelli & Marcus Milton                  Tel: 2342 (322342)    However, on-call staff can be
                                                                                                           tone before hanging up.
                                                                         contacted as follows:
N.D.D.H. Switchboard                               Tel 0 (322577)
                                                                         We hope that you have found this newsletter interesting
Full contact details are available on the ‘Contact Us’ page of the       and helpful. If you would like to see information on a spe-
Pathology Handbook on Tarkanet.                                          cific topic in the next newsletter, please contact the Pathol-
Internal telephone extensions are shown above. Numbers in                ogy Quality Manager, Mr. Bruce Seymour on ext. 2324 (or
brackets are the direct dial numbers from outside the hospital.          01271 322324), email bruce.seymour@ndevon.swest.nhs.uk
Barnstaple area code is 01271.                                           with any requests.

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