The container is placed in an individual transparent plastic transport bag with Biohazard motif as soon as it has been labelled. The transport bag is sealed by means of the integral sealing strip. Request forms need to be placed in the side pouch of biohazard bags and not in with the sample. For large specimens e.g. 24 hour urine specimens the containers may be enclosed in individual plastic sacks. The request form is attached to the specimen in such a way that it is not contaminated by urine and both are placed in the plastic sack. Suitable sacks may be obtained from the laboratory front office. Multiple Specimens must be transported in the secure transport boxes provided. When transporting a small number of specimens (e.g. via taxi or district nurses etc.), we would advise that the specimens should be contained in a suitable, clean robust sealed container which is either single use or can be easily cleaned by the transporter who also ensures that it is secured satisfactorily during transit. One patient per bag. DO NOT put multiple samples and forms in one bag. COMMUNICATIONS AND TRANSPORT GP practices are now receiving fully compliant encrypted messaging. We are happy to discuss any issues about electronic results transfer. If you require any information please contact the Laboratory IT Manager or his deputy. The courier/transport system is continually being improved. If you experience problems or would like to discuss improvements our Clinical Service Lead would like to hear from you. URGENT SAMPLES FROM GP SURGERIES Identification of urgent samples in the transport boxes would help to identify these samples sooner. Please place these samples in a large envelope marked urgent then the laboratory can give these samples priority. DATA PROTECTION The laboratory abides with the policy for Data Protection of personal information. Every measure will be taken to ensure confidentiality. Should a breach occur, a full investigation will be carried out. The trust has a formal complaints procedure should a unsatisfactory conclusion is found. FACTORS AFFECTING THE VALIDITY OF RESULTS Insufficient sample volume Insufficient samples may have unsuitable ratio. Insufficient volume of specimen to carry out the test Inappropriate anticoagulant Using wrong type of specimen container Decanting blood from one container to another! in transporting specimen to laboratory Degeneration of specimens Small time window for some tests - Infertility needs to be analysed within 1 hour. Incorrect transportation of specimen Does it require insulating? Does it need transporting on ice? Timing of specimen
APPENDIX 2 Protocol for the Management of Outpatients with Prolonged INR Secondary to Anticoagulant Therapy The following protocols are on the British Committee of Standards in Haematology Guidelines but take into account that the Anticoagulant clinic is a monitoring clinic staffed by Biomedical Scientists and an Anticoagulant Nurse Specialist. The BCSH guidelines and those given in the BNF, state that the use of Vitamin K for patients with an INR > 8.0 should only be considered for those with additional risk factors for bleeding (stated below) however, it is not feasible for clinic staff to assess whether any of these risk factors apply to patients in the community. Given there is good evidence in the literature that the risk of bleeding significantly increases with an increasing INR, we aim to ensure that haemorrhagic complications are kept to a minimum by recommending that Vitamin K is given to all patient’s with an INR >8. We are confident this policy will not put patients at risk of excessive anticoagulant reversal and at the same time simplifies the process for patients in the primary care setting. High Risk Factors* Age >70 years Previous GI bleeding Previous anticoagulant-related bleeding Cerebrovascular disease Hypertension Alcoholism disease Thrombocytopenia Recent surgery Receiving anti-platelet drugs e.g. NSAIDS Major Bleeding There are no generally accepted definitions of what constitutes a major bleeding episode. Acceptable criteria for are as follows (Makris 2001): Intracranial Retro-peritoneal (excluding conjunctival) Muscle haematoma with compartment syndrome If is evidence of any of the above, or if there is doubt concerning the possibility of major bleeding occurring, the patient will require referral to hospital as an emergency. This
MICROBIOLOGY INVESTIGATIONS Provisional results may be available if you contact the laboratory during working hours. Urgent requests or significant microscopy/ culture results etc. will be telephoned. Turn round times do not include the transport time from collection of sample to receipt of sample in the microbiology laboratory. INVESTIGATION SPECIMEN TYPE TRANSPORT DELIVERY TIME REQUEST FORM STORAGE TEMP TURNROUND TIME TO FINAL RESULT (working days) 1 Ascitic fluids Aspirate Sterile container and culture set if available ASAP Electronic order/Standard laboratory form Room temperature 48-96 Aspirates pus) 2 Aspirate/pus Sterile pot ASAP Electronic order /Standard laboratory form 4O C 48-96 hrs Bacteraemia Venous blood Blood culture set (2 bottles) ASAP Electronic laboratory form 37O C 48-72 hrs Chest infection Sputum Sterile 60ml pot 24 hrs Electronic order/Standard laboratory form 4O C 48 hrs-7 days Chlamydial Infection see note below 3 Endocervical/Urethral/ Conjunctival/Urine Special collection kit 3 48 hrs Electronic laboratory form 4O C 7 days 7 Cystitis Urine Sterile 10ml container 48 hrs Electronic order /Standard laboratory form 4O C 24-72 hrs Diarrhoea Faeces Blue container with 72 hrs Electronic laboratory form 4O C 96 hrs Diarrhoea ?CDT Faeces Blue container with spoon ASAP Electronic order/Standard laboratory form 4O C Within 24 hrs of receipt of sample in laboratory. Testing done 7 days per week, 1 run per day.
Fungal Infection Nail clippings/Skin scrapings/Plucked hairs Special ‘Dermapaks’ available from lab also sterile universal or pot 48 hrs Electronic order/Standard laboratory form Room temperature Micro up to 1 week Culture 2-3 weeks Joint Fluids Aspirate Sterile container and blood culture set if available ASAP Electronic order/Standard laboratory form Room temperature 48-96 hours Pregnancy EMU Sterile 10ml container 48 hrs Electronic order/Standard laboratory form. 4O C 24 hrs, batched testing afternoon Semen analysis Infertility Semen Collection pack is available from the laboratory – contains a ‘how to collect’ leaflet , request form and directions to laboratory and a container with blue label is now required which needs additional information such as length of abstinence, time of collection etc. Within 1 hour of ejaculation Standard laboratory form Keep Warm (Samples will only be examined : Mon-Fri 1 week Semen analysis post vasectomy Sterile pot 24 hrs Standard laboratory form Room temperature 1 week Streptococcus pneumoniae Urinary antigen test Legionella urinary antigen test Urine Sterile 10ml urine container ASAP Electronic order/Standard laboratory form Room temperature if to be tested within 24 hours otherwise store at 2-8 0C 24 hrs Tuberculosis Sputum x 3 EMU x 3 – contact the lab for details of collection required and for special container Sterile pot – special large urine container 48 hrs Electronic laboratory form 4O C 1 week (positive smears phoned as an urgency) Culture 8 weeks 7 Vaginal discharge bacterial vaginosis, TV, yeast, HVS Bacterial transport medium 48 hrs Electronic/Standard laboratory form 4O C 48-72 hrs Vaginal discharge PID, Post-op, Post-partum Endocervical/Urethral swab/HVS Bacterial transport medium ASAP Electronic/Standard laboratory form 4O C 48-72 hrs
Consultant Histopathologist Dr Richard Hale 5615 Consultant Histopathologist Dr Umi Hatimy 5607 Consultant Histopathologist Dr Preethi Joseph 5605 Consultant Histopathologist Dr Rajagopal Saravana 4495 Consultant Histopathologist Dr Laxmi Radhakrishnan 5023 Consultant Histopathologist Dr Gavin Udall 4809 Consultant Histopathologist Dr Amani Brown 5625 Consultant Histopathologist / Clinical Lead of Dept. Dr Shailesh Agrawal 4963 Technical Head of Department Mr David May 5623 Histology Laboratory – enquiries 5223 Histology Fax 4757 Cytology Technical Enquiries 4674 Cellular Pathology General Enquiries 4358 Mortuary 5222 Coroners Liaison Officer Mrs Rita Wilkinson 5222 MICROBIOLOGY Consultant Microbiologist Dr Dominc Scarr 5603 Consultant Microbiologist Dr Moira Taylor 4673 Consultant Microbiologist / Clinical Lead of Dept. Dr Michael Fisher 4489 Microbiology Clinical Advice 4695 (out of hours phone switch) Technical Head of Department – acting up from 01/10/15 Mr William Cheetham 5601 Deputy Technical Head of Department Mrs Susan Durham 5047 Microbiology Laboratory - enquiries 5616 Virology Results (MRI) 0161 276 8834