North Devon Pathology Department June 2009 Edition No. 3 Pathology Department North Devon District Testing Times Hospital Newsletter for ALL Pathology Users Raleigh Park Barnstaple Devon 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 HbA1c 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 Tab. 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. http:// www.northdevonhealth.nhs.uk/ndht/ departments/clinical_support/ pharmacy/FORMULARIES/HF%20- %20ch5%20-%20Cellulitis% 20Pathway.pdf (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 3) 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. Equipment 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 handset/phone 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 firstname.lastname@example.org Barnstaple area code is 01271. with any requests.
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