North Devon Pathology Department
Edition No. 3
North Devon District
Hospital Newsletter for ALL Pathology Users
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
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)
The pathway is for those pa-
to be inadequate doses of
tients whose cellulitis has not
oral antibiotic therapy... “
responded to first line oral
therapy and may require hospi-
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.
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
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-
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
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
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.)
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 firstname.lastname@example.org
Barnstaple area code is 01271. with any requests.