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Laboratory Medicine User Manual Electronic - AMNCH

1. Page 135 of 157 Gentamicin a blood Adults YES Mon Sun each 3pm Weekdays red topped 5 10ml day weekdays Result by 50m neonates a i 1 2 ml Bank Result by 1pm Infants holidays 2 3 mls Pre teen 3 5 mls Vancomycin Clotted blood Adults YES Mon Sun each 3pm Weekdays 5pm sample day weekdays red topped 5 10ml Weekends amp Neonates oe Bank holidays 1 2 mi Bank Result by 1pm ie Infants holidays 2 3 mls Pre teen 3 5 mls Amikacin Clotted blood Adults YES Mon Sun each 3 pm Weekdays 5pm sample 5 10ml day weekdays Weekends amp red topped Neonates ae Bank holidays 1 2 ml Bank Result by 1pm Infants holidays ti 2 3 ml Pre teen 3 5 ml Tobramycin Clotted blood Adults YES Mon Sun each 3 pm Weekdays 5pm sample 5 10ml day weekdays Weekends amp red topped Neonates oe Bank holidays 1 2 ml Bank Result by 1pm Infants holidays i 2 3 ml Pre teen 3 5 ml Teicoplanin Clotted blood Adults Lithium YES Mon Thursday 2 pm By 5pm the sample 5 10ml ae cs following day red topped Neonates samples are e is 1 2 ml unsuitable not Infants a AO 2 3 mls weekends Pre teen 3 5 mls 135 A few antibiotics e g aminoglycosides exhibit a narrow range between therapeutic and toxic concentrations Assays of antibiotic levels in the blood may be necessary to confirm that adequate concentrations of antibiotic are being achieved in blood OR in order to avoid exce
2. Cultured isolate sent from laboratory Laboratory Medicine User Acanthamoeba Vitreous Fluid Corneal scrapings Conjuctival swabs Antibiotic Reference Cultured isolate sent from laboratory Anthrax Serology Clotted blood sample 1 10ml Cultured isolate sent from laboratory Anti Staphylococcus Antibodies Clotted blood sample 1 10ml Arbovirus Clotted blood sample Flavivirus 1 10ml Rickettsiae Weil Felix Test Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor 143 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Bacillus identification slope Cultured isolate sent from laboratory Bartonella serology Clotted blood sample 1 10ml Bordetella pertussis antibodies serology Bordetella pertussis PCR Clotted blood sample 1 10ml Nasopharyngeal swab or aspirate H influenza respiratory isolates from immunocompromised patients and carriage isolates from patients with invasive disease Ureaplasma Cultured isolate sent from laboratory Clotted blood sample 1 10ml Campylobacter serology IgG IgM IgA Clotted blood sample 1 10ml Cardiomyopathy Screen serology Myocarditis Screen Coxsackie
3. Registrar 3930 Bleep 7285 Results Enquiries and Helpline 3952 or 3954 General Clinical Chemistry Lab 3951 Endocrinology Lab 3955 Sweat Test Appointments 3952 Glucose Tolerance Tests 3041 Phlebotomy STAT Lab 3951 ON CALL Medical Scientist On Call Ring STAT Lab in First Instance Bleep 7283 Otherwise On Call HAEMATOLOGY AND BLOOD TRANSFUSION Registrars 3937 Bleep 6258 7025 Haematology Results Enquiries 3932 3933 3959 Routine Haematology 3961 Coagulation 3963 Special Haematology 3960 Blood Transfusion Results Enquiries 3964 3965 On Call Bleep 7281 Medical Scientist On Call Page 6 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 MICROBIOLOGY Results Enquiries 3934 3935 Registrar 3936 General Microbiology Lab 3941 3942 Blood Cultures 3939 TB Lab 3944 Main Lab 3941 3942 ON CALL Senior Medical Scientist On Call Registrars 3922 Routine Laboratory 3973 Specimen Reception 3925 Frozen Sections 3973 Fine Needle Aspiration 3929 Enquiries 3929 3928 3985 POSTAL ADDRESS Department of Laboratory Medicine Tallaght Hospital AMNCH Dublin 24 Ireland Tel 353 1 4143918 Fax 353 1 4143980 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author
4. Specimens gt 5 days old are unsuitable for C difficile toxin test If apatient has had a positive C difficile test in the last 4 weeks the specimen is not processed The assay is not a test of cure If patient has tested negative in the previous 48 hours test is not performed Please state on the request form whether antibiotic therapy could have induced the diarrhoea or if pseudo membraneous colitis is suspected Specimens for viral detection are referred to the National Virus Reference Laboratory Please refer to the Referral section Printed 23 Nov 2015 03 20 al Version 8 5 Index LM UI 0010 o 0 gt o 3 3 fo v a Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 22 Authorised on 23 Nov 2015 Authorised by Ann Leonard P Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 122 of 157 9 8 5 Genital Infections Please label all samples clearly with the patient s name DOB or Hospital number date and time of collection and the specimen type If transport is delayed please keep sample at room temperature Genital Tract Specimens Culture amp sensitivity High Vaginal Swab HVS YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours Low Vaginal Swab LVS YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours Endocervica
5. have taken this sample This section must be filled in by person taking the blood otherwise the request form is rejected awaiting correction or new form This may or may not be the same person that requested the tests If not completed the testing will not proceed and a new form and sample may have to be sent It is allowable for the person to come to the lab and fill in the details retrospectively This section does not have to be filled in for ADD ON requests as a sample is already in Laboratory 7 6 IDENTIFYING THE PATIENT Correct hospital patient identification is essential to ensuring patient safety All patients having samples taken should wear an identity bracelet Positively identify the patient verbally too if possible confirm the first name surname and date of birth and check against the ID bracelet This is essential to ensure patient safety and to prevent errors Patients who are unconscious confused undergoing general anaesthesia all unaccompanied minor and patients whose first language is not English Must wear two identity bracelets Refer to policy on patient identification Ref PPC DG POL 022 on Tallaght Hospital intranet under Hospital Policies through Q Pulse Page 82 of 157 Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Laboratory Medicine User Manual 7 7 TAKING THE SAMPLE The Person taking the sample is responsible for identifying the patient The sample must be
6. 68 6 8 2 ROUTINE COAGULATION LABORATORY ALL COAGULATION SAMPLES MUST BE RECEIVED WITHIN 4 HOURS OF PHLEBOTOMY Assay Sample Type Special Conditions TAT State if patient is on Warfarin or Urgent 1 hour Heparin Routine 2 hours State if patient is on Warfarin Urgent 1 hour Routine 2 hours Routine 2 hours Only when specifically requested by 3 hours the Haematology team Coagulation Screen PT INR APTT ratio Thrombin Time D Dimers Should only be requested once daily 3 hours in cases of suspected DVT amp DIC Not appropriate for GP patients Fibrinogen Urgent 1 hour Routine 2 hours All of the above samples may be sent in the Pneumatic Tube System PTS 69 Page 69 of 157 6 8 3 SPECIAL COAGULATION LABORATORY SPECIAL CONDITIONS NB The following tests MUST NOT be sent in the Pneumatic Tube System PTS Samples must be sent without delay to the laboratory The following tests should only be requested following consultation with the Haematology team or Laboratory Please state family clinical history and anticoagulant status Samples for special coagulation requests must be received by 3 30pm Mon Fri For more details on availability and special considerations for referral tests including turn around times please contact the coagulation lab 4143963 Type Hyper Coagulation 6 weeks post acute event 12 weeks Screen Thrombophilia screen Pu
7. 6ml EDTA Blood sample Available within 40 minutes Phone request in advance Contact Haematology team if cryoprecipitate is indicated Available within 40 minutes Check Rh D group and antibody screen result Phone lab in advance Available within 40 minutes See product insert for expiry once thawed Discuss with Haematology Medical Team if required Available in 40 mins if in stock otherwise it will take longer Check with Laboratory staff Routine amp Urgent One 6ml clotted Blood sample without gel 6ml EDTA Blood Sample pink top bottle The clotted sample must be kept at 37 C Heatblock is stored in the Immunochemistry Laboratory Clinical Chemistry Department Room A1Lab 0236 3 5 27 Bring to transfusion lab immediately Results available 2 days from receipt Clotted sample tubes without serum gel separator are available in Blood Transfusion Routine results available same day if received before 15 45 Routine results received after 15 45 will be processed on the next routine working day Urgent results available within 4 hours 77 Page 77 of 157 SERVICE WHEN SAMPLE TURNAROUND TIMES PRODUCT AVAILABLE REQUIRED NOTES SPECIAL REQUIREMENTS e Stop Transfusion Transfusion Reaction Investigation HLA typing for all potential transplant patients bone marrow Disease Association Tissue Typing Leucocyte Antibodies Platelet Antibodies Mon Thurs 09 00 15 45 On
8. 7 30am 12 00am 7 30am 12 00am 7 30am 12 00am 7 30am 12 00am 7 30am 12 00am 7 00am 10 00am 7 00am 10 00am CLINICAL CHEMISTRY 5 0 CLINICAL CHEMISTRY 5 1 INTRODUCTION Advice concerning interpretation of the investigations available and comments or suggestions relating to the service or this manual should be addressed to the Consultant Chemical Pathologist Dr Gerard Boran or other senior staff 5 2 CLINICAL CHEMISTRY PERSONNEL Please dial appropriate members of staff directly for clinical enquiries and enquiries regarding service provision and operational issues DR GERARD BORAN Consultant Chemical 3911 Pathologist CLINICAL CHEMISTRY SpR 3930 or Bleep 7285 MS BERNADETTE GANNON Administrative Assistant 3952 or 3954 Grade V Insert 01 414 before extension number for direct access from outside 5 3 REQUESTING INVESTIGATIONS REQUEST FORMS AND SAMPLE LABELLING Order Communications System OCS must be used for requesting unless the test is not available on the system The use of forms increases the risk of patient sample identification errors and missed tests Turnaround time for request forms will be significantly greater than for requests made through OCS All requests must be requested as outlined above Verbal requests for tests are NOT accepted under any circumstances These will be required until the Order Communications System OCS is fully operational Please use iPMS stickers for P
9. Human Protein C Can be ordered in if Prescribed in consultation with required Haematologist Fibrin Sealant Fibrinogen amp Human Thrombin Supportive treatment in surgery suture support for Haemostasis Stored frozen Therefore orders to allow defrost time Page 97 of 157 97 Components suitable for use in intrauterine transfusion neonates and infants under one year General requirements are e Components are prepared from donors who fulfil the following criteria e Have given at least 1 donation in previous 2 years and have tested negative in microbiology tests that were designated mandatory at that time CMV Neg K antigen negative red cell components only Free from clinically significant blood group antibodies Free from high titre Anti A and Anti B components suspended in plasma only e Have not received a Blood Transfusion or organ transplant e Have not spent one year or more in total in the U K e Have not taken aspirin in the last five days Components for neonates are split into pedipacks thereby providing the potential to reduce donor exposure 2 Sickle Cell Patients lt is desirable where time permits to select red cells matched for Rh and K antigens and which is HbS negative CMV negative 3 Washed Components available for patients who have had a significant reaction to plasma No longer designated for patients with IgA deficiency 4 HLA Matched Components requ
10. In the event of extreme shortage of blood the hospital EBMG will meet The aim of this group is to ensure the effective use of available blood when blood stocks have fallen to pre specified critical levels nationally The group can be chaired by the Consultant Haematologist and has members from interested parties e g Surgical Medical etc Further details are available on the Intranet 7 4 OPENING HOURS e Blood Transfusion Laboratory is opened Monday Friday 08 00 20 00 Saturday 09 00 12 30 e Routine testing is carried out between 09 00 17 00 Mon Fri Samples must be received by Blood Transfusion Laboratory no later than 15 45 in order for testing to be completed by 17 00 Page 79 of 157 09 00 12 30 Samples must be received by Blood Transfusion Laboratory no later than 17 00 in order for testing to be completed by 12 30 All samples received after stated cut off times will be processed by 12pm on the next routine working day Between 08 00 09 00 and 17 00 20 00 only emergency samples will be processed and telephone queries will be taken Outside these hours an emergency on call service is available for all urgent requests Bleep 7281 Specimens from patients for elective surgery must be received in the Blood Transfusion laboratory not later than 15 45 on the last normal working day prior to the scheduled operation If a definite date for operation is not known a Group Sav
11. These antibodies are found in Hospitals CH approximately 40 of patients with Pathology negative anti acetyl choline receptor laboratory myasthenia gravis Typical TAT 28 days IMMUNOLOGY Voltage Gated Ca VGCC Oxford Radcliffe These antibodies are associated with Channel Ab Hospitals CH Lambert Eaton myasthenic syndrome Pathology Typical TAT 28 days laboratory IMMUNOLOGY Version 8 5 Page 16 of 157 16 Anti Voltage Gated K VGKC Oxford Radcliffe Typical TAT 28 days channel Ab Hospitals CH Pathology laboratory IMMUNOLOGY Myelin associated AMAG Oxford Radcliffe Typical TAT 28 days glycoprotein Hospitals CH Pathology laboratory IMMUNOLOGY Allergen Testing There are two phases to testing firstly an IgE level is determined in Clinical Chemistry protein chemistry unit secondly specific allergens are measured at Immunology SJH In the case of rarer allergens these are sent to Sheffield NHS for analysis The criteria suggested by Immunology SJH with regard to allergen testing is as follows 20 For the diagnosis of specific allergy in children and adults a good clinical history is recommended with testing for a limited number of suspected allergens Requests for allergy testing should reflect these recommendations For allergy education amp step by step guidelines to clinical allergy diagnosis with pdf versions of clinical history forms go
12. 155 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 e The type and number of blood blood products currently available for collection in the Blood Transfusion lab e Instruction to refer to the paper crossmatch report for complete details on products issued This report does not contain unit numbers or unit flags The electronic KEY OCS report is continuously updated to reflect the number of units currently available in the laboratory Below is an example of a Blood Transfusion Product Availability report on Key Order Coms E KEY Patient Management Patient Results EE Master Index Inpatients Orders Results Enquiries Edit Tools Window Help QUIT Patient Number PID61896 Patient Name ZZTEST Livelier Female Location ATest Ward Date of Birth 01 Oct 1999 Consultant KOE Stanley Paediatric Emergency Medicine Age 15 years BLOOD TRANSFUSION FINAL REPORT on 07 01 2015 at 15 45 Specimen Ho 1015022225 Blood group A Rh D POSITIVE Antibody Comment HO ANTIBODIES DETECTED Product Availability 1 units of REDCELL ready for collection at B T LAB DETAILS ON PAPER REPORT Special Requirements K NA Group and Save on Sample Date and Time 07 Jan 2015 15 21 Print List Cumulat Alison Harper KPRD 07 01 2015 15 4 A start E winPath ws L15 67 E WinPath AMNICH Bloo KEY Patient Managem SEO 14 Insert Please contact Bloo
13. 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 153 of 157 153 Adult Phlebotomy Service Section 4 0 Page Change Clinical Chemistry Section 5 0 Page Change 52 Drug Interference Table added 41 TAT for Urinary electrophoresis added 44 24h plain urine for Urinary electrophoresis added to table Page 154 of 157 154 Haematology Section 6 0 Page Change RETROSPECTIVE REQUESTING ADD ON REQUESTS 62 Only the requesting doctor or person nominated by them may request additional testing 62 RETROSPECTIVE REQUESTING ADD ON REQUESTS Blood film 24 hours post phlebotomy morphology may not be reportable RESULTS ENQUIRIES TECHNICAL AND CLINICAL ADVICE 62 e Advice on interpretation of results sampling amp storage procedures and frequency of requesting will be directed to the appropriate person URGENT TESTS AVAILABLE ON CALL Malaria Screen only rapid diagnostic test performed out of hours 63 nee ls A T Examination of thick and thin films including speciation will be carried out on the next routine working day 66 Peripheral Blood Film TAT 2 routine working days 66 E S R TAT 24 hours Blood Transfusion Section 7 0 Page Change he Information Leafl
14. 4 7 BLOOD COLLECTION ORDER OF DRAW CAT SPEC ORDER OF COLOUR TUBE EXAMPLE ASSAYS MIXING SPECIAL NO VOL DRAW CLOSURE CONTENT INSTRUCTIONS INSTRUCTIONS Blood 10ml Draw MUST gt Whichever system is used to draw Rotate gently to Deliver by hand Culture Adult be first blood please ensure Blood mix to Microbiology 4ml preferably Cultures are taken first to avoid immediately Paed separate gt contamination See Infection venesection E gt Control Blood Culture Policy Order of draw minimizes carry over of anticoagulant 454349 3ml 1 Tri sodium FILL TO LINE ON BOTTLE After blood Fill to arrow Citrate All coag tests for increased collection invert line under or Solution accuracy 2 coag samples can be tube 4 times over filled tubes taken and first discarded tissue CANNOT be factor contamination during used venepuncture Renal transplant workup 20ml take a clotted sample as well 2 Black ESR After blood FILL BLOOD TO LINE ON collection invert BOTTLE tube 4 times 454071 4ml 3 Clotting Serology Immunology amp Virology After blood Allow 30 mins ti Accelerator Tests Cold Agglutinins Viral collection invert before Antibody amp Antigen Testing tube 5 10 centrifuging Antibiotic Assays Anti Cardiolipin times AB B12Folate Ferritin RA Intrinsic Factor AB SPEP FLC LDH Li Cyroglogulins 454083 4ml 4 Heparin General Biochemistry Lipid Profile After blood Lipid Profile may TDM Hormone Studies collection inve
15. 9 8 16 Specimens for Mycology Specimens for mycology e g skin hair and nails should be placed in a sterile universal container and sent to the Microbiology Laboratory These specimens are referred to external laboratories See Reference lab section for a list of commonly referred tests Page 137 of 157 137 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 9 9 LIST OF TESTS SENT TO REFERRAL LABORATORIES All Microbiological referred specimens must be processed through the AMNCH Microbiology Laboratory 9 9 1 Virology Requests for virology are referred to the National Virus Reference Laboratory University College Dublin Belfield Dublin 4 Please contact the Microbiology Laboratory with any queries relating to specimens for virology testing Some virology requests may be sent to other reference laboratories see below Please label all samples clearly with the patient s name DOB or Hospital number date and time collected TESTS AVAILABLE Requests for Urgent investigation must be arranged by telephone with the NVRL clinical team See website for additional information relating to diseases pathogens and specimens required www nvrl ie Requests for Viral screen routine virology or atypical screen without accompanying clinical information will not be processed Failure to supply the required information will lead to delays in reporting Requests fo
16. Chlamydia trachomatis Female Endocervical swab First void urine 15 20ML Male First void urine 15 20ML Urethral swabs Microbiology Laboratory St James s Hospital Syphilis VDRL TPHA RPR Clotted blood sample 1 10ml Microbiology Laboratory St James s Hospital Version 8 5 Index LM Ul 0010 Printed 23 Nov 2015 03 20 Laboratory Medicine User Manual Pneumococcal Antibodies Clotted blood sample 1 10ml Immunology Laboratory St James s Hospital Tetanus Antibodies Clotted blood sample 1 10ml Immunology Laboratory St James s Hospital Mycobacterium culture of blood and bone marrow Blood culture Bone Marrow Irish Mycobacterial Reference Laboratory CPL St James s Hospital Mycobacterium Susceptibility testing TB positive isolatest Irish Mycobacterial Reference Laboratory CPL St James s Hospital TB PCR Early Morning Urine EMU BAL Sputum Body Fluids CSF Irish Mycobacterial Reference Laboratory CPL St James s Hospital Please contact the Microbiology Laboratory for the appropriate swabs ABBOTT Multi Collect Transport Tubes and sampling protocol If there is a delay in transporting specimens to the laboratory please refrigerate at 4 C t All TB positive isolates processed in the Microbiology Laboratory Tallaght Hospital are referred to the Irish Mycobacterial Reference Laboratory for identification and s
17. LM UI 0010 Printed 23 Nov 2015 03 ry Medicine User Manua boratc Lat 3 Reports for inpatients Blood Transfusion Cellular Pathology amp referral laboratories will be sent to ward clinical areas 4 Reports for outpatients Blood Transfusion Cellular Pathology amp referral laboratories are sent to the clinical team 5 Reports to A amp E adult and paediatric will be delivered to the A amp E Departments Note this service is presently under review 1 7 SAFETY The hospital safety statement is available on the hospital intranet site at http intranet amnch ie Departments Health8 Safety Safety_statement htm The laboratory safety statement is available on request THE LABORATORY USES STANDARD PRECAUTIONS WHEN HANDLING ALL PATIENT SAMPLES 1 7 1 General Safety Guidelines Always use approved sample collection containers and ensure lids are securely closed 2 Observe Standard Precautions when taking patient samples Please ensure that you are familiar with the Infection Control and Prevention Guidelines pertinent to specimen collection which are available on QPULSE see hospital intranet website 3 Always dispose of sharps appropriately and according to the hospital waste disposal policy 4 Samples must be placed in approved biohazard bag with request form if available placed separately in the sleeve provided DO NOT PLACE SAMPLE AND FORM TOGETHER IN SAME POUCH OF BIOHAZARD BAG Always supply c
18. NAME WARD c FORE a i n Slane SEX M F Uv pe ii A a gt E ADDRESS NHS No DOB oe t StS is A 3 oe a o DATE ua amp HOSP TIME a gt 2G No PM 9 En S O wi sic 6 0 9 8082263 mel BD PL6 7BP UK aoe mL STERILETR IVD 07 1234567 2008 12 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Author s Gerard O Connor Page 83 of 157 83 7 9 MINIMUM SAMPLE LABELLING ACCEPTABLE FOR UNIDENTIFIED PATIENT S EMERGENCY SITUATIONS Medical record number Gender Date amp Time sample taken Signature of person taking the sample all hand labelled To be accompanied by a completed request form The above sample must be accompanied by a completed request form which should include an approximate age if possible 7 10 7 11 SENDING THE SAMPLES TO LABORATORY Use Blood Transfusion PTS 005 or use hospital porter phone 3503 Always place sample in plastic biohazard bag to protect the carrier the general public and staff in the Blood Transfusion laboratory Samples should be sent to the Blood Transfusion as soon as possible after taking Samples can be transported at room temperature Samples received 24hrs after taking will be rejected Samples received in the laboratory are recorded in the Laboratory Computer System Following testing the sample is stored in the laboratory at 4 C for at least 72 hours 3 days Referral samples are se
19. No blood is actually crossmatched The sample is held in the laboratory The MSBOS can be bypassed if clinically indicated by phoning the Blood Transfusion laboratory at 3965 The term 2 units indicates a Group 8 Crossmatch is performed and 2 units of red cells crossmatched Blood once crossmatched is held for 24 hrs from 09 00 of day of operation unless otherwise instructed A new sample is required for each inpatient episode Sample must be handwritten and must have the following Surname Forename Hospital number Date of birth Signature of sample taker and date taken Page 95 of 157 95 Sample must be in Blood Transfusion Laboratory by 15 45 on routine working day prior to the operation This MSBOS has been reviewed by the Hospital Transfusion Committee Updated 2015 7 23 BLOOD COMPONENTS PRODUCTS INFORMATION For further information on Blood Components Products and medical indications refer to Hospital Transfusion guidelines on QPulse and or BT Intranet Webpage All Blood Components Products must be prescribed in the Blood and Blood Product Transfusion Record and Prescription Record purple document All Traceability labels must be completed and returned to the Blood Transfusion Laboratory All adverse reactions and events must be reported to the Haemovigilance Department Blood Transfusion Laboratory Blood General Information Special Requ
20. Results and then Results for a patient Then change the Discipline selection from All to Blood Transfusion Select Find All results from the last 4 days should be visible To see previous requests extend the date range of the search Laboratory Medicine User Manual Version 8 5 Index LM Ul 0010 Printed 23 Nov 2015 03 20 1 00 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 100 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Group and Save Report A group and antibody screen report is available on KEY OCS This report contains the following information e Patient ABO and Rhesus group e Results of antibody screen e Patient special requirements if applicable e The date and time the sample was taken is displayed in the bottom left corner of the report This can be used to check if a group and save sample is still valid samples are valid for 72 hours from time taken KEY Patient Management Patient Results BEE Master Index Inpatients Orders Results Enquiries Edit Tools Window Help QUIT Patient Number PID61896 Patient Name ZZTEST Livelier Location Date of Birth 01 Oct 1999 Consultant KOE Stanley Paediatric Emergency Medicine Age BLOOD TRANSFUSION FINAL REPORT on 07 01 2015 at 15 34 Specimen Ho 10
21. The laboratory operates a collection service at designated times from the following areas Theatre ae Endoscopy Urology Mon Fri 10 30 X X X X Mon Fri 14 00 X X X Mon Fri 15 30 X X X X Saturday 10 00 X The laboratory must be notified of urgent specimens requiring collection at other times Ext 3925 Specimens from other areas in the hospital may be hand delivered to Cellular Pathology specimen reception 8 5 SAMPLE LABELLING 8 5 1 Request form All specimens must be accompanied by a completed Cellular Pathology or Andrology Semen Analysis request form see below Details must be legible addressograph labels are preferable THE ADELAIDE AND MEATH HOSPITAL DUBLIN INCORPORATING THE NATIONAL CHILDREN S HOSPITAL Hospital y THE ADELAIDE AND MEATH HOSPITAL DUBLIN INCORPORATING THE NATIONAL CHILDREN S HOSPITAL Tallaght Dublin 24 Ireland Tel 353 1 414 3971 Hospital No Surname First Name LAB No Previous Lab Number s Ward Clinic Address Consultant Hospital Tallaght Dublin 24 Ireland Tel 353 1 414 3925 Hospital No em Surname TAU Ward Clinic First Name IN Alass r gt e PRA i gt i Consultant Signature Contact Bleep No D O B Sex Priority Routine Urgent SPECIMEN TYPE if multiple specimens please list by CLINICAL DETAILS suffi
22. lt 2 For OD dosing Trough levels If Normal Renal Function monitor should be taken gt 18 hours post level twice weekly dose If Normal Renal Function monitor level once weekly Peak 10 20 Peak 5 10 Vancomycin Trough 10 20 For complicated infections e g Endocarditis Hospital Acquired Pneumonia a higher Trough of 15 20 is recommended If advice required please discuss with clinical microbiology or pharmacy Peak Not routinely required 136 Gerard O Conno Page 136 of 157 Amikacin Trough lt 5 Peak gt 50 Trough 5 10 Peak 20 30 Tobramycin Trough lt 1 Peak 10 20 Trough lt 2 Peak 5 10 Teicoplanin Standard Trough 215 For severe infections higher Trough s are required See medicines guide Peak Not routinely required 9 8 15 Serology Please label all samples clearly with the patient s name DOB or Hospital number date and time collected The following serological test is undertaken on site and requires approximately 10mls clotted blood Test Sample Sample Special PTS Frequency Cut Off Turnaround Type Volume Conditions of Test Time Time Pseudomonas Clotted blood 5 10 mls YES Batched 6 weeks Antibodies sample red top All other serological and immunological tests are referred to external laboratories for testing See Reference lab section for a list of commonly referred tests
23. with Guillane Barre syndrome Typical TAT Pathology 28 days laboratory IMMUNOLOGY Anti GAD Abs AGAD Oxford Radcliffe AntiGAD glutamic acid decarboxylase Hospitals CH antibodies are found in approximately 80 Pathology of newly diagnosed type 1 diabetes and in laboratory stiff man syndrome Typical TAT 28 days IMMUNOLOGY Anti Hu RI Yo Abs Neuronal Oxford Radcliffe Anti HU RI 8 YO are associated with Abs Hospitals CH paraneoplastic syndromes affecting the Pathology nervous system Typical TAT 28 days laboratory IMMUNOLOGY Anti Insulin Abs IA The Doctors Anti insulin antibodies are found in Laboratory approximately 30 of patients with type 1 Sonic diabetes Typical TAT 28 days Healthcare London Anti Islet Cell Abs ICA UCLH Islet cell antibodies are found in University approximately 70 of patients presenting College London with type 1 diabetes Typical TAT 28 days Hospital London England Anti Adrenal Abs ADR UCLH Anti adrenal antibodies are found in University patients with addisons disease and in College London patients with auto immune polyglandular Hospital syndrome Typical TAT 28 days London England Anti Ovarian Abs OVA UCLH Anti ovarian antibodies are found in patients University with hypogonadism addisons disease and College London in patients with auto immune polyglandular Hospital syndrome Typical TAT 28 days London England Anti MusK Ab MUSK Oxford Radcliffe
24. within 30 bacteria mins present Biopsiest In a sterile YES Mon Sat 4 30pm Culture leak proof Mon Fri 16 72 hours container 11 30 Sat Bone In a sterile YES Mon Sat 4 30pm Culture leak proof Mon Fri 16 72 hours container 11 30 Sat 1 Biopsies for H pylori the biopsy should be in sterile nutrient broth and transported to the laboratory immediately Sterile nutrient broth is available in the Microbiology Department Other tissues and biopsies Place in a sterile container for transport as soon as possible The volume of the specimen influences the transport time that is acceptable Larger pieces of tissue maintain the viability of anaerobes for longer Tissue or biopsy material in a sterile container has an optimal time for transport to the laboratory of up to 30 mins If processing is delayed refrigeration is preferable to storage at ambient temperature Delays of over 48 hrs are undesirable Culture amp sensitivity Chest Drain In a sterile YES Mon Sat 4 30pm Culture Tip leak proof Mon Fri 16 72 hours container 11 30 Sat Pacemaker In a sterile YES Mon Sat 4 30pm Culture leak proof Mon Fri 16 72 hours container 11 30 Sat Page 126 of 157 126 9 8 9 MRSA Vancomycin Resistant Enterococci VRE CRE Screens amp Environmental Screens Please label all samples clearly with the patient s name DOB or Hospital number date and time of col
25. 1 hour Tube Paed is likely Lactate Serum Clotted Red Aldosterone Electrophoresis FLC Lithium LDH Tube Cyroglobulins Laboratory Me Trace element Tube Navy Copper Zinc Copper Zinc Aluminium White Aluminium Balanced Heparin ABG lonised Calcium ABG Syringe Ez Fluids for pH SAMPLE VOLUMES It is preferable that blood tubes especially those containing preservatives are filled to their stated capacity This avoids any risk of insufficiency or interferences from excess concentrations of preservative This is mandatory for some tests e g PTH where the increased EDTA concentration that results from under filling would invalidate the test EDTA tubes for PTH must be filled to the mark It is usually possible to process smaller samples where the tube is at least half filled i e 2mls or in the case of paediatric tubes 0 7ml A limited chemistry profile can usually be obtained on such samples Laboratory Medicine User Manual Authorised on 23 Nov 2015 Authorised by Ann L Version 8 5 Index LM UI 0010 Print 2015 03 20 2 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 43 of 157 We will always try to maximise the use of any sample In the case of very short samples please indicate those tests that are of highest priority SPECIAL CASES Requests for RENIN should be accompanied by two 4ml EDTA tubes Contact the laboratory at
26. A B PCR EDTA Sample Echovirus EBV viral load Clotted blood sample 1 10ml CJD vCJD TSE CSF 2 5mls Chlamydia Psittacosis Clotted blood sample 1 10ml Corynebacterium diphtheriae Anti diphtheria toxin Streptococcus reference serology slope Clotted blood sample 1 10ml Cultured isolate sent from laboratory Clotted blood sample 1 10ml Cultured isolate sent from laboratory Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 144 of 157 144 03 20 5 LM UI 0010 Printed 23 Nov 201 Version 8 5 Index Cystic fibrosis genotype EDTA 3 5mls E coli 0157 serology E coli0157 PCR E coli 0157 Confirmation Clotted blood sample 1 10ml Faeces sent from laboratory Cultured isolate sent from laboratory Enterics Identification amp typing Salmonella Shigella Cultured isolate sent from laboratory Francisella tularensis serology Clotted blood sample Yellow fever 1 10ml Lassa Virus Clotted blood sample Marberg Virus 1 10ml Ebola Virus Crimean Congo Haemorrhagic Fever Virus CONTACT MEDICAL MICROBIOLOGIST BEFORE SENDING SAMPLE Haemophilus influenza Anti Hb antibodies CSF Joint aspirate Serum Haemophilus influenza Ant
27. DO NOT GIVE OUT YOUR PASSWORD TO ANYONE Page 26 of 157 ADULT PHLEBOTOMY SERVICE 4 0 ADULT PHLEBOTOMY SERVICE The Phlebotomy Manager may be contacted at 3040 41 4 1 PROCEDURE FOR ORDERING FOR IN PATIENTS Monday to Friday Phlebotomy Ward Rounds are given in table 4 8 below Saturday and Sunday service is for urgent requests only All requests for tests are raised on the OCS system and manual ordering using request forms is only used where there is no OCS provision this should be the exception Cut off time for ordering of blood tests is 6 00 a m Staff placing orders after this time must be aware they will not be collected until the following day In special circumstances after consultation with and the agreement of the attending phlebotomist additional requests may be placed Completed and dated request forms must contain the following information Patient Surname and First name D O B Gender MRN Clinical details Location Tests required Requesting Clinician If urgent please state clearly on request form and it will be given priority This status should be used for requests where an urgent result will add to immediate patient care as urgent requests are handled outside the normal test stream and require resources to achieve For routine tests turn around times are given in each department section in this manual and are frequently reviewed to improve efficiency Patient Identification is confirmed b
28. Ext 3952 with special queries SENT AWAY REFERRED SPECIMENS UNUSUAL REQUESTS Please contact a senior member of laboratory staff to discuss any unusual requests before sending the specimen Specimens for some specialised analysis are referred to external laboratories Samples for certain analysis will be sent away when the capacity of the local system is exceeded Reports returned for referred tests are scanned and saved on the shared drive F Shared UserGroups Clinical_ Chemistry_Referral_Reports Instruction CC LI 701G User Guide finding scanned External Referral reports Clinical Chemistry describes how to find these and is available on request Files are arranged in Year titled folders and the date returned YYMMDD The date returned is recorded in the Key OCS report The original reports are sent to the requesting team PROTOCOL FOR BLOOD GAS SPECIMENS Please Note The Blood Gas Analysers in ICU Theatre Accident amp Emergency and PHDH are for use by trained staff in those areas only Samples for Blood Gas analysis from any other location should go directly to the laboratory The protocol outlined below must be followed for samples going to the laboratory In order for the laboratory to process Blood Gas samples as quickly and safely as possible the following simple rules must be followed The heparinised syringe must be labelled with a IPMS addressograph label or a hand written label The patient s name IPMS num
29. FURTHER INFORMATION 54 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 55 of 157 55 ADULT REFERENCE VALUES Please note Reference Values are subject to regular review and may be updated The appropriate values are always shown on the report GENERAL CLINICAL CHEMISTRY COMMON PROFILES RENAL PROFILE Sodium 135 145 mmol L Potassium 3 5 5 0 mmol L Urea plasma 62 106umol L M Bilirubin plasma ALT plasma M lt 45 IU L F lt 35 IU L Alkaline Phosphatase plasma M 40 130 F 35 105 Age related variations eee F lt 40 IU L Talal Protein plasma Albumin plasma BONE PROFILE Calcium Total and adjusted plasma 2 15 2 55 mmol L Phosphate plasma 0 8 1 4 mmol L Alkaline phosphatase plasma M 40 130 F 35 105 Age related variations Albumin plasma 35 50 g L F 140 340 umol L M 16 60 umol L 285 295 mOsm kg 24 hour Urine Sodium 80 250 mmol day Potassium 30 100 mmol day Calcium 2 5 7 5 mmol day Phosphate 15 50 mmol day Urate 2 1 3 6 mmol day Creatinine 9 19 mmol day Urea 250 580 mmol day Protein lt 0 15 g day Chloride 95 105 mmol L Bicarbonate 22 28 mmol L 56 Page 56
30. Gerard O Connor Page 147 of 157 APPENDIX 1 USER SATISFACTION COMMENTS AND COMPLAINTS Description Report Mechanism Responsible 1 General Incidents and Operational Issues Laboratory Medicine Laboratory and Non conformities report departmental form management team 2 Health Safety issues Laboratory Medicine Laboratory and non conformities report departmental form management team AMNCH Risk Occupational Health management Team occurrence form Occupational Health Report 3 Complaints received verbally from staff and Laboratory Medicine Laboratory patients non conformities form Management and AMNCH Risk DISCO management Quality Manager occurrence form If deemed necessary Affected staff 4 Written complaints Laboratory Medicine Laboratory non conformities form Management and AMNCH Risk Director management Quality Manager occurrence form If deemed necessary Affected staff Medical Director Patient Advocacy letter AMNCH Patient Advocate 5 Significant operational exceptions Laboratory Medicine Laboratory Manager Service Exception Analysis form 6 Significant risk incidents AMNCH Risk Laboratory management Management team occurrence form Quality Manager Affected staff Risk Manager AMNCH Page 148 of 157 148 User satisfaction is monitored in a variety of ways User focus groups e g GP Liaison Committee User satisfaction surveys Multidisciplinary team
31. Index Lh Test Sample requirements Comment Fluorescent in situ Hybridisation FISH for detection of gene rearrangement lymphoma Formalin fixed paraffin embedded tissue selected by a pathologist Available in consultation with Dr Michael Jeffers consultant pathologist Ext 3921 HER2 amplification status Formalin fixed paraffin embedded tissue selected by a pathologist Requests for HER2 testing must be made via a consultant histopathologist Molecular testing e g EGFR ALK RAS BRAF GIST molecular analysis Formalin fixed paraffin embedded tissue selected by a pathologist Please contact the Cellular Pathology office Ext 3929 Renal Biopsies Place in saline Transport immediately to the lab Must be accompanied by the multipart Beaumont Hospital request form these request forms are not available in the lab must be sourced directly from Beaumont Hospital Please attach an addressograph label to all parts of this form Cellular Pathology must be notified in advance when a renal biopsy is planned Phone 3925 3973 and the sample must be received in the lab no later than 4pm to ensure dispatch to Beaumont Hospital Duodenal biopsy for disaccharidase analysis Fresh wrap in saline moistened gauze Send immediately to the lab Samples are snap frozen and held at 70 C until a paediatric pathologist has reviewed the permanent sections and decided whether disaccharidase analysis is
32. NUMBER IS CORRECT Close the door Green indicator light comes on The carrier will automatically transfer when the system is ready 2 3 QUEUING The central processor continuously monitors the status of each station and will hold the carrier until the line is clear for transfer When possible users should batch items to reduce traffic in the system This will speed up transfer times by reducing the queue length 2 4 RECEIVING A CARRIER When a carrier is approaching e Itis automatically slowed down before entering the station The amber Carrier Arriving light comes on An audible alarm sounds The carrier pod on arrival will be deposited in the basket attached to the station The alarm and lights go off The station display indicates ARRIVAL and the SENDER STATION THE RECEIVER SHOULD EMPTY THE CARRIER AND IMMEDIATELY RETURN TO SENDER STATION PLEASE REDIRECT MIS ADDRESSED CARRIERS TO THE CORRECT LOCATION ere 150 Page 150 of 157 2 5 SYSTEM FAILURE OR MALFUNCTION In the event of a system failure or malfunction a code will be displayed on the workstations The system may purge automatically in which case it will dump the 2 carriers in the system down to stations These stations will require that those carriers are redirected In the event of a full malfunction the contact numbers for Technical Services are as follows In Hours 414 2901 2902 Lunch Time Phone Security Department on 2100 Out of Hours Dial s
33. Pathology Lab Beaumont Hospital final report Duodenal biopsy for Paediatric Biochemistry Haematology Royal i3 weeks disaccharidase analysis Hospital for Sick Children Edinburgh Nasal brushings for Biomedical Imaging Unit Southampton General 13 weeks electron microscopy Hospital Skin biopsy for Glutaric Chemical Pathology Sheffield Children s 13 weeks Acidaemia Type 1 Hospital Cervical Smear Samples Cytology Coombe Hospital 4 6 weeks 8 8 3 Specimen retention time and requesting additional tests e Histology specimens are kept for approximately 6 weeks post receipt or 4 weeks following authorisation of the report e Cytology specimens are kept for 2 weeks post receipt e Paraffin blocks and stained slides are retained permanently e Any additional tests must be arranged through direct contact with the reporting consultant pathologist 111 Page 111 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 8 9 CLINICO PATHOLOGICAL CONFERENCES MDTS Clinico pathological conferences are held in the Seminar Room in the Laboratory Medicine Department and in the Seminar Room in the Radiology Department Details of cases for discussion Name MRN Specimen Type Date of Procedure must be supplied to the departmental secretaries extension number 3929 3928 at least 2 working days before the date of the conference See chart below This is to allow sufficient time for slides to
34. Potassium lt 2 50 mmol L gt 7 0 mmol L Calcium Corrected lt 1 80 mmol L gt 3 20 mmol L Phosphate gt 5 00 mmol L Magnesium lt 0 50 mmol L gt 2 00 mmol L Urea gt 50 0 mmol L Table 3 Table of Serum Therapeutic drug critical levels for phoning Carbamazepine gt 25 0 mg L Digoxin lt 0 3 and gt 2 6 ug L Phenobarb gt 45 0 mg L Phenytoin gt 30 0 mg L Theophylline gt 30 0 mg L Valproate No need to phone unless stated overdose Cyclosporin Renal gt 300 ng ml Lithium lt 0 30 mmol L gt 1 00 mmol L Table 4 TABLE OF ENDOCRINOLOGY CRITICAL LEVELS FOR PHONING Cortisol lt 90 nmol L Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 36 of 157 36 FT4 TSH Grossly Abnormal results eg TSH gt 75 IU L FT4 gt 75 pmol L HCGS HCGU All positive pregnancy tests 5 7 STAT LAB EMERGENCY SERVICES The emergency service is available on a 24 hour 365 day basis The range of tests outside routine hours is restricted see below In certain circumstances other tests may be requested but these would require discussion with the person on call or with the laboratory medical staff on duty NOTIFICATION OF EMERGENCY WORK Within routine hours pleas
35. a guideline for ordering blood for surgical procedures e A Group and Save is where the sample is Grouped screened for antibodies and plasma saved in advance of the proposed procedure If the screen is negative crossmatched blood can be provided in an emergency within 35 45minutes of a phoned request If the screen is positive provision of blood can take longer depending on the antibody e Blood is not crossmatched for operations associated with little or no blood loss e Blood is reserved for a period of 24 hours from 09 00 on day of operation unless otherwise requested e f the Operation has been cancelled and blood has been ordered inform the Laboratory 93 Page 93 of 157 Orthopaedic Surger ORIF OTHER ind Sacrum 6 S ORIF PELVIC 2 units TKR JG ss TKR revision 2 units TRO fs IHR revision 2 units Bone Grafting G S Dynamic Hip Screw G S Depends on severity of fracture Girdlestone 4units __ Arthrotomy 7 Arthroscopy None emiarthoplasty Austin Moore 2 units Laminectomy Prosthesis Thompsons 2 units Leg Amputation 2 units Prosthesis Fractured NECK of Femur auns M nail femur units o M nail tibia and otherbones es i ebridement knee ankle units Wiring wrist finger toes units MUA Manipulation under O Decompression anaesthetic EUA Examination under ee oe surgery G S anaesthetic General Surgery G I Surgery Cholecystectomy None Abdominal Peritoneal 4 units Res
36. date and time of sampling DD MM O O 000 All samples for Blood Transfusion e g Group and Antibody screen should be handwritten with Full Name Date of Birth Date and time of sampling Signature of person taking the blood o0o0o0o 0 Note Use a 6ml EDTA tube for these Blood Transfusion tests 2 1 2 PACKING REQUIREMENTS FOR TRANSPORT OF SAMPLES The laboratory does not process leaking unlabelled or mislabelled specimens e Samples must be placed in a biohazard bag with request form placed separately in the sleeve provided DO NOT PLACE SAMPLE AND FORM TOGETHER IN THE SAME POUCH IN BIOHAZARD BAG gt Samples are placed in the approved transport box carried by the courier gt In the case where patients are requested to drop in samples to the laboratory it is important that the same level of care is taken with the identification and packaging of specimens SAMPLE REJECTION CRITERIA Test requests may be rejected if the following situations apply e Sample types not compatible with tests requested Significant difference between patient identifiers on sample and corresponding request form MRN provided does not match the other details on the request form Samples that do not have at least two acceptable identifiers Sample volume inappropriate where applicable Samples which are past the recommended time from phlebotomy to analysis Expired sample collection tubes Where sample quality would effect analysis e g haemol
37. dimer 24 hours post phlebotomy Fibrinogen 24 hours post phlebotomy Haematinics 3 days if sample supplied in gel tubes otherwise 24 hours post phlebotomy Reticulocytes 24 hours post phlebotomy Blood film 24 hours post phlebotomy morphology may not be reportable RESULTS ENQUIRIES TECHNICAL AND CLINICAL ADVICE Haematology General Enquiries result enquiries 3933 3959 e Advice on interpretation of results sampling amp storage procedures and frequency of requesting will be directed to the appropriate person e Clinical advice amp information for users of laboratory services on medical indications and appropriate selection of available procedures should be sought directly from the Clinical Haematology Team 6 4 EMERGENCY ON CALL SERVICES FOR HAEMATOLOGY amp BLOOD TRANSFUSION Haematology amp Blood Transfusion Monday to Friday 8 pm 8 am Saturday 12 30 pm Sunday 9 am Sunday Bank Holiday 9 am 8 am Emergency On Call Bleep 7281 On Call Service covers both Haematology and Blood Transfusion Departments The Scientist On Call MUST be bleeped when Urgent Samples are being sent during On Call periods Page 64 of 157 Printed 23 Nov 2015 03 20 User Manual Version 8 5 Index LM UI 0010 Laboratory Medicine STAFF COMPLEMENT Up to Midnight 2 Scientific Staff Midnight 8 am 1 Scientific Staff URGENT TESTS AVAILABLE ON CALL Full Blood Count Differential PT INR APTT A
38. drink driving cases Additional Toxicology investigations can be included in the local emergency repertoire as the need arises Any such requirements should be discussed with the Consultant Chemical Pathologist Toxicology requests which cannot be met locally should be discussed with the Toxicology Lab in Beaumont Hospital Tel No 01 8092673 01 8092675 Mobile 087 2590749 Fax 01 8092435 5 8 SERVICE AGREEMENTS FOR VARIOUS INVESTIGATIONS We will endeavor to meet the following standards subject to availability of sufficient staff and other resources including the Order Communications System OCS ALL USERS STANDARD SET Routine Clinical Chemistry OCS 90 released to OCS within 4 hours of receipt subject to cut off requests Routine Endocrinology OCS 90 released to OCS on the next working day requests Blood Gases Release to OCS within 15 minutes of receipt SPECIAL ARRANGEMENTS STANDARD SET Agreed daily ICU Profile received before 07 45 will be released to OCS by 09 00 Dialysis Potassium Release to OCS within 20 minutes of receipt Page 39 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 5 9 ASSAY FREQUENCY TURNAROUND TIMES SAMPLE TYPE Available Urgently without consultation Normal Hours 8am 8pm Sample Type Analyte Assay Frequency TurnAround Time Comment Turnaround times TAT of Clinical Chemistry tests are regularl
39. dut ARE cad is a del eth ase 12 1 8 SPECIMEN TRANSFOR Tecnicacnsocio cicatrices a ee oth adh hat e elo 12 1 9 AMNCH MAJOR EMERGENCY PLAN cosita aiii ii 13 1 10 IMMUNOLOGY REFERRALS cuts e o 14 TELE GENENG TESNO cistitis rata tete reitera 19 1 12 POINT OF GARE TESTING POGT s cc 4 0 nthe diamond ae anden ici 22 2 0 GENERAL PRACTITIONER GP SERVICES cooconicnnnicnncnincincnnnncaconanra nora rra rr rn 23 1 1 PARTICULAR REQUIREMENTS FOR USE OF COURIER SERVICE FOR SAMPLE COLLECTION FROM GP PRACTICES 2 i c 0 2esicnieeeiiletidcaciecidnediisedilacladllcileslalenieides 23 22 GP REPORTS AND ENQUIRIE S sane por ee totalidad di dl dei 24 2 3 GP LIAISON GROU P nenita A A a ld de le ad 25 2 4 INFORMATION FOR GP S ON AMNCH INTERNET SITE ou eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeneeees 25 2 5 SAMPLE TYPE SAMPLE VOLUME AND REQUIREMENTS FOR PARTICULAR TESTS 25 ORDER COMMUNICATIONS SYSTEM KEY cecceeceeeeeeeceeeeeeeereeaeceeeeeeaecaeeseeseeseaesaeseeseaeeaeeeessaesnaeeaeeeees 26 3 0 ORDER COMMUNICATIONS SYSTEM KEY ceceeceeceeceeeeeeeeeeeeeeeeeeseeserseaecaeeeeseaeeeeeeeseneeeetenes 26 ADULT PHLEBOTOMY SERVICE niairt ie oa naea tai aa aae aa ataiadi 27 4 0 ADULT PHLEBOTOMY SERVIC Epia nt araa aa fate 27 4 1 PROCEDURE FOR ORDERING FOR IN PATIENTS oc cocc niooo rosso eins ia cebada ica li 27 4 2 PROCEDURE FOR MANUAL ORDERING FOR OUT PATIENTS seese 28 4 3 REQUEST FOR GROUP amp CROSSMATCH SAVE SAMPLE ooocccnccccocccncconcnancnncnncno
40. genotype In all cases the referral laboratory issues a commented report and you will find that they may include specific useful references associated with the particular mutation reported on and the tests methodology probes used in the analysis gt Reporting of genetics and molecular genetic testing is viewed as confidential The Laboratory Medicine Department maintains a scanned copy of those reports that have been returned to them gt As noted above the National Centre for Medical Genetics may forward samples for genetic testing to a specialised centre in the UK Europe or North America In these cases reports will be returned in the first instance to the NCMG and subsequently forwarded to the requesting clinician with a copy going to Laboratory Medicine These latter requests are expensive and the Hospital at AMNCH is specifically charged for these referral tests If you have technical questions relating to the constitutional genetic service please contact Dr Gerard O Connor at 3905 or a senior member of the Laboratory team The Laboratory continues to develop the Genetic Reporting Service to our clinicians amp are presently reviewing ways in which OCS may be utilised as part of the service Important General Notice Regarding Referral Testing We regard referral testing as vital to our clinical colleagues and supportive of their clinical need to deliver the best possible care to their patients In particular we regard it as
41. is department policy to respond in an open positive and professional manner to issues raised in line with the value statement of the hospital corporate and open disclosure If necessary adjustment to process may ensue Please refer to APPENDIX 1 for information on comment and complaint reporting mechanisms 2015 03 20 10 2 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 10 of 157 1 4 IMPORTANT ISSUES WHEN USING THE LABORATORY MEDICINE SERVICE THE MECHANISM FOR REQUESTING TESTS IS THE OCS ELECTRONIC REQUESTING SYSTEM KEY THIS SHOULD BE USED IN ALL CASES UNLESS A TEST OR PROCEDURE IS NOT LISTED SAMPLES ARE LABELLED WITH THE BARCODE LABEL PRODUCED BY THE SYSTEM IF A PAPER REQUEST FORM IS USED PLEASE COMPLETE ALL SECTIONS OF REQUEST FORMS IN A FULLY LEGIBLE MANNER IN PARTICULAR IT IS IMPORTANT TO INCLUDE PATIENT ID INFORMATION THE AMNCH PATIENT REGISTRATION NUMBER MRN INVESTIGATIONS REQUESTED DATE AND TIME OF SAMPLE COLLECTION RELEVANT CLINICAL INFORMATION RESPONSIBLE CLINICIAN S NAME THE LOCATION OF THE PATIENT IT IS ESSENTIAL THAT ALL SAMPLES ARE LABELLED WITH A MINIMUM OF TWO IDENTIFIERS PATIENT FULL NAME AND MRN OR DATE OF BIRTH THE PERSON TAKING THE SAMPLE SHOULD INITIAL THE LABEL ON THE TUBE SAMPLES FOR BLOOD TRANSFUSION MUST HAVE 3 IDENTIFIERS PATIENT FULL NAME MRN DATE OF BIRTH AND MUST BE SIGNED BY THE PERSON TAKING THE BLOOD ALWAYS USE BLOOD COLLECTION T
42. legibly Addressograph labels are acceptable on the request forms only e Fill out all details on form as follows Patient Details Full name Date of birth Hospital number and gender must be stated otherwise the request form is rejected awaiting correction or new form Addressograph label is acceptable but ensure you hand write the Consultant and Ward as this information is not on the label Tick if patient Day case or in patient Clinical Details Primary This assists laboratory in blood selection for diagnosis the Patient Surgical Some surgical procedures require Procedure crossmatched blood others do not The number of units to request is listed in the suggested Maximum Surgical Blood Order Schedule contained in this manual Blood Group This section collects transfusion history on patient Fill in information as is available Haematology value E g Hb Platelet count Coag Screen Results etc Test Required Group and Save This is a blood group and antibody screen and sample is saved in case a crossmatch is required later Group and Crossmatch This is a Group Antibody Screen and Crossmatch This should be ticked if you are going to transfuse a patient or for a surgical procedure check the M S B O S to find out how many units to request If in doubt contact the Scientist 3964 3965 Other This is for requesting another test e g DCT cold agglutinins or ADD ON request fo
43. of laboratory staff before sending the specimen Specimens for some specialised analysis are referred to external laboratories A complete list of details of all referral laboratories is contained in the form CC LF 701G this is available on request Referral Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 42 of 157 42 20 LM UI 0010 Printed 23 Nov 2015 03 dicine User Manua laboratories are evaluated and selected in terms of competence to perform the requested examinations and accreditation status 5 10 SPECIMEN GUIDE BLOOD SPECIMENS The common specimen requirements are heparinised plasma serum from whole blood which has clotted fluoride oxalate plasma and EDTA whole blood or plasma For most biochemical and endocrine tests the preferred specimen tube is a 5mL heparinised tube Requests raised using OCS will generate a label with the appropriate sample type indicated Specimen Guide Blood Tubes Lithium Heparin Green Orange Most Clinical Chemistry analyses except those Tube Paed stated below Glucose assuming analysis within 1 hour EDTA Tube Purple HbA1c Renin ACTH PTH Lead Homocysteine Cyclosporin FK506 Fluoride Oxalate Grey Yellow Glucose where a delay before analysis of gt
44. of patients with atrophic gastritis and pernicious anaemia They may also be found in patients with other autoimmune endocrine disorders and in healthy relatives of patients Typical TAT 3 7 days Anit Liver Kidney Microsomal Fraction LKM Anti Liver Kidney Microsomal antibodies are associated with autoimmune hepatitis LKM titre follows positive tests Typical TAT 3 7 days CSF for Oligoclonal Banding CFSO Should be sent through the normal requesting mechanism for CSF examination It is imperative in all cases that a serum sample is taken in order to correctly calculate the IgG index in the CSF and facilitate proper comparison of the Electrophoresis Protein Pattern Page 15 of 157 15 Common referral immunology tests ae Referral Test Abbreviation Laboratory Notes Acetyl Choline Abs ACHR Oxford Radcliffe Anti acetyl choline receptor antibodies are Hospitals CH strongly associated with myasthenia gravis Pathology but the test may be negative in laboratory approximately 10 15 of patients with this IMMUNOLOGY disorder Typical TAT 28 days Anti Ganglioside Abs AGM1 Oxford Radcliffe Anti ganglioside antibodies are associated GM1 Hospitals CH with Guillane Barre syndrome Typical TAT Pathology 28 days laboratory IMMUNOLOGY Anti Ganglioside Abs AGQ1 Oxford Radcliffe Anti ganglioside antibodies are associated GQib Hospitals CH
45. of the tubes are mixed thoroughly with the blood The following protocol should be followed for optimal results For each patient collect 1 ml of blood directly into each of Quantiferon TB gold IT blood collection tubes As they are 1 ml tubes draw the blood relatively slowly keeping the tube on the needle for 2 3 seconds once the tube appears to have completely filled to ensure the correct volume is drawn The black mark on the side of the tube indicates the 1ml fill volume If a butterfly needle is being used to collect blood a purge tube should be used to ensure that the tubing is filled with blood prior to the Quantiferon TB gold tubes being used Mix the tubes thoroughly by turning the tube end over end 8 10 times or shaking the tubes for 5 seconds Label the tubes appropriately and deliver the sample to the specimen reception area in the microbiology laboratory Samples will be accepted up to 4 30pm Monday to Thursday Samples should be stored at 33 37 C if there is a delay this should be done in the laboratory They should not be refrigerated or frozen Any queries regarding the collection and transport of samples please contact Microbiology specimen reception at 4143940 These samples are processed in the Mater Misericordiae Hospital 134 Page 134 of 157 9 8 14 Antibiotic Assays Please label all samples clearly with the patient s name DOB or Hospital number date and time collected
46. sputum S Friday processing processing container specimens Culture collected on Negative 3 8 weeks consecutive Positive days Telephoned on day of detection Urinet At least 5mls 3 early Y By request only By 9am on Microscopy in a sterile morning E See note below day of On day of universal urine S processing processing container specimens Culture collected on Negative 3 8 weeks consecutive Positive days Telephoned on day of detection BAL At least 5mls Y Monday By 9am on Microscopy bronchial in a sterile E Wednesday amp day of On day of brushes universal S Friday processing processing bronchial container Culture washings Negative 8 weeks Positive Telephoned on day of detection Pleural At least 1ml Y Monday By 9am on Microscopy Fluids in a sterile E Wednesday 8 day of On day of universal S Friday processing processing container Culture Negative 8 weeks Positive Telephoned on day of detection Body fluids At least 1ml Y Monday By 9am on Microscopy in a sterile E Wednesday amp day of On day of universal S Friday processing processing container Culture Negative 8 weeks Positive Telephoned on day of detection Gastric At least 5mls Y Monday By 9am on Microscopy lavage in a sterile E Wednesday amp day of On day of universal S Friday processing processing container Culture Negative 8 weeks Positive Telephoned on day of detection CSF At least 1 N Monday By 9am
47. studies o Constitutional karyotype Chromosome FISH testing for all other patients is referred to an independent laboratory currently www Biomnis ie for analysis o Molecular testing is referred in the first instance to the National Centre for Medical Genetics at Our Lady s Hospital for Sick Children Crumlin Dublin 12 This is the designated national centre for medical genetics Hereditary Haemochromatosis testing is not available at NCMG The NCMG will carry out onward referral for tests outside their scope to reputable laboratories abroad o Tests for Array CGH Chromosome analysis are referred to ViaPath at Guy s and St Thomas NHS Foundation London In all cases correct request forms for the designated referral laboratory together with a signed consent form are required Request and consent forms are available on the referral laboratory websites and illustrated below Cut off time for receipt of requests is 12 00 noon on Thursday of each week 19 rsion 8 5 Index LM UI 0010 Page 19 of 157 03 20 2015 23 Nov 010 Printed LM UI 0 Inde ry Medicine User Manua Direct referral to international centres of excellence may be required by our clinical teams when a patient presents with a known or suspected rare molecular defect The Laboratory facilitates this service following discussion and the arrangement is for samples to be sent directly to these centres using their designated request forms see i
48. the hospital pneumatic tube system PTS Blood 2 bottles agreen 10 mlof Do not exceed NO Mon Sun Culture Culture top Aerobic and blood the l blood Negative Adults a purple top manufacturer s cultures are 5 days Anaerobic recommended continuously Positive maximum volume tor each monitored Peat bottle on ay o detection Blood 1 bottle a yellow Neonates Do not exceed NO Mon Sun Culture Culture top bottle 1 2 ml the blood Negative Paediatrics f paediatric Infants manufacturer s cultures are 5 days bottle unavailable 5_3m recommended continuously Positive use 1green maximum aerobic bottle dead volume for each monitored eta children bottle on day o 3 5ml detection Optimal time of collection Before Antimicrobial therapy where possible and as soon as possible after a spike of fever except in endocarditis where timing is less important NOTE If blood for other tests such as blood gases or ESR is to be taken at the same venepuncture the blood culture bottles should be inoculated first to avoid contamination It is preferable to take blood for culture separately Notes on transport Where there is a delay in transport to the laboratory and or loading on to the automated system blood cultures should be incubated at 33 37 C as soon as possible after inoculation pending processing and must not be refrigerated If an incubator is unavailable on the ward storage at
49. to all children O Rh D Positive uncrossmatched blood will be issued to all women above child bearing age O Rh D Positive uncrossmatched blood will be issued to all men When Patient Blood Group becomes available group specific blood will be issued 7 25 Referral Tests A number of tests are not performed in Tallaght Hospital and are referred out for testing by external laboratories See 7 3 Services amp Products amp turnaround times Tissue Typing Request Form 99 Page 99 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 National Tissue Typing Reference Laboratory NTTRL REQUEST FORM BT 255 1 Irish Blood Transfusion Service National Blood Centre James s Street Dublin 8 Tel 353 1 432 2975 Fax 353 1 432 2933 Please ensure specimen is labelled with Full name Date of birth Hospital No and date of collection Nature of specimen Date time sample taken ii Date of Birth Sex Laboratory No Order No Refering Centre Surname Copy of report to Dr z Diagnosis amp clinical history PLEASE COMPLETE FOR IMMEDIATE AND EXTENDED FAMILY MEMBERS ONLY Donor relationship to patient Patient name Date of most recent Any history of NAITP Previous transfusion Additional Intormation Investigations Required HLA B27 typing 7 10m citrate EDTA HLA Class amp Il t
50. to http www allergyeducation co uk Criteria for Ordering Specific Allergy Tests As a guide to allergy testing in rhinitis and childhood eczema due to food allergy the following screens may be considered LM UI 0010 Printed 23 Nov 2015 03 e Perennial Rhinitis Screen Specific IgE to House Dust Mite HDM Cat and Dog Dander e Seasonal Rhinitis Screen Specific IgE to Mixed Grass Pollen and Mixed Tree Pollen e Childhood Eczema Food Allergy Screen Specific IgE to Mixed Food Milk wheat cod soya bean egg white Mixed fish Cod mussel shrimp salmon and tuna and peanut THIS SCREEN WILL ONLY BE AVAILABLE FOR CHILDREN lt 13 YEARS Samples from adults should be tested for a maximum of 3 specific food allergens y Medicine User Manua Available resources St James s Hospital Department of Immunology Allergy Advice Service is intended to support medical staff in the diagnosis of allergy For allergy advice please email AllergyAdvice stjames ie 2015 03 20 17 2 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 17 of 157 1 10 4 Immunology Result Reporting Immunology result reporting takes place in 2 stages e A copy of the printed laboratory report is provided on all completed requests These reports are returned to Laboratory Medicine Department where they are reviewed and then sent to the clinical teams medical records for charting e Reports are transferred daily by electronic means fro
51. you need further tests on a specimen that is already in the laboratory send a Request form for Additional Tests CC LF 001A to the laboratory All sections must be completed including Reason for the addition of these tests Use this form only for Clinical Chemistry tests Analyses for additional tests are subject to stability of analyte In general tests can be added up to 24 hours post collection after 24 hours it is preferable to collect another sample Some tests are not suitable for add on requesting these are 34 edicine User Manual Version 8 5 Index LM UI 001 Page 34 of 157 Alcohol ETOH May be possible up to 6hrs Subject to sample suitability Ammonia Bicarbonate C Peptide Electrophoresis Glucose HCG Insulin lonised Calcium Lactate Tumour Markers UIBC May be possible up to 6hrs Subject to sample suitability TELEPHONING OF RESULTS All reasonable efforts will be made to communicate critical results These will be telephoned to the requesting source or the requesting team Special arrangements will be agreed with certain users to reduce unnecessary phoning of results Table of Critical Values for Specific Serum Analytes for phoning Analyte Results to be Phoned Sodium lt 125 mmol l gt 150 mmol L Potassium In patient lt 2 50 mmol l gt 6 00 mmol L Potassium GP OPD lt 2 9 mmol L gt 6 0 mmol L Potassium Haemol
52. 032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 138 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Stool 5 to 10g should be transported in a sterile universal container Transport medium is not required For Molecular detection of Norovirus specimens should be transported to the laboratory as soon as possible post collection Alternatively soecimens may be stored at 4 C for up to 72 hrs before dispatch For Norovirus Winter Vomiting Bug faeces samples should be restricted to 1 in 4 patients Cerebrospinal Fluid If possible collect 1ml into a sterile container for virus isolation and molecular investigation Transport medium is not required Specimens should be transported without delay Urine 10 to 20ml of urine should be sent in a sterile container Specimens should be transported without delay Respiratory Secretions Respiratory viruses are extremely thermolabile and therefore should be transported to the laboratory without delay The quality of the sample is a major determinant in identifying the causative agent Throat swabs and other swabs are obtained by swabbing the affected site with Viral Transport Swabs Nasopharyngeal secretions should be aspirated into a sterile plastic mucous extractor Transport the mucous extractor with the secretions to the NVRL Throat washings are collected by asking the patient to gargle with 10ml of saline solution w
53. 15022225 Blood group A Rh D POSITIVE antibody Comment HO ANTIBODIES DETECTED DETAILS ON PAPER REPORT Special Requirements K 1 Group and Save on Sample Date and Time 07 Jan 2015 15 21 djk Print List Cumulat Return Alison Harper KPRD 07 01 2015 15 36 A start E winPath ws L15 BT El WinPath amich loo KEY Patient Managem Foro 15 36 Product Availabilit A crossmatch report similar to the printed crossmatch report is not available on KEY OCS Please contact Blood Transfusion Laboratory for information on product availability Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 01 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 101 of 157 CELLULAR PATHOLOGY 8 0 CELLULAR PATHOLOGY The Department of Cellular Pathology provides a comprehensive Histopathology and Cytopathology service The Department complies with the International Standard ISO 15189 Registration Number 330 MT and the regulations policies terms and conditions of the Irish National Accreditation Board INAB Contact for general enquiries reports etc 3929 3928 3985 Enquiries for clinical advice and sampling procedures will be directed to the appropriate person 8 1 CELLULAR PATHOLOGY CONTACT NUMBERS Key Personnel Dr Barbara Loftus Consultant Hi
54. 3 15 May 2015 Page 53 of 157 53 HPRA SN2015 09 Issue Date 21 May 2015 Uric Acid N Acetyl Cysteine Interference y Results Roche Safety Notice CCFSN 03 15 May 2015 HPRA SN2015 09 Issue Date 21 May 2015 Testosterone Nandrolone Strong interaction with Method Nandrolone Do not use information sheet samples from patients on Nandrolone treatment Urine Toxicology Various This is an immunological Method Screen based screening test and is subject to interferences A full list of interfering substances is available on request information sheet Cyclosporin Tacroli mus Itraconazole Patients on Itraconazole treatment must be discussed with the laboratory to arrange measurement of Ciclosporin or Tacrolimus at another site analytical interference with Tallaght Method information sheet Immunoassays Cobas 8000 Biotin gt 5mg day Samples should not be taken until at least 8 hours following biotin administration Method information sheet lron TIBC Satura tion Oxytetracycline Iron Supplements Deferoxamine Ferritin gt 1200ug L Oxytetracycline causes artificially low TIBC Iron Supplements may result in falsely high TIBC Deferoxamine binds iron and interferes If Ferritin gt 1200ug L do not use TIBC or sat results Method information sheet THIS IS NOT A COMPLETE LIST CONTACT CLINICAL CHEMISTRY FOR
55. 6 72 hours universal 11 30 container Sat Sinus Secretions Ina YES Mon Sat 4 30pm Culture sterile Mon Fri 16 72 hours leak proof 11 30 container Sat Nasopharyngeal Ina YES Mon Sat 4 30pm Culture Aspirate sterile Mon Fri 16 72 hours leak proof 11 30 container Sat Conno Page 120 of 157 120 Note BALs are routinely cultured for bacterial pathogens as well as TB and fungi Specimens requiring examination for Pneumocystis jiroveci formerly carinii are referred to Biomnis Laboratories Requests for examination for CMV are referred to the National Virus Reference Laboratory Normally culture results are available 48 hours after receipt of the sample but sputum from cystic fibrosis Sar take dE as some of the bacteria are slow rue and difficult to Tura Legionella Urine 20ml YES Mon Fri 4 30pm Result Urinary Mon Fri available on antigen day of testing Pneumococcal Urine 20ml YES Mon Fri 4 30pm Result Urinary Mon Fri available on antigen day of testing If transportation is delayed please refrigerate at 4 C 9 8 4 Gastrointestinal Infection Please label all samples clearly with the patient s name DOB or Hospital number date and time of collection and the specimen type Please send separate specimens and forms for each test request If only one specimen is received with multiple requests it will cause delays in re
56. 74 s Gerard O Connor Page 74 of 157 7 2 CONTACT NUMBERS PERSONNEL LIST POSITION NAME CONTACT NUMBER Consultant Haematologist Prof Helen Enright Ext 3912 Head of Department Consultant Haematologist Dr Johnny Mc Hugh Ext 3913 3966 Consultant Haematologist Dr Ronan Desmond Ext 4132 Registrars Bleep 6258 or 7025 Routine Laboratory Routine Laboratory Ext 3964 3965 08 00 17 00 On Call On Call Bleep 7281 Chief Medical Scientist Mr Gerry Judge Ext 3910 Senior Medical Scientist Ext 3998 3999 Haemovigilance Officer Mary Judge CNM II Ext 2437 Bleep 2111 Haemovigilance Officer Helen Byrne CNM II Ext 2372 Bleep 2110 Blood Delivery Porter Blood Delivery Porter Bleep 7266 Page 75 of 157 75 7 3 SERVICES amp PRODUCTS amp TURNAROUND TIMES SERVICE WHEN SAMPLE TURNAROUND TIMES PRODUCT AVAILABLE REQUIRED NOTES SPECIAL REQUIREMENTS Routine 6ml EDTA For routine requests results blood will Group Requests Blood be available same day if received before Save Sample 15 45 or by 12 00 next routine morning if INAB Mon Fri pink Top received after 15 45 Accredited 09 00 15 45 Bottle Test For urgent requests results blood will Sat be available in 4 hrs If required sooner Group 09 00 11 00 the lab must be phoned by the INAB requesting doctor Results blood will be Accredited Urgent available in 45 60 mins Test Requests at all times Emergency unc
57. A A Ea ze oe CCU ICU MALE FEMALE MALE FEMALE DECISION RELATED PSYCH O P D G P SURG SURG MED MED UNIT HEALTH REFER REFER 7 30am 7 30am 7 30am 7 30 am 7 30 am 7 30am 7 30 am 7 30 am 7 30 am 7 30am 8 00am 10 00am 11 30am 9 30am 8 30am 12 00pm 12 00pm 12 00pm 12 00pm 8 30am 8 30am 8 30am 4 45pm 1 30pm 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 8 00am 10 00am 11 30am 9 30am 8 30am 12 00pm 12 00pm 12 00pm 12 00pm 8 30am 8 30am 8 30am 4 45pm 1 30pm 7 30am 7 30am 7 30am 7 30 am 7 30 am 7 30 am 7 30 am 7 30 am 7 30 am 7 30am 8 00am 10 00am 11 30am 9 30am 8 30am 12 00pm 12 00pm 12 00pm 12 00pm 8 30am 8 30am 8 30am 4 45pm 1 30pm 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 8 00am 10 00am 11 30am 9 30am 8 30am 12 00pm 12 00pm 12 00pm 12 00pm 8 30a 8 30am 8 30am 4 45pm 1 30pm 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 7 30am 8 00am 10 00am 11 30am 9 30am 8 30am 12 00pm 12 00pm 12 00pm 12 00pm 8 30am 8 30am 8 30am 4 45pm 1 30pm N A 6 50am 6 50am 6 50am 6 50am 6 50am 6 50am 6 50am 6 50am N A N A N A 8 00am 7 30am 12 00pm 12 00pm 12 00pm 12 00pm 8 30am 8 30am A A A A 7 00am N A 7 00am N A N A N A N A N A N N N 10 00am 11 00am Gogarty Crampton Maguire Osborne Burkitt SACU CCU Page 31 of 157 N SACU
58. ANOTHER HOSPITAL All Blood Components Products leaving the hospital must be Correctly stored during transport Correctly documented to ensure traceability Inform the blood transfusion Laboratory of patient transfer and of what blood components products are required Staff in the Blood Transfusion Laboratory will prepare Blood Components Products for transfer in Blood Transport boxes 90 Page 90 of 157 e The Blood Components Products will be labelled for the patient and be accompanied by a Crossmatch Report Chart Copy form for red cells which will contain patient and product information For other products the appropriate chart copy report will be sent e g Platelet Report Chart Copy e All blood blood products and components transfused during transfer must have their traceability labels removed signed dated and Returned to the blood transfusion laboratory e It is mandatory that all blood components and products transfused are traceable When a patient is being transferred all components products transfused must be documented in the Blood and Blood Product Prescription Record all traceability labels must be completed and returned to the Blood Transfusion lab in Tallaght Hospital e Itis the responsibility of the nurse doctor accompanying the patient to return the Blood Transport boxes with any unused blood components products to the Blood Transfusion lab in Tallaght Hospital along with traceability lab
59. GY o Assay Sample Special Conditions sample handling TAT g Type requirements Full Blood Count EDTA Urgent 1 hour E Purple Routine 3 hours FDifferential White Cell Count EDTA Urgent 1 hour g Purple Routine 3 hours Peripheral Blood Film EDTA 2 routine working 3 Purple days FReticulocyte Count EDTA Urgent 1 hour Purple Routine 3 hours FE S R od 1388 Small label on the top of inner tube 24 hours Es Bla must be labelled with one form of a patient id Do not stick addressograph gt labels along the length of the inner tube Infectious Mononucleosis EDTA 24 hours Screen Purple Malaria Screen Blood Smear EDTA Must contact lab before sending Efor Parasites Purple sample Fresh sample to be sent without delay to the laboratory Sickle Cell Screen EDTA 8 hours Purple Urine Myoglobin Urine 8 hours Haemolytic FBC Film Retic 2x EDTA Urgent 1 hour anaemia DCT Purple DCT Routine 3 hours screen performed in blood transfusion Haptoglobin 1 x Serum Red 3 weeks Urine Urine 2 days haemosiderin 1 EDTA specimen is sufficient to perform FBC Diff Blood Film Infectious Mononucleosis Screen Sickle Cell Screen and Retic Count All of the above samples may be sent in the Pneumatic Tube System PTS Version 8 5 Index LM UI 0010 Print Laboratory Medicine User Manual 2015 03 20 by Ann L Author s Gerard O Connor Page 68 of 157 2 Due for review on 03 Jul 2016
60. Genetics testing Important general information included in the guide Contact information is provided for key members of staff Opening times Instructions for completion of requests via the Order Communications System KEY Minimum sample labelling requirements Access to clinical advice and interpretation The manner in which a complaint or comment may be made OF OV OOO 1 2 QUALITY MANAGEMENT SYSTEM The Department of Laboratory Medicine is committed to providing a high quality efficient and comprehensive service to our patients and clinical users Central to this commitment is the Quality Management System QMS The Laboratory is accredited to ISO 15189 2012 from the Irish National Accreditation Board INAB and is compliant with the requirements of EU Blood directive 2002 98 EC The laboratory maintains a strong focus on continuous quality improvement for all aspects of its service The quality of results is of fundamental importance and the laboratory operates to strict scientific and management standards Results are authorised within a framework of comprehensive internal and external quality control and quality assurance The Laboratory Medicine Department Quality Policy is displayed in the department and available at www amnch ie laboratory 13 USER SATISFACTION COMMENTS AND COMPLAINTS There are a number of channels by which comments and complaints may be identified to the Laboratory Medicine Department In all cases it
61. HF medical personnel should seek advice from the Consultant Microbiologist Patients for whom diagnosis of VHF cannot quickly be excluded should be referred to specialist centres without delay Please contact the Microbiology Laboratory for further information on the above tests if required Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 46 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 146 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 9 10 INFECTION CONTROL There is an Infection Control Committee ICC responsible for hospital infection control policy and an Infection Control Team ICT responsible for the day to day control of hospital infection The ICT is committed to the provision of quality healthcare to all patients The ICT will facilitate the effective prevention detection and control of hospital infection in patients staff and visitors There is an infection control manual which describes the objectives and content of the infection control programme and contains all policies and procedures Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 47 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s
62. ICROBIOLOGY The Microbiology Department provides Bacterial Virology Parasitology Mycology and Serology services The tests available and the sample requirements are listed in the tables below Please note Service restrictions may apply trom time to tine due to staff shortages 9 1 MICROBIOLOGY PERSONNEL Consultant Microbiologist Professor Philip Murphy Ext 3919 Consultant Microbiologist Dr Susanna Frost Ext 3936 Consultant Microbiologist Dr Deirdre Brady Ext 3920 Microbiology Registrar Ext 4707 Infection Control Team Ms Dympna Mc Donnell Ext 3938 4278 Ms Rosarii Cosgrave Bleep 2609 Ms Terry Smith Ms Maura Rushe Chief Medical Scientist Acting Donal Smith Ext 3906 Microbiology Ext 3934 3935 Enquires Secretary Reports Results Microbiology Main Laboratory Ext 3940 Specimen Reception Microbiology Main Laboratory Ext 3941 3942 Urine Sputa Pus Swabs CSF Mycology Parasitology Microbiology Blood Cultures Serology Ext 3939 Antibiotic assays TB Laboratory Ext 3944 Microbiology Laboratory Faeces Cl Ext 3940 difficile toxin testing IV tips MRSA VRE screens Environmental testing Medical Scientist on Call Bleep 7280 Page 114 of 157 9 2 MICROBIOLOGY ROUTINE HOURS Monday to Friday 08 00 18 00 Deadline Deadline for reports by 17 00 Specimens in Lab by 16 30 Antibiotic assays in Lab by 15 00 Saturday a m 09 00 12 30 Deadli
63. LABLE FROM CELLULAR PATHOLO GV ciooioconocccoccconcconncnnnnconcconncnnnncnrncnnncno 103 8 4 SPECIMEN COLLECTION AND DELIVERY caian rra 103 8 5 SAMPLE LABELLING ociosa 103 8 6 URGENT SERVICES tata atada EAT TEETE TES 105 8 7 SPECIMEN REQUIREMENTS weneci ce ieeda dae dadednd da 106 8 8 REPORTING ARRANGEMENTS secuaces trates de dee die ee Me eh oa 111 8 9 CLINICO PATHOLOGICAL CONFERENCES MDTS ccococcccccoccnocononcconccnoncnnnncnnccnnncnnnncnnccnnnnnos 112 8 10 AUTOPSY POST MORTEM SERVICES aiiin titi KER ERAN Ree 113 9 0 MIGROBIQEO iii lid e 114 91 MICROBIOLOGY PERSONNEL 00d ad a 114 9 2 MICROBIOLOGY ROUTINE HOUR Sicilia 115 9 3 LABORATORY NOTIFICATION OF EMERGENCY WORK cooccicocccocccconcconcconccnnnconncnnncnanccannnos 115 9 4 LIST OF TESTS AVAILABLE OUT OF ROUTINE HOURS oooocccocccoccconocinoncconcconcconcnonnncnnccnnnnns 115 925 CEINIC AL CONSUL TATION sun curlrca canoa brco ree dos Lera od o os o docs oe ahh o it 116 9 6 ROUTINE RESULTS AND REPORTING ccsioccconoiiarri ianadcandrar acaricia ad s 116 9 7 GUIDELINES FOR MICROBIOLOGICAL SPECIMENS cccoccccocccoccnoncconncnnncnnnncnnncnnncnnnncnnccnnnnnos 116 TUTO UNES a an aaa 118 Stated averaged turnaround times cover normal working days Monday to Friday excluding bank holidays The stated turnaround times may be extended outside these times 118 9 8 SPECIMEN REQUIREMENTS ocioteca 118 CSF References ranges and Critical values 0 0 2 eeeeeeseeeeeeese
64. LABLE OUT OF ROUTINE HOURS LIST OF TESTS AVAILABLE 5PM 12 MIDNIGHT mba All CSF specimens where a diagnosis of infectious meningitis is suspected 2 All Skin scraping specimens where a diagnosis of Meningococcal septicaemia is suspected 3 Blood cultures 4 Urgent Tissue Pus Gram stains 5 Bronchoscopy specimens requiring urgent Gram stain and culture Contact the Consultant Microbiologist 6 Respiratory specimens requiring urgent ZN stain Contact the Consultant Microbiologist 7 Urgent urine specimens i e one specimen per patient for microscopy and culture 8 Emergency antibiotic assay which cannot wait until the following morning Contact the Consultant Microbiologist 9 Hepatitis B C Acute pre dialysis patients for Hepatitis B needlestick injuries This is available up to 10pm see NVRL guidelines Contact the Consultant Microbiologist Page 115 of 157 LIST OF TESTS AVAILABLE POST 12 MIDNIGHT All CSF specimens where a diagnosis of infectious meningitis is suspected All Skin scraping specimens where a diagnosis of Meningococcal septicaemia is suspected Urgent urine specimens i e one specimen per patient for microscopy and culture Any other tests Contact the Consultant Microbiologist PONS For specimens that cannot be sent via the Pneumatic Tube System PTS please contact the portering pool to transport the specimens to the Microbiology Laboratory 9 5 CLINICAL CONSULTATION A Clinical consu
65. LE FOR ANALYSIS Adequate clinical details must be included with each request The following indications are generally recognized in the international literature Medical Oncology Gastroenterology and Related Teams z For the monitoring of established malignancy 7 AFP for surveillance for hepatocellular carcinoma in high risk patients i e cirrhosis or other chronic liver diseases such as chronic active hepatitis Abnormal LFT s is NOT sufficient evidence m For the investigation of Cancers of Unknown Primary ESMO NCCN suggested panel HCG AFP PSA CA 125 CA 15 3 m CEA is offered for colorectal cancer CRC monitoring Gynaecology 7 CA 125 Rapid Access Service for ovarian tumours as agreed with the Gynaecologists Surgical Oncology n C19 9 for the investigation of pancreatic tumours and chronic pancreatitis Breast Markers 7 C15 3 is only accepted from an Oncology Team including breast surgeons accompanied by appropriate clinical details PSA z PSA is normally confined to the monitoring of prostate cancer Currently we are accepting samples for the diagnosis screening of prostate cancer 7 Rarely PSA in females e g carcinoma of periurethral Skene s glands Other Categories m Certain other conditions which are known to be pre malignant e g various paraneoplastic syndromes m Friedrich s Ataxia request for AFP 49 Page 49 of 157 7 All requests for a specific marker where cancer patholo
66. LECTION FROM GP PRACTICES A daily sample collection and report delivery service is in operation for a number of GPs who use the services of the Laboratory Medicine department at AMNCH Please note the following requirements 2 1 1 PATIENT IDENTIFICATION DETAILS Each request form use AMNCH GP request form only should include the following minimal information Patient surname Patient first name Patient full address please note if address has changed Date of Birth DD MM YYYY Sex Date and time of sampling Tests requested Clinical and relevant treatment details GP name GP practice telephone fax number Alternative contact number for urgent results if outside practice hours 0500 0 70 00 0 0 0 O If you have an AMNCH MRN for your patient please include in the top left hand box on the form Please use only ballpoint pen when completing the request form With the commencement of Healthlinks it is vital that correct patient demographics and GP name practice are filled in on the request form Specimen containers should be labelled correctly Minimum demographic details to be included on the bottle Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 23 Ss e 386 58815032 Due for review on 03 Jul 5 Page 23 of 157 20 LM UI 0010 Printed 23 Nov 2015 03 ry Medicine User Manua borate Lat Patient surname Patient first name Date of Birth DD MM YYYY Please also include
67. Laboratory IMMRL Samples being referred to the IMMRL must be sent using the IMMRL request form and not AMNCH request form Ensure specimen and request form are correctly labelled with Patients Name Surname and Forename Patients Hospital number Patients date of Birth Date of onset of Disease Date and time of collection of sample Gender Address Patient Location Hospital Ward Consultant Clinician Signature and bleep of person who has taken the specimen Clinician Nurse Test required specimen type and clinical details PCR CSF at least 100ul 3 Meningococcal PCR EDTA blood 2 5 5mls Mon Friday Positive results are phoned to CSF at least 1004 the Microbiology Laboratory by 5pm on day of receipt of 5 specimen by the IMMRL Meningococcal Clotted blood sample Mon Friday g Serologyt red top at least 0 5 ml Pneumococcal PCR EDTA blood 2 5 5mls Mon Friday Positive results are phoned to CSF at least 10011 the Microbiology Laboratory by E 5pm on day of receipt of 2 specimen by the IMMRL z Haemophilus EDTA blood 2 5 5mls Mon Friday Positive results are phoned to influenzae PCR CSF at least 1001 the Microbiology Laboratory by E 5pm on day of receipt of specimen by the IMMRL Group B Streptococcal EDTA blood 2 5 5mls Mon Friday Positive results are phoned to the Microbiology Laboratory by 5pm on day of receipt of specimen by t
68. Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Tallaght Hospital AMNCH LABORATORY MEDICINE USER MANUAL Edition 8 5 2015 VALID UNTIL NEXT RELEASE AUTHORISED BY DR ANN LEONARD MINOR UPDATES WILL BE MADE TO THE PDF VERSION LOCATED ON THE INTRANET INTERNET Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 1 of 157 0 0010 P 8 5 Index LM UI er Manual Version Use of the guide Every effort has been made to ensure accuracy of the content of this guide to our services It is written for clinical staff that use the Laboratory at Tallaght Hospital AMNCH From time to time it is necessary to update the content for operational reasons This will lead to new version of the manual being published online We normally do this on a twice yearly basis The volume is published in pdf format The present edition 8 5 is valid from January 2016 CHANGES TO THE PREVIOUS EDITION ARE LISTED IN AMENDMENT SECTION at end of manual AND MUST BE CHECKED PRIOR TO USING THE MANUAL Consent for individual investigations may require prior agreement with the patient or guardian see for instance the section on Genetic testing pp 19 27 Users of the Laboratory Medicine Service are advised t
69. PTT Ratio Fibrinogen D Dimers Hb S Screen when indicated Malaria Screen only rapid diagnostic test performed out of hours Examination of thick and thin films including speciation will be carried out on the next routine working day Myoglobin serum amp urine Other requests may be facilitated after clearance with the Haematology Consultant on call and appropriate arrangements made with the laboratory Laboratory Medicine User Manual Version 8 5 Index LM Ul 0010 Printed 23 Nov 2015 03 20 65 Authorised on 23 Nov 2015 Authorised by Ann Leonar P Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 65 of 157 6 5 DIVISION OF SERVICE ATA Ms Therese Driscoll Ms Lorraine McMahon Ms Brona Maguire Scientist PR A es Full Blood Count PT INR Bone Marrow Examination Differential White Cell Immunophenotyping for Count Lymphoma Leukaemia CA e Morpholog TA cad AAA A Mononucleosis Screen Screen Malaria Screen Blood Hypo coagulation Hereditary Haemolytic Assa gt tee Inhibitor Assays o screen Meningococcaemia aspariginase therapy Heparin Induced ee Thrombocytopenia These samples should not be sent in the Pneumatic Tube System Please use separate Request Forms for each section within the Haematology Department when OCS is not available 66 Page 66 of 157 6 6 SAMPLE REQUIREMENTS CONSIDERATIONS FOR REFERRED TESTS
70. ST BE USED WHEN USING L_ THESE FIXATIVES Personnel using formalin must be aware of the proper procedure for dealing with small or large formalin spills 104 lanual Version 8 5 Index LM UI 0010 Print Page 104 of 157 8 6 URGENT SERVICES 8 6 1 Frozen Sections A frozen section service is offered between 9 a m and 5 p m Monday to Friday frozen sections outside of these hours may be provided on an individual basis by prior agreement with a Consultant Histopathologist Specimens from patients with risk of infection HepB HepC HIV TB etc and radioactive samples should not be submitted for frozen section If a suspicion of such infection exists the clinical staff concerned have a duty of care to inform laboratory personnel e f the laboratory inadvertently processes such a specimen a decontamination procedure must be carried out on all frozen section equipment Decontamination takes a minimum 24 hours During this time the frozen section service will be limited or unavailable Booking a frozen section e Frozen sections should be booked at least 24 hours in advance by contacting the Cellular Pathology Lab Ext 3973 with the following details o Theatre Consultant Surgeon Patient Name and MRN Type and Site of Surgery Time of surgery 0000 e If a frozen section is required on a specimen that has not been booked the Laboratory must be informed by telephone ext 3973 as soon as possible to ensure that personn
71. TORY c ccesceeseeeeeeeeeeeeeeeeeeeeeaeeeaeeseeeeaeeeeaeeseeetneeeaes 84 Tole URGENT REQUESES its iaitl sald ace cctdes Nate dtite die ccd end ota tarea satan iba 85 7 13 REQUESTS FOR ADDITIONAL EXAMINATIONS BLOOD COMPONENTS PRODUCTS 86 7 14 PRESCRIBING BLOOD COMPONENTS AND PRODUCTS coinccnccccoccnoccconcconnnononcnnnncanccnnncnancnnns 86 7 15 DELIVERY OF BLOOD TO THE CLINICAL WARD AREA cecceeeeeeeeeeeeeeeeeeeeeeeeneeeaeeeneees 87 7 15 RETURN OF UNUSED BLOOD PRODUCT COMPONENTS TO LABORATORY 88 7 16 THEATRE BLOOD FRIDGE ci ll did 89 7 17 TRANSFER OF BLOOD COMPONENTS PRODUCTS TO ANOTHER HOSPITAL 90 7 18 RECEIPT OF BLOOD COMPONENTS PRODUCTS FROM ANOTHER HOSPITAL 91 7 19 BLOOD ADMINISTRATION POLICY ioccimociocnicaaicn sun caseca dada ceadieataentigenncastivtancadecaueeaanteeeseceees 91 7 20 DISPOSAL OF EMPTY BLOODY PRODUCT PACKS csi td 92 7 21 TRANSFUSION ADVERSE REACTIONS AND EVENTS REPORTING ccoocccoccccoccccncccnnccanncao 93 7 22 MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE M S B O S ceses 93 7 23 BLOOD COMPONENTS PRODUCTS INFORMATION cececeeeceeeeeeeeeeeeeeeeeeeeeneeeeeeeaeeeeneeeas 96 7 24 MAJOR EMERGENCY PLAN oscars 98 720 Reterral AA E E E RA 99 7 25 KEY ORDER COMMUNICATIONS oye cits 00 A A A dea adeacn totes 100 8 0 GELLULAR PATHOLOOY cit ad tia 102 8 1 CELLULAR PATHOLOGY CONTACT NUMBERS ususarios 102 8 27 ROUTINE HOURS inp isha nanan ati danna 102 8 3 SUPPLIES AVAI
72. U YES phoned to the Suprapubic YES Microbiology aspirate Laboratory EMU YES Bag Urine YES Pad Urine YES Clean Catch YES Urine Ileal conduit YES Cystoscopy YES urine Nephrostomy YES urine Ureteric urine YES N B It is essential to tighten container lids to prevent leakages It should be stressed that urine specimens submitted for culture are screened for significant growth If a special situation is being investigated please inform the laboratory It is important to instruct the patient to cleanse the genitalia before micturition for a mid stream specimen to be collected Any sample which may be subjected to delay of more than 2 hours before being sent to the laboratory should be refrigerated Urine specimens from adult and paediatric A E are processed up to 5pm For processing of urgent urine specimens outside routine hours 5pm to 8am the following morning please contact the microbiology medical scientist on call on Bleep 7280 118 Page 118 of 157 Urine Microscopy White and Red Cell Counts are reported according to the following bands WCC 100 200 acc Nil lt 10 10 20 20 50 50 100 200 4699 gt 1000 9 8 2 ENT Infection Please label all samples clearly with the patient s name DOB or Hospital number date and time collected and the specimen site Swabs should be taken before antimicrobial therapy where possible S
73. UBES THAT ARE IN DATE BLOOD TAKEN INTO EXPIRED COLLECTION TUBES MAY RENDER THE SAMPLE UNSUITABLE OR IMPACT THE RELIABILITY OF THE RESULT WHEN TAKING A BLOOD SAMPLE BE SURE TO WAIT UNTIL THE TUBE HAS FILLED TO THE LINE Reference to Order of Draw if more than one sample is being taken should be included here WHEN REQUESTING OUT OF HOURS AND USING THE BLEEP FACILITY NOTE PLEASE LEAVE MESSAGE amp ADEQUATE TIME FOR PERSONNEL TO RESPOND the activation of the AMNCH Major Emergency Plan may supersede this requirement 1 5 SPECIMEN RECEPTION The specimen reception area in the Laboratory provides the following functions 1 Supply of containers request forms urine dipsticks FOB kits and pregnancy test kits This service is available Mon Fri 9 30 a m to 11 30 a m Reception collation and registration of specimens from GP patients Dispatch of referral samples via courier to other institutions within Ireland Dispatch of referral samples to international destinations 1 6 REPORT DELIVERY The following reporting arrangements stand 1 The primary reporting mechanism for all reports from the laboratory is to the electronic OCS database KEY Access is widely available throughout the hospital 2 GP s may access their patient s results through the use of Healthlinks www healthlink ie and KeyWeb which provides an alternate access e User Manuc 1 8 5 Index LM UI 2015 03 20 11 Page 11 of 157 20
74. age at ambient temperature Delays of over 48h are undesirable 129 sion 8 5 Index LM Ul 0010 SOP Uniq erard O Connor Page 129 of 157 010 Printed 23 Nov LM UI 0 Inde ry Medicine User Manua 9 8 12 CSF Skin Scrapings Please label all samples clearly with the patient s name DOB or Hospital number date and time collected N B IT IS VERY IMPORTANT TO SPEAK WITH THE CONSULTANT MICROBIOLOGIST BEFORE ANY SPECIMENS ARE TAKEN FROM PATIENTS SUSPECTED OF TSE NvCJD AND TO NOTE THIS IN CLINICAL DETAILS ON REQUEST FORM Culture amp 1 2ml Send Mon Sun No cut Microscopy amp sensitivity in 3 sterile immediately 24 hours a off time Gram results universal to the day are available containers laboratory on day of sequentially receipt marked Culture 16 1 283 72 hours Skin scrapings Material Send NO Mon Sun No cut Gram results for from rash immediately 24 hours a off time are available meningococcal collected to the day on day of detection on slide laboratory receipt Please note CSF and skin scraping samples are never sent via the PTS Please send as large a volume as possible CSF is normally collected sequentially into three or more separate sterile universal containers which should be numbered consecutively Send all samples immediately to the Microbiology laboratory unless the CSF is from a Haematology patient in which case the CSF is sent directly to Haematolo
75. ambient temperature is preferable to refrigeration before transportation Method of Collection Disinfect the skin at the venepuncture site with 2 chlorohexidine and 70 isopropyl alcohol and allow to dry Remove the flip caps and disinfect the septum of the blood culture bottle with 2 chlorohexidine and isopropyl alcohol and allow to dry the use of iodine based disinfectants is NOT recommended for some commercial systems as this is said to affect the integrity of the butyl rubber septum If inoculating more than one type of BacT Alert blood culture bottle using a butterfly blood collection set and direct draw adapter cap inoculate first the aerobic culture bottle and then the anaerobic culture bottle so that any oxygen trapped in the tubing will not be transferred to the anaerobic bottle Monitor the direct draw process closely at all times during collection to assure proper flow is obtained and to avoid flow of the bottle contents into the adapter tubing Due to the presence of chemical additives in the culture bottle it is important to prevent possible backflow and subsequent adverse reactions 128 Page 128 of 157 010 Printed 23 Nov LM UI 0 Inde ry Medicine User Manua e Hold the culture at a position below the patients arm with the bottle in an upright position e Blood may be collected with a butterfly blood collection set and the Blood collection adapter cap NOTE The manufacturer has informed us of an issue where t
76. amples received by 3 30pm Between 8am 9am and 5pm 8pm only emergency samples will be processed Saturday 9am 12 30pm Outside these hours an emergency on call service is available for all urgent requests see section 6 4 Non urgent requests will be stored at 4 C if applicable and processed the following routine morning Page 62 of 157 6 3 REQUESTING INVESTIGATIONS MINIMUM LABELLING REQUIREMENTS There is a requirement for a minimum of two acceptable identifiers on both sample and request form Acceptable identifiers are gt Primary identifier Full Patient name gt Secondary identifiers o MRN when available o Date of Birth Other information which should be included with the request Date and time of sample collection Destination for report Requesting clinician name and contact details Patient address if MRN not available Patient gender Priority status Sample type Tests requested Identity of person taking the sample Relevant clinical details VVVVVVVVVV SAMPLE REJECTION CRITERIA Test requests may be rejected if the following situations apply Sample types not compatible with tests requested Significant difference between patient identifiers on sample and corresponding request form MRN provided does not match the other details on the request form Samples that do not have at least two acceptable identifiers Sample volume inappropriate where applicable Samples which are past the recommended tim
77. appropriate if patient was Yes 10 days 5 Purple recently transfused q o jj Hereditary Varies In consultation with the Varies depending Haemolytic Anaemia depending on Haematology team or laboratory on Investigation Investigation investigation 1 Slides should be made using a minimum volume of the bone marrow aspirate 1 small drop To avoid dilution of the sample the total volume drawn should fill the nozzle of the syringe only 2 Please contact the Haematology team bleep 7025 6258 for instructions and advice on taking CSF amp BMA samples 71 Page 71 of 157 6 9 REFERENCE INTERVALS REFERENCE VALUES IN CHILDREN Please contact the laboratory for interpretation of results in children REFERENCE VALUES IN ADULTS Adult reference intervals for common investigations are tabulated below Many reference intervals depend on age sex and other variables and the values given are for guidance only Please contact the relevant laboratory section if you have any problems in interpretation Reference intervals are method dependent and can change if there has been a change in assay methodology Changes in reference ranges will be highlighted on report forms ROUTINE HAEMATOLOGY PARAMETER UNITS ADULT REFERENCE RANGE RED CELL COUNT X1012 I M 4 5 6 5 F 3 8 5 8 HAEMOGLOBIN g dl M 13 0 18 5 F 11 5 16 5 HCT L L M 0 380 0 510 F 0 360 0 460 MCV fl 80 96 MCH
78. as changed consultation with the appropriate consultant histopathologist may be required 105 Page 105 of 157 LM UI 0010 Printe 8 7 SPECIMEN REQUIREMENTS 8 7 1 Histology Test Sample requirements Comment Routine histology Specimens must be immersed in an adequate volume of 10 neutral buffered formalin in an appropriately sized container The volume of formalin must be enough to fully immerse the specimen Tissue for frozen section Must be sent fresh to the laboratory and without delay See section 8 6 1 above Frozen sections must be booked in advance Phone 3973 Muscle Nerve biopsy Fresh wrap in saline moistened gauze Send immediately to the lab Clinical details are mandatory Notify lab in advance ext 3973 Skin punch for Direct immunofluorescence DIF Send two samples one fresh and one fixed in 10 neutral buffered formalin Wrap fresh sample in saline moistened gauze Immediate transport to the lab Temporal artery biopsy Send in 10 neutral buffered formalin no need to send fresh Lymph node possible lymphoma Fresh wrap in saline moistened gauze Transport immediately to the lab Notify lab in advance ext 3973 Radioactive Specimens e g Sentinel Lymph Node The specimen should be clearly marked with Radioactive Stickers 320 106 Gerard O Connor Page 106 of 157 Printed 23 No A Ul 0010 8 5
79. ate Sodium Laboratory Medicine User Manual Version 8 5 Index LM Ul 0010 Printed 23 Nov 2015 03 20 Sweat Test T3 Free T4 Free Testosterone Theophylline Thyroid Function Test TSH FT4 TPO Triglyceride Troponin TSH CSF Protein UIBC Urate Urea Valproate Zinc Daily on arrival 4hrs Daily on arrival 24hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 4hrs Three times per week Day of test 3 days per week Mon Tues Thurs Daily on arrival 72 hrs Requests subject to screening Daily on arrival 24hrs Daily on arrival 24hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 24hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 24hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 4hrs Monthly 4 weeks LH Lithium Heparin SE Serum Clotted FIOx Fluoride Oxalate TE Trace Element Urines general chemistry Urgently processed requests 90 within one hour of receipt Non Urgent requests within 2 working days of receipt Urinary electrophoresis requests within 14 days of receipt For tests not listed above please contact a senior member
80. ated with connective tissue disease Typical TAT 3 10days depending on degree of reflex testing required Rheumatoid Factor RHF Levels of Rheumatoid factor may increase with age infection malignancy therapy with certain drugs and a range of inflammatory disorders As an approximate guide higher levels of rheumatoid factor are more likely to be associated with connective tissue disease Typical TAT 5 days DNA Antibodies DNA A DNA ELISA assay is performed if ANA is positive with a titre of 1 160 or greater Typical TAT 10 days depending on degree of reflex testing required 14 Page 14 of 157 TEST ABBREVIATION NOTES Extractable Nuclear Antigen ENA Extractable Nuclear Antigen Antibody is the screening test for all extractable nuclear antibodies In general repeat testing is unhelpful If the ENA ELISA test is positive the Immunology Laboratory will attempt to identify the antibody specificity JO 1 LA RNP RO SCL 70 SM Typical TAT 3 16 days depending on degree of reflex testing required Tissue Transglutamase tTG Anti tissue TransGlutamase antibodies are strongly associated with coeliac disease Anti EMA test will follow all positive tTG tests Anti EMA antibodies are highly specific for coeliac disease An IgG EMA assay will be performed on samples known to be IgA deficient Samples which show no no detectable anti tTG Abs will have serum protein electrophoresis an
81. atient I D and complete all sections legibly you must provide the Tallaght Hospital Number MRN if available There is a requirement for a minimum of two acceptable identifiers on both sample and request form Acceptable identifiers are gt Primary identifier Full Patient name gt Secondary identifiers o MRN when available o Date of Birth 32 Page 32 of 157 Other information which should be included with the request Date and time of sample collection Destination for report Requesting clinician name and contact details Patient address if MRN not available Patient gender Priority status Sample type Tests requested VVVVVVV V SAMPLE REJECTION CRITERIA Samples may be rejected if the following situations apply Sample types not compatible with tests requested Significant difference between patient identifiers on sample and corresponding request form MRN provided does not match the other details on the request form Samples that do not have at least two acceptable identifiers Samples which are past the recommended time from phlebotomy to analysis Samples that have been left un separated overnight will not be analysed Expired sample collection tubes Where sample quality would effect analysis e g haemolysis Sample volume insufficient VVVVVVV VV PATTERNS OF REQUESTING Tests may be requested specifically by name or by group Specific requesting is preferred when possible Renal liver and bo
82. be retrieved from the archive and reviewed by the pathologist prior to the meeting Recent cases may be discussed but only by prior arrangement with the Consultant Pathologist DEPARTMENT OF CELLULAR PATHOLOGY CLINICO PATHOLOGICAL CONFERENCES conference pmr ol 20 CI e all wy ee le Wednesday Laboratory Radiology MDT Monthly 1 Friday of Wednesday Dr P Crotty Radiology MDT Monthly 3 Friday of Wednesday Dr P Crotty A A el ed egean aereo ae le Tuesday 12 30pm Br Grn Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 1 2 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 112 of 157 8 10 AUTOPSY POST MORTEM SERVICES Autopsy services are provided by the Department of Cellular Pathology Autopsies may be performed at the direction of a coroner Coroner s case or at request of the clinician responsible for the care of the patient Non coroner s or House case Tallaght Hospital is under the jurisdiction of the Dublin Coroner the current Dublin Coroner is Dr Brian Farrell telephone 01 8746684 01 8743006 e mail coroners dublincity ie Coroner s cases Circumstances where a death should be reported to the Coroner are listed in the link below http Awww coronerdublincity ie faqs death htm Post mortem reports for Coroner s cases are sent to the Coroner s offic
83. ber and location must be clearly identified The specimen must be accompanied by a Clinical Chemistry Request form completed with the patient s name etc as per section 5 3 REQUESTING INVESTIGATIONS REQUEST FORMS AND SAMPLE LABELLING Please include a bleep number if available Any air in the syringe must be expelled The needle must be removed from the syringe and destroyed as soon as the sample has been taken The cap provided must be fitted to the syringe The sample may be sent to the laboratory via the PTS or brought by hand If the PTS is used the sample must be held securely within the canister so that it cannot move about It is essential that the syringe contains NO air Sending a sample in the PTS will exacerbate the effects of air in the sample If you have any questions about the taking or analysing of Blood Gas samples contact the laboratory at ext 3951 44 Page 44 of 157 URINE SPECIMENS Analytes in urine are usually determined in one of the following 1 a timed e g 24 hour collection 2 a random spot urine 3 a random urine with results expressed as a ratio with creatinine URINE ACID ACID Plain 24 Comment SPECIMEN WASHED l hr GUIDE earne ae container added water Aasers A S SSS Amino acids A S amino lasvulinate ALA O Prog Amass TA Esti RRA LESA O Po Bence Jones Protein BJP See Elecwophoresis Y Calcium refrigerate Ca re rs Catecholamines Ad
84. ble from the Microbiology Laboratory Appropriate swabs for N gonorrhoeae investigation include urethral endocervical cervical rectal and pharynx A HVS swab is suitable for candida and trichomonas detection For the investigation of PID please send a cervical swab Syphilis hepatitis B and HIV send serum samples Please refer to referral and serology sections 9 8 6 Pus amp Wound Specimens Please label all samples clearly with the patient s name DOB or Hospital number date and time of collection and the specimen type FOR HEALTH amp SAFETY REASONS DO NOT SEND PUS IN SYRINGES WITH NEEDLE ATTACHED Wound swabs Wound swabs YES Mon Sat 4 30pm Culture Culture amp Mon 16 72 hours sensitivity Fri 11 30 Sat Pus culture amp Pus Ina sterile YES Mon Sat 4 30pm Culture sensitivity leak proof Mon 16 72 hours container Fri transported 11 30 to the lab Sat within 30 mins Fluids non Fluids At least 1ml YES Mon Sat 4 30pm Culture sterile sites wound absces in a sterile Mon 16 72 hours culture amp s drain leak proof Fri sensitivity container 11 30 Sat Note Samples of pus are preferred to swabs Ideally a minimum volume of 1 ml of pus should be sent lf swabs are used sample the deepest part of the wound and soak well in pus Specimens should be transported and processed as soon as possible The volume of specimen influences the transport t
85. boratory e Frozen plasma and other blood products can take up to 50 minutes with the exception of Platelets platelets are ordered from the IBTS on an individual basis please see section 7 3 Note A delay in providing compatible blood or other blood product may occur due to a positive antibody screen A second sample may be requested if additional testing is required due to positive antibody screen or grouping anomaly Notes e Request for some Blood Components Products such as coagulation factor concentrates must be done in consultation with the Haematology Medical Team e All Blood Components Products issued from Blood Transfusion Lab will be labelled with Tallaght Hospital compatibility labels Absolute Emergency Requests for Uncrossmatched Red Cells Requests for uncrossmatched blood must be made by a medical doctor If the laboratory has a current valid sample from the patient ABO and Rh D group specific blood can be given If there is no current sample O Rh D Negative will be issued In Emergency Situations ABO Rh D group of patient unknown _ Uncrossmatched O Rh D Negative blood can be requested by Medical Doctor ABO Rh D group already confirmed Uncrossmatched ABO Rh D i e group save on current sample i e patient Group Specific blood can be requested by Medical Doctor ABO and Rh D group specific blood cannot be issued without a current valid sample 85 Page 85 of 157 Emergency O R
86. calculated for all creatinine requests received on outpatients and GP patients This eGFR is based on the formula derived in the Modification of Diet in Renal Disease MDRD Study The MDRD formula is based on 4 variables serum creatinine age gender and ethnicity Serial measurement of eGFR is essential in assessing the severity of any renal condition The eGFR will replace the 24 hour creatinine clearance for many patients see below eGFR underestimates normal or near normal glomerular function so results above 90 will be reported as gt 90 ml min per 1 73m THE CHRONIC KIDNEY DISEASE CLASSIFICATION IS AS FOLLOWS Stage Description AA EA eGFR gt 90 ml min 1 73 m with other evidence of chronic kidney damage MA eGFR 60 89 ml min 1 73 m with other evidence of chronic kidney damage 3 Moderate impairment eGFR 30 59 ml min 173m 2______________ 4 Severeimpairment____ eGFR 15 29 ml min 1 73m ____________ 5 Established renal failure eGFR lt 15 ml min 1 73 m orondialysis The other evidence of chronic kidney damage may be one of the following e Persistent microalbuminuria e Persistent proteinuria e Persistent haematuria after exclusion of other causes e g Urological disease e Structural abnormalities of the kidneys demonstrated on ultrasound scanning or other radiological tests e g polycystic kidney disease reflux nephropathy and or Biopsy proven chronic glomerular nephritis NB Withou
87. compliance Daily Routine Hours Refer to AMNCH Adult Medicines Guide for further information Page 51 of 157 51 20 2015 03 Printed 23 Nov qual Version 8 5 Index LM Ul 0010 Laboratory Medicine User Mar 5 14 REFERENCE VALUES Adult reference values for common investigations are tabulated below Many reference intervals depend on age sex diet posture etc and the values given are for guidance only Please contact the relevant laboratory section if you have any problems in interpretation Please note that reference intervals for urine vary markedly with body size hence with age and sex and often with dietary composition as well as renal function Reference ranges are method dependent and can change if there has been a change in assay methodology Changes in reference ranges will be highlighted on report forms REFERENCE VALUES IN CHILDREN Please contact the laboratory for interpretation of results in children 5 15 INTERFERENCES 52 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 52 of 157 Many tests are subject to interference This may be biological where the offending substance alters the true concentration within the body or analytical where the method is not specific Samples are checked for haemolysis lipaemia and icterus Interference due to these is included in the final report Lists of substances that interfere with each method are available i
88. d First name D O B Gender MRN Clinical details Location Tests required Requesting Clinician If urgent please state clearly on request form and it will be given priority Patient Identification is confirmed allowing sampling to proceed by asking the patient to state their full name and date of birth without prompting Full Patient name D O B This information is written on the sample tube when samples have been taken or alternatively a label generated in phlebotomy containing patient details is applied to the tube f ordering fasting blood glucose levels please clearly state fasting on request form and inform the patient taking cognisance of the insulin dependent diabetic When requesting a Glucose Lactose Tolerance Test it is necessary to make an appointment Contact ext 3041 for appointment Refer to 4 8 below for adult phlebotomy hours of service 4 3 REQUEST FOR GROUP amp CROSSMATCH SAVE SAMPLE See Blood Transfusion Section Itis mandatory that in patient is wearing an identity bracelet which can be checked for his her Surname First Name D O B MRN 4 4 PROCEDURE FOR TEST ORDERING FOR ST LOMANS There is an interim policy for Phlebotomy pending introduction of positive patient identification mechanism in Psychiatric Unit The Nurse in Charge shall allocate staff member to identify each patient requiring blood tests The allocated staff member shall positively identify each patient requiring bloo
89. d Ig quantitation performed Typical TAT 3 10 days depending on degree of reflex testing required Glomerular Basement Membrane Antibody GBM Anti Glomerular Membrane Antibody is available on an urgent basis by arrangement with the Immunology laboratory CPL For urgent tests the turnaround time is approximately two hours from time of specimen receipt Typical TAT 7 days for routine requests Anti neutrophil Cytoplasmic Antibody ANCA Anti Neutrophil Cytoplasmic Antibody is available on an urgent basis by arrangement with the laboratory For urgent tests the turnaround time is approximately two hours from time of specimen receipt ANCA titre will follow all positive ANCA results together with anti PR3 and anti MPO Typical TAT 3 10 days depending on degree of reflex testing required Anti Mitochondrial Antibodies MIT This is an immunofluorescence test If positive anti PDH antibodies will follow In general repeat testing is not helpful Typical TAT 3 7 days depending on degree of reflex testing required Anti Smooth Muscle Antibodies SMA Elevated levels of smooth muscle antibodies may be found in a variety of infectious disorders and in autoimmune hepatitis Higher levels more often are associated with autoimmune hepatitis A titre will follow for positive tests Typical TAT 3 7 days Anti Parietal Cells Antibodies PCA Anti parietal cell antibodies are found in approximately 90
90. d Transfusion Laboratory for information on product availability Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 56 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 156 of 157 Cellular Pathology Section 8 0 Page Change 99 Added line about clinical advice in cellular Pathology Added line The Department complies with the International Standard ISO 15189 99 Registration Number 330 MT and the regulations policies terms and conditions of the Irish National Accreditation Board INAB 100 Removed reference to PTS in cell path 101 Sample type site is mandatory on the form container 1008101 10 formalin changed to 10 neutral buffered formalin 102 Radioactive samples should not be submitted for frozen section 103 Added temporal artery to table removed radioactive sample comment Added GIST molecular analysis renal biopsy request forms not available from lab 104 Pe fill in PCD request form 107 Semen analysis appointment days changed 108 TAT for all cytology samples is 5 days 109 MDT table updated Microbiology Section 9 0 Page Change Page 157 of 157 157
91. d dd 52 5145 INTERFERENCE Se tencrrccte canibal Oe lib pude rl Lo 52 6 0 HAEMATOLOGY atiae a a ee a nea 62 6 1 HAEMATOLOGY PERSONNEL iodo il i ir palalia 62 6 2 NORMAL HOURS AND DEADLINES FOR ROUTINE ANALYSIS ieee 62 63 REQUESTINEAINVES TIGATION Sci cette de neti ei Ga ae pate et deat 63 6 4 EMERGENCY ON CALL SERVICES FOR HAEMATOLOGY 8 BLOOD TRANSFUSION 64 6 5 DIVISION OF SERVICE cuida ul ii il iia 66 6 6 SAMPLE REQUIREMENTS CONSIDERATIONS FOR REFERRED TESTS 67 6 7 TURN AROUND TIMES Page 3 of 157 6 8 SAMPLE REQUIREMENTS CONSIDERATIONS concocccioncoccnnnconcnoncancnancnncnoncnn conc can cnn cnn cnn 68 6 9 REFERENCE INTERVALS 000 ii ta tati 72 7 0 BLOOD TRANSFUSION veronica aa 74 fal INTRODUCTION ica 74 7 2 CONTACT NUMBERS PERSONNEL LIST vices ie atienda alice tain 75 7 3 SERVICES amp PRODUCTS amp TURNAROUND TIMES 0 cceecceeeeeeeeeeeeeeeeneeeeeeeeeeeeeesneeeeneeeas 76 e O A etcenihot geet ct at chaneketct E E ol et su5 cpnachuactatcbcuabaehae 79 7 5 Blood Transfusion Request AAA ves dubs aubssbesevnsctasavelehicndocstedceaaceaeceenaces 81 7 6 4 IDENTIFYING THE PATIENT riannee hice discordancia ion 82 Pet TAKING THE SAMPLE ica 2s fees ie eck A a ete a ea i ta ia ad A tata 83 7 8 SAMPLE LABELLING 2 2sc c 253 c 2chcs ideales 83 7 9 MINIMUM SAMPLE LABELLING ACCEPTABLE FOR UNIDENTIFIED PATIENT S EMERGENCY SITUATIONS ties sale sae tse etal seis A io 84 7 10 SENDING THE SAMPLES TO LABORA
92. d tests sign the OCS request sheets or requisition forms remain with the Phlebotomist and assist with venepuncture procedure if required 28 Page 28 of 157 010 Printed 23 Nov 2 LM UI OC Inde ry Medicine User Manua 4 5 REQUEST FOR PATIENT ON CLOZARIL MEDICATION The request is signed by the Nurse in charge and the Phlebotomist on the OCS request list Clozaril packs are made up by Night Staff and left in the Nurses Station for the Phlebotomist 4 6 GP PHLEBOTOMY SERVICE FOR ADULTS Patients referred by their GP can have blood samples taken by the phlebotomy service at AMNCH Patients can avail of this service by booking an appointment at htto www amnch ie Departments Clinics Departments A Z Phlebotomy Blood Tests Adults There is a patient information leaflet available to instruct patients on preparation for their blood tests Information is also regularly sent to GP practices regarding the provision of the phlebotomy service for their patients Requirements for completion of request forms and sample labelling as given in 4 2 above apply to GP patients OPENING HOURS FOR GP PHLEBOTOMY Monday Friday 10 00 am 1 30pm LOCATION The GP Blood Test Area is adjacent to the OPD Reception Area nual Version 8 5 Index LM Ul 0010 P s Gerard O Connor Page 29 of 157 29 a A D a pe gt o i 8 5 Index Version Manua icine User
93. e specimen should be sent to the laboratory A Group amp antibody screen will then be performed and sample stored The stored sample can be used for crossmatch for up to 72 hours 3 days A new sample is required if the patient is discharged or if 72 hours has elapsed since the sample was taken Consent forms are not required and patients do not have to adhere to special instructions before samples are collected Where possible order blood or blood products during 09 00 15 45 Monday to Friday Keep out of hours and weekend orders to a minimum Order blood on a Friday to cover weekend Haemoglobin and other Haematology values should be checked in morning and blood product ordered e g fibrinogen concentrate This reduces out of hours testing and transfusion Before issuing blood the laboratory checks that the blood group of a current sample matches that of previous sample s historical group If this is the first group and save sample received and there is no historical group available on file a second sample should be sent for confirmation of the ABO group where this does not impede delivery of blood to the patient Note Repeat samples are required every 72 hours 3 days on patients receiving regular Transfusions 80 Page 80 of 157 7 5 Blood Transfusion Request Card A completed request form must be forwarded to the Blood Transfusion Laboratory and accompany the sample e Itis important to fill in details accurately and
94. e 12 of 157 20 201 LM UI 0010 Printed 23 Nov 2015 03 dicine User Manua ry Me borate La Use approved in date sample collection containers Use approved sample collection biohazard bags which can contain any spills or leaks within the bag when properly sealed Use the PTS sample transport system where available and if appropriate to sample type Use sample transport boxes closed where appropriate Do not try to carry multiple specimens by hand Do not leave samples in other locations en route to the laboratory If there is doubt about the safe packaging presentation of samples for transport ask a supervisor for advice 8 Do not transport broken or leaking samples from their source report to supervisor 9 Report any spills or breakages to supervisory staff 10 If required follow appropriate spill procedures as provided by the hospital ICP guidelines on QPULSE 11 Ensure that samples transported to the Laboratory are in line with prevailing ADR regulations 12 Please ensure that samples are transported in the correct condition to the Laboratory In general samples at room temperature that are transported without delay are acceptable However there are important exceptions and users are referred to individual disciplines for guidance DN NO gl EE Please refer to specific instructions in individual department sections of this user manual for transport of samples which require special conditions or handli
95. e 6ml EDTA Blood sample e Contact Blood Transfusion Laboratory and Haemovigilance Officers bleep One 10ml 2110 2111 clotted Blood e Fill out Report of Suspected sample Adverse Transfusion Reaction and Request Form This is available in First voided the Blood amp Blood Product urine Transfusion Record and Prescription specimen Form Please ensure the request for post transfusion reaction investigation is incident signed by a medical doctor involved in the patient s care peripheral blood cultures to microbiology FBC Return all blood Components and administration set and above form to the Blood Transfusion Laboratory Routine Blood Transfusion Serology KTS investigation results available same Liver and day if received before 15 45 Renal Otherwise next routine day by 13 00 Profile LDH Urgent investigation results available t in 4 hours Haptoglobin IgA levels Please inform scientist on call at bleep 7281 if outside routine hours Other investigations e g cultures IgA levels can take much longer Phone specific laboratory for turnaround time details 10mls minimum Citrated EDTA Blood sample External laboratory tests Fill in appropriate request forms Results reported when available Up to 3 weeks N B Contact transplant co ordinator Haematology Oncology 10mls minimum Citrated EDTA Blood sample Results available in 3 weeks approximately Results avai
96. e Cytogenetic requests for Haematological malignancy must arrive in the lab by 3pm Thursday at the latest Cytogenetic requests cannot be accepted on Fridays e T amp B lymphocyte subset investigations must arrive in the lab before 2 15pm daily e Plasma viscosity phone ahead before taking the sample to make arrangements with referral lab e Samples for coagulation must be received before 3 30pm Mon Fri e Oxidative burst tests must be pre arranged with St James Immunology Dept and must be received in Lab before 9am e Hereditary Haemochromatosis Screening request should be accompanied by Patient Information Request Form available from Haematology Laboratory For more details on availability sample requirements and special considerations for referral tests including turn around times please contact the haematology lab 6 7 TURN AROUND TIMES We will endeavor to meet the following standards subject to availability of sufficient staff and other resources including the Order Communications System OCS Reporting of results may take longer pending further investigation of initial results Reporting of results may also take longer during on call periods depending on the work load URGENT REQUESTS ROUTINE TURN AROUND TIMES INVESTIGATIONS Haematology Full blood count 1 hour of receipt Coagulation 1 hour Excluding D dimer of receipt INR Warfarin Clinic 90 minutes NON URGENT REQUESTS TURN AROUND TIMES Ro
97. e and time the box was packed will have been completed by laboratory staff This form must be signed by the staff member receiving the delivery e The box must not be opened unnecessarily All documentation should be kept in the plastic pocket attached to the outside of the transport box e The Crossmatch Report Chart copy must be signed dated and the time recorded when removing blood from the Blood Cool Box e It is important to return the transport box within the specific timeframe stated on the form i e within 4 hours of time packed e f returned to the laboratory containing blood the relevant section in Blood Cool Box Record Form BT M DC 090 regarding storage of blood in the Blood Cool Box must be completed It is important to store units in the transport box at all times If blood has been stored incorrectly i e not in the box at all times this must be documented and laboratory staff informed Blood must never be stored in any ward fridge 7 15 RETURN OF UNUSED BLOOD PRODUCT COMPONENTS TO LABORATORY e Itis essential for accurate record keeping reduction of wastage and to allow traceability that all unused blood or blood products are returned to the laboratory Bleep Blood Porter 7266 or porter supervisor 7264 to arrange return 88 Page 88 of 157 0010 Printed 23 Nov 2015 03 20 8 5 Index LM Ul 1 er Manual Version Us atory Medicine abor Li e Please arrange return to the laboratory wit
98. e from phlebotomy to analysis Expired sample collection tubes Samples received after cut off time which require separation e g Special coagulation investigations Where sample quality would affect analysis e g haemolysis for coagulation investigations Test requests which are not considered relevant based on clinical information provided Haematinic requests over the weekend or public holiday VV Y Vv Y VV VVV WV SPECIMEN COLLECTION AND PACKAGING Specimen collection should comply with requirements stated in the Specimen Guide Specimens together with the Request Form should be placed inside a plastic biohazard bag and dispatched to the Laboratory 63 Page 63 of 157 HEALTH AND SAFETY Standard precautions should be observed when handling all pathological material Specific instructions for sending radioactive samples are available in the local rules RETROSPECTIVE REQUESTING ADD ON REQUESTS In some cases further tests on a specimen that is already in the laboratory may be added to the request Only the requesting doctor or person nominated by them may request additional testing Please contact the relevant laboratory section to add on test requests Analyses for additional tests are subject to stability of analyte as follows EDTA samples 24 hours post phlebotomy Infectious mononucleosis screens 3 days post phlebotomy Sickle cell screening 3 days post phlebotomy Coagulation tests 6 hours post phlebotomy D
99. e only and all related inquiries should be directed to that office House cases Cases which are being considered for a house case should be discussed with the consultant pathologist on call prior to obtaining consent It is essential that the requesting clinician is in a position to sign a death certificate for these cases and if the cause of death is unknown then the coroner MUST be informed If a house case is to be performed written consent from the next of kin on a post mortem examination consent form is required This is to be obtained by the requesting consultant or a senior member of their team Post mortem examination consent forms are available in the mortuary or can be obtained from the cellular pathology secretariat ext 3929 It is the responsibility of the individual who requests the post mortem to ensure that the completed consent form patient s case notes to include a concise clinical summary for the pathologist are delivered to the Mortuary in order for the autopsy to be performed In the case of deaths occurring out of normal working hours the individual who obtained consent for autopsy must ensure that the relevant documentation is forwarded to the Mortuary the following morning When the autopsy is completed the Pathologist will contact the clinician with a summary of the findings The clinician may also attend a presentation of the relevant autopsy findings if they so wish Under normal circumstances a provisional repor
100. e telephone the Stat Lab This is essential to ensure that the specimen is expected and is handled as an emergency test Please note that marking a sample Urgent or requesting an urgent test on OCS will not cause it to be handled urgently unless the Stat Lab has been telephoned Critical results will be telephoned to the location on the original request All requests from the A amp E ICU Theatre Children s HDU and Paeds A amp E will be automatically treated as emergency tests without the requirement of phoning the Stat Lab Outside routine working hours 8pm to 8am the On Call scientist must be paged to let them know samples are being sent to the laboratory ALL URGENT WORK MUST BE NOTIFIED BY PHONE Within Normal Working Hours Outside Normal Working Hours In the first instance Phone 3952 Phone the Stat Lab 3951 Otherwise Contact the Scientist on call on HOSPITAL BLEEP 7283 and leave a message Contact Switch if there is no reply COMMON INVESTIGATIONS UNRESTRICTED Acid Base Blood Gases Carboxyhaemoglobin Meth Hb Renal Liver Bone profiles CRP Glucose Lactate Amylase Pregnancy tests Conjugated bilirubin where appropriate Calcium ionised calcium albumin phosphate magnesium urate Ammonia inform lab in advance Iron suspected overdose in children Cardiac Markers Troponin T Salicylate paracetamol ethanol CSF Glucose and Protein Spot Urine Na K Serum or urine osmolality Urine Toxic
101. eceive the delivery A Crossmatch Report Chart Copy will accompany the first unit of blood to clinical area Place this report in the patient chart This copy will cover any subsequent units on the same report 87 Page 87 of 157 e Blood must be transported in blood transport boxes provided by the Laboratory e Itis important that transfusion of blood components products does not continue past the stated expiry date time on the unit Therefore the transfusion of a blood component product due to expire at 12 midnight must not commence unless it can be completed or the transfusion stopped before 12 midnight e All blood products must be signed for in the appropriate sign out registers in the blood transfusion laboratory This should only be done by staff who have received training from the Blood Transfusion Laboratory e Inform the Blood Transfusion Laboratory if blood blood product is not going to be used on the date and time indicated on the request The laboratory can then allocate the blood to another patient or place it back in stock This is important to reduce wastage and optimise use of the product Delivery of Blood in Blood Cool Box e In emergency situations where 2 or more units are required at the patient s bedside blood is transported in a Blood Cool Box This can store a maximum of 6 units of red cells e The Blood Cool box will be accompanied by a Blood Cool Box Record Form BT M DC 090 Information on the dat
102. ection reast Biopsy one Gastrectomy Partial units AAN units Colostomy Closure Revision G S Oesophageal unis units one Fundoplicaton S nguinal S units units units Splenectomy elective Whipples Radical 4 units Pancreatectomy igation Stripping of Veins units units units iver resection units enal Biopsy S S nits 5 AJN Q OIOI Z 09 NoN Q nm E c 5 PF o S S i AININ ZIO NIN O ajo k S S e n S S N ON cl PAPAS Q Page 94 of 157 94 vascular Surgery Urology Prostatectomy TURP O Nephrectomysimple G 8 o Nephrectomy radical 2 Carotid Endartectomy S Nephrolihotomy JG Femoral Distal Bypass f2 units Cystectomy J4 units Lower limb bypass 2 units Cystoplasty G S units G S i S Radical Urethropexy elective S S uni ive S S S Embolectomy Transpubic Urethroplasty AAA Gynaecology APS Vaginal GS Oophorestomy G S Bowelobstruction PO Trosietomy Vagrepar GS Nephreciomy Laproscopic examination None or G S Splenectomy tunit Repair of Rectocoele FemoralOsteolomies fi unt Dec DUNN EEES EAN NOTES Paediatric This MSBOS was compiled in agreement with Consultants Surgeons Anaesthetists and Haematologist G S describes Group and Save sample This consists of an ABO and Rh D Group and Antibody screen for irregular antibodies
103. ed CVD Diabetes Type 2 or Type 1 with Microalbuminuria or with severe Hyperlipidaemia are already at high risk For all other people the SCORE charts can be used to estimate total risk Established Diabetes Markedly raised Dietary and exercise advice together with attention to all Lifestyle advice for 3 Lifestyle advice risk factors comes first months then reassess to reduce SCORE and fasting lipids total cholesterol Aim to reduce Total Cholesterol to lt 4 5 mmol L or lt 4 lt 5 mmol L mmol L if feasible and LDL Cholesterol to lt 2 5 mmol L or and lt 2 mmol L if feasible 40 lt 5 mmol LDL C SCORE is and LDL C lt 3 mmol L This will require statin treatment in many Some still 2 5 ee Hilt recommend statins for all CVD and most diabetic patients now lt 5 Regular follow regardless of baseline levels up Treatment goals are not defined for HDL Cholesterol and Triglycerides but HDL C lt 1 0 mmol L for men and lt 1 2 mmol L for women and fasting Triglycerides of gt 1 7 mmol L are markers of increased cardiovascular risk Table adapted from European guidelines on cardiovascular disease prevention in clinical practice See document for details and SCORE charts http www escardio org guidelines surveys esc guidelines GuidelinesDocuments guidelines C VD prevention ES FT pdf Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 59 Authorised on 23 Nov 2015 Authoris
104. ed by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 59 of 157 5 16 Use of HbA1c as a diagnostic test for diabetes in adults The WHO 2011 Diabetes Guidelines for the first time permits the use of HbA1c as a diagnostic test for diabetes in certain circumstances www who int diabetes publications diagnosis diabetes2011 en index html This should simplify the diagnosis particularly of the very common Type 2 Diabetes in adults and hence we are implementing this strategy at Tallaght Hospital In combination with judicious use of plasma glucose measurements this should also obviate the need to perform Glucose Tolerance tests in these patients except in rare circumstances Initial Testing Recommendation Initial testing in non pregnant adult patients suspected of having type 2 diabetes should now include a Fasting Venous Plasma Glucose and concurrent HbA1c measurement Patient selection may be further refined by using a type 2 diabetes risk assessment questionnaire such as FINDRISC see www diabetes fi en finnish diabetes association dehko publications Diagnosis A Symptoms When classic symptoms of hyperglycaemia are present any ONE of the Laboratory measurements B is sufficient to establish the diagnosis and usually the quoted thresholds are significantly exceeded In the absence of classic symptoms ANY TWO of the Laboratory measurements B may be used
105. ed to analyse creatinine If you have any queries please contact the Chemical Pathology team in the Clinical Chemistry Laboratory Nov 2015 03 20 46 Jue for review on 03 Jul 2016 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Print Authorised on 23 Nov 2015 Authorised by Ann L Author s Gerard O Connor Page 46 of 157 PROTEIN CREATININE RATIO Protein Creatinine Ratio PCR is available for screening and monitoring of proteinuria A random urine sample is the specimen required for this investigation PCR is not affected by hydration status This will be reported as mg Protein mmol of Creatinine mg mmol A 24 hr urine collection will no longer be required for assessing renal protein excretion Interpretation of results should be based on the table below Table Based on the UK CKD Guidelines PCR UK CKD Approx dipstick Comment mg mmol Equivalent lt 15 Normal Negative Normal 15 44 Trace protein Trace Trace proteinuria 45 100 Clinical proteinuria 1 Two or more PCR results gt 45 in Macroproteinuria the absence of UTI indicates proteinuria gt 100 Clinical proteinuria 2 Marked proteinuria Macroproteinuria Suggest referral to Nephrologist 2 450 Nephrotic range 3 Nephrotic Syndrome Range proteinuria Suggest urgent referral to Nephrologist NB Urinary Microalbumin measurement is still the gold standard for detecting early renal impairment in diabetic pa
106. edical Scientist Senior Lecturer N B Atthe time of request a name and a mobile phone contact number must be provided for the communication of results As the test is being conducted on an urgent basis the results should be regarded as preliminary and confirmatory results will be available on the next working day A courier service must be organised for specimen transportation by the sender This service is being provided on a voluntary non payment basis by the scientific staff and it is important that it is used appropriately 18 Page 18 of 157 03 20 2015 23 Nov 010 Printed LM UI 0 Version 8 5 Ind Version 8 5 Index anua ry Medicine User Ma MONITORING RESPONSE TO PLASMAPHERESIS IN PATIENTS WITH ANTI GBM DISEASE When a patient has been prescribed a course of plasmapheresis as part of treatment for anti GBM disease serial measurements of Anti GBM titre are often used to guide therapy As the majority of IgG is extravascular a period of 24 Hrs should elapse to allow equilibration before the final post plasmapheresis sample is taken In addition for optimal comparative purposes samples taken during a course of plasmapheresis should be assayed together In such circumstances these samples will not be considered urgent and will be batched and processed at the same time at the end of planned course The serial results will be made available the day after completion of the last planned sessio
107. eeseeeeeeeeseeeseeseaeeeaeeesaeseaeeeseeseeesaeeeeeeaeeey 131 This test is for a respiratory or pre immunosupr ession screen only Please contact Clinical microbiology team for any QUETICS oooooooconcconncccionccononccnoncnononcnnnnn cnn corno conan cnn nn cn nan ncn narco 133 9 9 LIST OF TESTS SENT TO REFERRAL LABORATORIES c ccescececeeeseeeseeseeeteaeeeneeeeeees 138 9 10 INFECTION CONTROL Page 4 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 IN 150 PNEUMATIC TUBE SYSTEM PTS arie gaei aara e a era aAa aaa aa a aep aiaeei aa Neid 150 21 SYSTEM OPERA TION aaa a su aa S a E E aa Nari 150 2 2 CARRIER DS PAT O ii ta ii 150 237 QUEUING aano aee eee rere ee ee 150 2 4 RECEIWING A CARRIER a a e e teh de 150 2 6 ADDRESSES OF LABORATORY PTS STATIONS ccceceeeceeeeeeeeeeeneeeeeeeeaeeeeesneeeeaeeeeeeeaaes 151 2 7 SAMPLES WHICH MUST NOT BE SENT VIA PTS oiresatiand matado dd 151 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 5 of 157 LABORATORY MEDICINE QUICK DIRECTORY Prefix 01 414 for direct access from outside Main Office 3918 4703 4875 Central Specimen Reception 3917 Team Leader Porter Access switch at 2000 for Bleep 6232 Phlebotom 3040 3041
108. el are available to perform the frozen section e The Theatre Porter or Theatre Staff must bring the fresh specimen with completed request form and contact phone number directly and without delay to the Cellular Pathology Laboratory e The laboratory must be informed in the case of cancellation of or delay to a frozen section Reporting of frozen sections The frozen section report will be phoned to the contact number supplied Failure to supply a contact number will result in a delay in the report being communicated to the clinician A typed report will be available following routine paraffin processing of the specimen The turnaround time of frozen section diagnosis varies from specimen to specimen depending on the complexity of the case 8 6 2 Other Urgent Specimens Urgent specimens are dealt with on an individual case basis The turnaround time of urgent cases varies according to the type of tissue to be processed the optimum fixation time and the complexity of the case The request form for an urgent case must be clearly marked by ticking the priority status box and the clinical details must reflect the reason for urgency A phone or bleep number should also be provided so that the urgent report can be communicated Alternatively if a sample that has been already sent down to the laboratory subsequently becomes urgent the main laboratory should be phoned ext 3973 clearly outlining the reason as to why the status of the specimen h
109. els from any used products 7 18 RECEIPT OF BLOOD COMPONENTS PRODUCTS FROM ANOTHER HOSPITAL Any blood components products not required immediately should be returned in original transport box to the transferring hospital with patient transport e Where this is not possible or does not occur please inform the Tallaght Hospital Blood Transfusion Laboratory Send all blood components products to the laboratory without delay e Any blood component product from the transferring hospital transfused as an emergency must be prescribed and fully documented by the Medical Surgical Team to ensure traceability Please inform the blood transfusion laboratory and Haemovigilance officer of any such transfusions 7 19 BLOOD ADMINISTRATION POLICY The decision to use blood is not one to be undertaken lightly and is the responsibility of the doctor in charge of the patient This is a branch of medicine where an error on the part of clinical or laboratory staff may have the most serious consequences For this reason everyone completing request forms and samples should do so with particular attention to the data requested If data is not provided correctly it will cause delays Further information such as previous transfusions and whether there were any reactions number of pregnancies all helps to increase safety Infections and Viruses Please refer to the patient information leaflet which is located in all clinical areas and on the Blood Tra
110. ence 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 73 of 157 03 20 2015 23 Nov 010 Printed LM UI O Inde ry Medicine User Manua BLOOD TRANSFUSION 7 0 BLOOD TRANSFUSION 7 1 INTRODUCTION The Blood Transfusion Laboratory is located in room 3 5 05 in Laboratory Medicine This laboratory provides blood blood components and products for hospital patients The various therapeutic and diagnostic services provided are listed below If you have any questions about Blood Transfusion phone 3964 3965 Information on Blood Transfusion can be found in Policy on Administration of Blood and Blood Product in Adults amp Children in Tallaght Hospital PPC HAE POL 009 and Transfusion Guidelines are available on Q Pulse via computers in all clinical ward areas and on Blood Transfusion intranet page Patient Information Leaflets are available on the clinical ward areas from Haemovigilance Department and on the Blood Transfusion intranet page Intranet All information on safe transfusion practice is available on Blood Transfusion Intranet Site Better Blood Transfusion E Learning there is an on line teaching programme available on the Blood Transfusion Intranet site titled Learnprouk Go to home page or http nhs learnprouk com Clinical advice on issues concerning Blood Transfusion is available from the Haematology team 24 hours a day nual Version 8 5 Index LM Ul 0010 P
111. eonates 0 30 cells cmm 1 4 years 0 20 cells cmm 5 puberty 0 10 cells cmm Adults lt 6 cells cmm Erythrocytes Newborn 0 675 cells cmm RCC Adults lt 11 cells cmm Protein 15 45mg dl 17 Years and 2 2 3 9 mmol l Glucose over lt 17 Years 3 3 4 5 mmol l Csf glucose values should be approx 60 of the plasma glucose values and must always be compared with concurrently measured plasma values for adequate clinical interpretation These values represent the upper and lower limits of normality Bacterial or viral infection may still need to be considered where leucocyte counts are near the upper normal limits in neonates and young children Due to this any WCC above 5 are fully investigated Abnormalities associated with bacterial meningitis are reduced glucose concentration elevated protein concentration raised white blood cell WBC count elevated intracranial pressure Page 131 of 157 131 9 8 13 Specimens for the TB Laboratory Please label all samples clearly with the patient s name DOB or Hospital number date and time collected If the patient is suspected of having T B wear appropriate PPE as identified by local risk assessment during collection and discard any waste material into clinical waste bags TB Culture amp Sputum Atleast 5mls 3 early Y Monday By 9am on Microscopy sensitivity in a sterile morning E Wednesday 8 day of On day of universal
112. er filled with Saline not formalin Using pencil label the frosted end of the slide with patient name and MRN Cerebro Spinal Fluid CSF Ideally at least 0 5ml is required for cytological analysis CSF for full laboratory investigation culture white cell count biochemistry profiles cytology etc must be submitted to the Microbiology department Samples for cytological investigation only should clearly state this on the request form and be submitted directly to Cellular Pathology Fine Needle Aspirate FNA The FNA sample is smeared onto glass slides which are air dried AD or spray fixed SF Slides are placed in a plastic slide mailer labelled with patient s details Rinse out the syringe and needle with sterile saline or Hanks Solution available from the cytology lab into a labelled Universal Container The needle must be discarded as soon as the sample has been taken Under no circumstances should the needle used to take the aspirate be submitted in the specimen container Consultant Pathologists SPRs attend at FNA procedures performed in the Radiology Department to assess adequacy of the sample by arrangement with the department of Radiology Please phone extension 3929 cellular pathology office for enquiries r s Gerard O Connor Page 109 of 157 109 Vov Printed 23 UI 0010 LM Index 8 7 3 Andrology Please note There are no sample production facilities a
113. es Progesterone plasma gt 30 nmol L indicates ovulation must be luteal phase DAY 21 sample 5 30 nmol L inadequate luteal phase etc lt 5 nmol L indicates anovulation Oestradiol plasma pmol L Follicular Midcycle Luteal Postmenopausal Males PTH whole molecule plasma 15 65 pg mL Prolactin Total plasma F 100 500 mU L M 90 320 mU L Prolactin Bioactive plasma F 75 381 mU L M 63 245 mU L Testosterone plasma Adult males 9 29 nmol L 0 1 1 8 nmol L Adult females IRON STUDIES Iron plasma M 14 31 umol L F 10 30 umol L TIBC plasma 50 80 pmol L Transferrin Saturation plasma M 20 50 F 15 50 PROTEINS Microalbumin Albumin creatinine ratio M lt 2 5 mg mmol F lt 3 5 mg mmol CRP Plasma lt 5 mg L Immunoglobulins See reports for appropriate age and sex related reference ranges Page 58 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 NEUROCHEMISTRY CSF Glucose 2 2 3 9 mmol L for adults 3 3 4 5 mmol L for children 16ys lt CSF glucose values should be approximately 60 of the plasma glucose values and must always be compared with concurrently measured plasma values for adequate clinical interpretation CSF Protein 15 45 mg dL LIPIDS Desirable levels See table below Management of total CVD risk Lipids Management of total CVD risk Lipids In all cases look for and manage all risk factors Those with establish
114. essential that access is provided to unusual and rare analytes amp molecular genetic analyses that will never be directly provided within the state We must however balance this against escalating costs which in 2014 are expected to reach 600 000 with substantial additional transport costs As a consequence and with the support of Senior Management It is policy that rare and uncommon tests and analyses which are referred to laboratories overseas must be approved at Consultant level by the requesting team Senior Laboratory Management may seek to discuss individual requests as part of any cost curtailment exercise 21 Page 21 of 157 1 12 POINT OF CARE TESTING POCT POCT testing is testing performed by non laboratory staff near to the patient rather that in the clinical laboratory The rapidity of obtaining a result can contribute to improved outcomes for patients It is essential that all POCT is conducted within a framework of quality standards in compliance with national guidelines Ee Point of Care Testing Manager Ms Jane Fogarty FE 3609 Jane fogarty amnch ie Access to Service TRAINING Training and competency assessment is required for access to POCT equipment under the governance of the POCT committee To schedule training please contact Jane fogarty amnch ie Blood Gas Analysis Analysers are located in ED ITU Theatre PHDU and AMU There is a backup service available in the Clinical Chemistry Laborator
115. ests directly to NBC Haematology Team for patients with suspected or confirmed HLA antibodies These above components are ordered as required from NBC Please inform the Blood Transfusion Lab if your patient requires these components 7 24 MAJOR EMERGENCY PLAN This policy is available on QPulse ref ORG MD POL 004 The hospitals response is divided into 3 phases Phase 1 the laboratory is not contacted Phase 2 limited mobilisation the laboratory is contacted Phase 3 full hospital mobilisation the laboratory is contacted and a number of extra staff is required to attend the hospital Patient Charts The Emergency Department have charts made up to be used in event of major accident plan being implemented These charts have a hospital number attached to a prefixed number in place of patient name Adult charts start at A102 A201 Paediatric charts P202 P300 98 Page 98 of 157 Sample Labelling The samples taken in the Emergency Department will be labelled as follows e Hospital number from ready made up charts e Name As the patients name is unknown Use the prefixed number e g A102 from the chart e Gender e Approximate age of patient e Signature of person taking the sample No addressograph labels on samples Samples to be accompanied by a completed request form Blood will be provided as follows where stocks allow O Rh D Negative uncrossmatched blood will be issued to all women of child bearing age and
116. et are available on the Blood Transfusion Intranet page Policy on the Administration of Blood and Blood Products amp Transfusion Guidelines amp Patient 73 Contact details for Dr Ronan Desmond added ext 4132 Information on Cold Agglutinin Screen added Heatblock is stored in the Immunochemistry i Laboratory Clinical Chemistry Department Room A1Lab 0236 3 5 27 77 Added M S B O S Maximum Surgical Blood Ordering Schedule 78 Change a 2 sample is desirable to should be sent for confirmation of the ABO group 80 Policy Ref number corrected from PPC DC POL 022 to PPC DG POL 022 81 Policy Ref number corrected from EMV GUI 13 to ENV GUI 13 SUR NAME WARD c FORE 7 E name __ Sex E amp ADDRESS NHS No DOB 82 See o 322 DATE Y pr 1 HOSP SSE No TIME ae Owu sic 60 9 anal 8D PL6 7BP UK Sin 8 lt a mL STERMETR IVO toH1234567 E 2008 12 Image added 87 amp 88 Theatre Fridge Section rewritten to include details on Electronic Blood Track System available This report applies to all products issued by Blood Transfusion 98899 The KEY OCS report contains the following information e Patient blood group and antibody screen result e Patient special requirements if applicable Product availability report on KEY OCS Removed However a product availability report is dicine User Manual Version 8 5 Inde Page 155 of 157
117. etails are desirable on the request form e Date and time of sample Clinical details Patient Location Consultant Clinician Name Legible signature and contact number of requesting doctor Priority Status of Request Routine Urgent Details of any Sample Associated Infection Risk Date of Patient s Next Appointment Patient Address if patient has no MRN For completeness of the final report clinical information provided should include sufficient detail regarding the reason for the procedure Failure to include any of the above information or a labelling discrepancy between the request form and container will result in a delay in processing of the specimen until the discrepancy has been rectified 8 5 2 Sample packaging Standard precautions must be exercised in handling and transporting all cellular pathology specimens Specimens for routine histology should be placed in appropriately sized tightly sealed approved containers with a sufficient volume of 10 neutral buffered formalin Proper and timely fixation is a critical step in tissue preparation and the importance of this step cannot be overemphasised The specimen s together with request form must be placed in a suitable plastic pathology biohazard bag for collection AE a e FORMALIN IS A CATEGORY 2 CARCINOGEN FORMALIN AND GLUTARALDEHYDE ARE POTENT EYE AND NASAL IRRITANTS AND CAN CAUSE RESPIRATORY DISTRESS AND ALLERGIC DERMATITIS GLOVES SAFETY GOGGLES AND APRONS MU
118. ferring specimens to external laboratories If transportation is delayed please refrigerate at 4 C Faeces Faeces 1 2g ina YES Mon Sat 4 30pm Culture culture amp sterile Mon Fri 16 72 hours sensitivity universal 11 30 Sat container Faecal Fluid 1 2mlina YES Mon Sat 4 30pm Culture sterile Mon Fri 16 72 hours universal 11 30 Sat container Ova amp Faeces 1 2g ina Please YES Mon Sat 4 30pm 24 48 hours Parasites sterile provide Mon Fri detectiont universal appropriate container history foreign travel etc See Below Clostridium Diarrhoeal 1 2mlina YES Mon Fri 9am Mon Result difficile toxin Faeces sterile Fri available on detection universal day of container testing Helicobacter Faeces 1 29 ina YES Mon Fri 4 30pm 24 48 hours pylori sterile Mon Fri antigen universal stool test container Faeces for Faecal Fluid 1 2g ina YES Mon Fri 9am Mon Result Molecular Faeces sterile Fri available on Testing universal day of container testing t Please contact the laboratory for information on the appropriate specimen required for the detection of certain parasites Page 121 of 157 121 Note The following is the acceptance and rejection criteria for specimens for C difficile toxin testing Non diarrhoeal stools are unsuitable for C difficile toxin test Specimens from patients less than 2 years old are not processed for C difficile toxin
119. gy Laboratory Do not refrigerate All samples and forms should be sent to Microbiology who will distribute samples to other laboratories such as Biochemistry etc Samples will be forwarded to Biochemistry for protein and glucose If oligoclonal bands are requested the clotted blood sample and CSF will also be forwarded to the Biochemistry laboratory Ideally a minimum volume of 1 ml should be sent for culture for Mycobacterium species TSE WCJD requests for 14 3 3 or prion detection please contact the Microbiology lab as these tests have to reach the Reference Lab by 4pm Where Meningococcal meningitis pneumococcal meningitis Haemophilus influenazae meningitis or Group B streptococcal meningitis are suspected CSF and blood specimens can be referred to the Irish Meningococcal and Meningitis Reference Laboratory IMMRL for PCR Please send Irish Meningococcal and Meningitis Reference Laboratory Temple Street Request form http www cuh ie index php id 69 amp file tl_files departments Pathology 20Dept IMMRL 20request 20for m paf with these samples Please send an EDTA blood sample 2 5 5mls Samples will be referred for requested virology or virology PCR tests to the National Virus Reference Laboratory NVRL 130 ial Version 8 5 Index LM UI 0010 P Uniqt Gerard Page 130 of 157 CSF References ranges and Critical values Normal CSF values Leucocytes WCC N
120. gy is either established or highly likely as indicated by clinical details e g HCG and AFP with clinical details Testicular mass detected or other mass lesions is allowable m GP requests on patients with known malignancy Any other requests not fitting these criteria need to be discussed on a case by case basis and will not be analysed where a clear indication is lacking Samples are stored for a minimum of three months to allow for processing following discussions 5 13 THERAPEUTIC DRUG MONITORING TDM A guide to the therapeutic drug monitoring service is given below e All urgent requests for analysis outside the scheduled days must be discussed with the laboratory on a case by case basis e Scheduled analysis will continue on Tuesday and Wednesday for Tacrolimus and Wednesdays for Ciclosporin e Patients on Itraconazole treatment must be discussed with the laboratory to arrange measurement of Ciclosporin or Tacrolimus at another site analytical interference with Tallaght Drug Sampling Time Minimum time for sampling Analysis Days Therapeutic after dose change Range 0 8 2 0 ug L 6 8 hours after Daily Routine Hours last dose CICLOSPORIN Pre Dose Suggested 3 5 days after a Wednesday PM Therapeutic ranges trough dose change initiation of vary depending on therapy or initiation of an transplant type and interacting medication timing of sample post transplant Target levels and dose adjustment
121. h Air Dried ple all di al slides from Spray Fixed slides by writing AD air dried or p SF spray fixed on the frosted end of the slide Sp t ii Ideally an early morning deeply coughed specimen is P sent down to the laboratory on three consecutive days Voided urine taken into a sterile 50m Universal Urine Container The specimen should be taken from the patient approximately 3 hours after the first early morning specimen Pleural Ascitic fluid Material should be submitted in a sterile 50ml Universal Container At least 20ml of sample is needed for processing Under no circumstances are drainage bags accepted please aliquot the sample from the bag into a 50ml universal container Bronchial Washings Bronchial Lavages Material should be taken into a sterile 50ml Universal Container r s Gerard O Page 108 of 157 108 Printed 23 No A Ul 0010 8 5 Index LN Sample type Sample requirements Comment Cyst Fluid Aspirate Material should be taken into a sterile 50ml Universal Container Bronchial Bilary Brushings Smear the brush end of the specimen onto labelled slides Spray the slide with spray fixative immediately and label the slide SF If the slides are not to be fixed leave to air dry and label AD Place slides into a plastic slide mailer labelled with the patient s details Cut the tip of the brush off and place in a sterile 50ml Universal Contain
122. h D negative blood stock up to 6 units is available in Blood Transfusion Lab at all times To get these delivered contact portering on bleep 7266 or 7264 and the Blood Transfusion Laboratory 3965 3964 routine hours or bleep 7281 out of hours 7 13 REQUESTS FOR ADDITIONAL EXAMINATIONS BLOOD COMPONENTS PRODUCTS The additional examination pertinent to Blood Transfusion is a request for blood or blood products Red cells Platelets Frozen Plasma and other blood products components can be requested by completing a Blood Transfusion Request form In the section Tests Required other write ADD ON Fill in the form with exception of sample taking details on bottom right The laboratory can be phoned to inform staff of request however verbal requests without an ADD ON are not processed until the ADD ON form is received Turnaround time for ADD ON requests is as described in 7 3 above Try to avoid out of hours transfusion Orders for additional blood should be made during routine working day e Ext 3964 3965 to Bleep 7281 out of hours e An Add On crossmatch may be requested using the Blood Transfusion request form if a suitable valid sample is held in the laboratory Samples are held for 72 hours 3 days e The following details must be filled out on the request form Patients name hospital number and date of birth Location of patient i e ward It is very important to inform the Laboratory of the current location of the patient The
123. he IMMRL 1 Paired serum specimens at least 0 5 ml for serology should be obtained Blood or serum submitted for PCR will serve as a suitable acute specimen as will any other blood or serum sample taken within 24 hours of admission Whether or not an acute specimen was obtained it is still worthwhile to collect a convalescent specimen ideally 14 to 21 days after admission to hospital Note Specimens for referral to the IMMRL for investigation need to be in the Microbiology Laboratory by 9am Monday to Friday for specimens to be processed on day of receipt Meningococcal PCR Pneumococcal PCR Haemophilus influenzae and Group B Streptococcal PCR If transportation is delayed please refrigerate sample at 4 C Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 141 of 157 141 For specific details of the IMMRL laboratory please refer to the following link at the Childrens University Hospital website Here alos is a link to the CUH request for for Meningococcal Request form http www cuh ie index php id 69 9 9 4 Lists of Tests referred to the Central Pathology Laboratory St James s Hospital Dublin Please label all samples clearly with the patient s name DOB or Hospital number date and time collected and the specimen site
124. he leur connector may disengage from the adapter exposing the needle and giving a risk to needle stick injury Maintain control of the leur connector by securing it between thumb and forefinger To prevent overfilling monitor the blood volume intake into the blood culture bottle using the 5ml incremental markings on the blood label e Do not use a bottle that contains media exhibiting turbidity excess gas pressure bulging septum these are signs of contamination Samples should not be taken through an intravenous catheter or other access device unless no other access is available Take two sets during any 24h period for each septic episode For neonates take a single aerobic bottle or special paediatric bottles 9 8 11 Intravascular Cannulae Please label all samples clearly with the patient s name DOB or Hospital number date and time of collection and the specimen type Culture amp Cannula 4cm of the YES Mon Sat 4 30pm 16 72 hours sensitivity Lines Tips tip into a Mon Fri sterile 11 30 Sat container Ideally the specimen should be obtained prior to antimicrobial therapy Method of Collection Cannulae Disinfect the skin around the cannula entry site remove cannula using aseptic techniques and cut off 4cm of the tip into a sterile container using sterile scissors Specimens should be transported to the laboratory and processed as soon as possible If processing is delayed refrigeration is preferable to stor
125. hich is then put into a sterile screw capped container A broncho alveolar lavage should be transported in a sterile container Eye Swabs Scrapings Conjunctival swabs and scrapings for virus isolation should be taken into VTM Specimens should be transported without delay Skin Lesions Virus isolation Vesicular fluids and cellular material from the base of lesions should be collected during the first 3 days of vesicle eruption Vesicle fluid may be aspirated with a needle and syringe into a sterile bottle or collected onto a swab which is then placed into VTM The base of the opened vesicle can then be scraped with a sterile scalpel and the cellular material washed into VTM Electron Microscopy Vesicular fluids and cellular material from the base of lesions should be collected during the first 3 days of vesicle eruption Vesicle fluid may be aspirated with a needle and syringe the base of the opened vesicle can then be scraped with a scalpel The cellular material and or the vesicle fluid should be smeared onto the centre of a clean microscope slide and air dried Do not fix this material for Electron Microscopy Place the slide in a plastic slide carrier for transport Deaff Tests Send an EDTA blood sample to the Microbiology Laboratory no later than 12 00 pm for dispatch Post mortem or Biopsy specimens Fresh unfixed tissues should be collected aseptically from the probable sites of infection using separate sterile instruments to c
126. hin 30 minutes of sign out time from monitored laboratory fridge e Blood out of fridge gt 30 minutes can not be re refrigerated but still must be returned to the blood transfusion laboratory 7 16 THEATRE BLOOD FRIDGE A monitored blood fridge is located in theatre specifically for theatre use Crossmatched blood is transferred from the blood transfusion laboratory fridge to this fridge when requested by the theatre staff Only units of red cells are placed in the fridge Theatre fridge has an Electronic Blood Tracking System EBTS kiosk fitted which should be used to transport red cells into and out of theatre fridge This kiosk is linked to the Blood Transfusion Laboratory by an interface which transmits patient information associated with individual red cell units which ensures the correct unit is collected and transfused Access to red cells in the theatre fridge is granted to trained authorised personnel only via 2D barcodes on staff swipe cards Any medical or nursing staff removing blood from the fridge must carry with them some relevant patient documentation to facilitate input of patient details They should also receive training from the Haemovigilance Officers on the use of theatre fridge In order to collect a unit from the fridge e Scan 2D barcode on swipe card e Select Taking Out Room Temperature e When prompted press Select Patient and enter the patient MRN Confirm patient details e Select unit from f
127. hould have their container lids securely tightened prior to transportation to ensure safe arrival in the laboratory Package all specimens in a biohazard bag before being sent through the Pneumatic Tube System PTS Please inform the laboratory in advance of any Hot specimens that require processing A lead box is available in the laboratory for transport of such specimens See Hospital Guidelines at http intranet amnch ie oldlinks htm lonising Radiation Local Rules TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHY AGENTS NvCJD Samples should be clearly marked with clinical details If a patient presents with a suspected TSE CJD the laboratory must be informed prior to sending samples as separate protocols are required for handling these specimens REASONS FOR REJECTING SPECIMENS FOR BACTERIOLOGICAL EXAMINATION Incomplete or illegible request form 116 Page 116 of 157 Improperly labelled samples and samples from patients whose details do not correspond with the request form The sample should be labelled with two unique identifiers Full name Date of Birth or Hospital number The accompanying request form should also be labelled with the corresponding details See below Specimens submitted in an unsterile container Tissue specimen received in formalin or other fixative Specimens which have leaked either because the container has been damaged or the lid has not been tightened correctly Unnecessary repeat
128. i Hb genotype Cultured isolate sent from laboratory Hantavirus Clotted blood sample 1 10ml Histoplasmosis serology Clotted blood sample 1 10ml Laboratory Medicine User Manua HPV Culture Tissue Cervical cells Hydrotherapy pool water Hydropool water Hydatid serology Clotted blood sample 1 10ml Insects for identification Insects Listeria PCR Clotted blood sample 1 10ml CSF Melioidosis serodiagnosis Clotted blood sample Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 145 of 157 145 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 10ml MRSA isolates Cultured isolate sent from laboratory for typing PCP Detection BAL PVC Pneumococcal Polysaccharide Conjugate Clotted blood sample Vaccine to measure the uptake of vaccine 1 10ml Polio serology Clotted blood sample 1 10ml Q Fever Clotted blood sample 1 10ml Rabies serology Clotted blood sample 1 10ml O c Whipples Disease Clotted blood sample Tropheryma whipelii 1 10ml CSF Body Fluids Yersinia serology Clotted blood sample 1 10ml If a patient presents with Viral Haemorrhagic Fever V
129. ility label from the compatibility label sign print name and date it and place in traceability box which is located on all clinical ward areas for traceability labels to be returned to the laboratory Please ensure all unused blood components products are also returned to the Blood Transfusion Laboratory to allow complete traceability 7 20 DISPOSAL OF EMPTY BLOOD PRODUCT PACKS e Following Uncomplicated Transfusion Dispose at ward level as per Infection Control Policy e Suspected Transfusion Reaction All Blood product packs with giving set attached must be returned to the Blood Transfusion Laboratory accompanying the relevant samples and forms 92 Page 92 of 157 7 21 TRANSFUSION ADVERSE REACTIONS AND EVENTS REPORTING In the event of a suspected transfusion reaction Refer to Management of Adverse Transfusion Reactions on QPulse PPC HAE POL 010 Adults PPC HAE POL 011 Paeds Report all suspected reactions events the Blood Transfusion Laboratory and Haemovigilance officers For procedures on investigating a suspected transfusion reaction please refer to the Management of an acute transfusion reactions in Adult Paediatric Patient Algorithms This is located in the Blood and Blood Product Transfusion Record and Prescription Record purple document Please see section 7 3 Transfusion reaction investigation for sample requirements 7 22 MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE M S B O S e This is
130. ime that is acceptable Large volumes of purulent material maintain the viability of anaerobes for longer Wound or Pus samples are screened for all likely bacterial pathogens and if present these organisms and their antibiotic sensitivity results are reported The inclusion of relevant clinical information on the request form assists in deciding the relevance of some bacterial isolates If transport is delayed please keep samples at room temperature 124 Page 124 of 157 9 8 7 Fluids Aspirates from Sites Normally Sterile Please label all samples clearly with the patient s name DOB or Hospital number date and time of collection and the specimen type Fluids Pleural At least YES Mon Sat 4 30pm Culture Aspirates Fluidst 1mlina Mon Fri 16 72 hours Culture amp sterile 11 30 Sat sensitivity leak proof container Continuous At least An aliquot YES Mon Sat 4 30pm Culture ambulatory 20ml ina of sample Mon Fri 16 72 hours peritoneal sterile inan EDTA 11 30 Sat dialysis leak proof tube if cell CAPD fluid container count required Peritoneal At least An aliquot YES Mon Sat 4 30pm Culture dialysis PD 20ml ina of sample Mon Fri 16 72 hours Fluid sterile in an EDTA 11 30 Sat leak proof tube if cell container count required Joint At least YES Mon Sat 4 30pm Culture Aspirates 1mlina Mon Fri 16 72 hours sterile 11 30 Sat leak proof container Ascitic Fluid At least YES Mo
131. irements for some Components Product patient s Refer to Transfusion Medicine Handbook CMV Red Cell Concentrate ABO amp Rh D Specific irradiated All leucodepleted Suitable for use in intrauterine transfusion neonates and infants under one year 1 Sickle Cell patients 2 Washed Platelet Concentrates ABO amp Rh D specific ordered on named patient basis from IBTS All leucodepleted All irradiated Apheresis or pooled CMV Suitable for use in intrauterine transfusion neonates and infants under one year Washed HLA Matched 4 Frozen Plasma FP LG Octaplas Uniplas ABO group specific Solvent detergent treated SD plasma pooled For use in AB patients Not routinely used for warfarin reversal consider use of Prothrombin Complex Concentrate Emergency issue where patient Blood group unknown Frozen Plasma Irish Fresh Frozen Plasma filtered Not routinely available special circumstances via Haematology Consultant CMV Suitable for use in intrauterine transfusion neonates and infants under one year Cryo depleted Human Albumin Solution 5 500mls 20 100mls Fibrinogen Concentrate Human Plasma Fibrinogen Concentrate factor 1 Viral inactivation Heat Page 96 of 157 96 Blood Components Product General Information Special Requirements for some patient s Refer to Transfusion Medicine Handbook Treated P
132. ival 4hrs Liver Profile TP Alb T Bil ALT Alk Phos GGT y Daily on arrival 4hrs 2 runs per week Tuesday and Bioactive prolactin 4 days Friday Magnesium y Daily on arrival 4hrs Methotrexate Daily on arrival 4hrs 2 Batches per Microalbumin Urine week 24hrs Occult Blood Guaiac card Daily on arrival 2 days Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 41 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 41 of 157 Oestradiol Available Urgently without consultation Normal Hours 8am 8pm Sample Type Osmolality Paracetamol Parathyroid Hormone EDTA pH Fluid Syringe Phenobarbitone Phenytoin Phosphate Potassium Progesterone Prolactin Protein Total Protein Urine Assay Frequency Daily on arrival TurnAround Time 24hrs Comment Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 24hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 4hrs Daily on arrival 24hrs Daily on arrival 24hrs Daily on arrival 4hrs 4hrs Prot Creat Ratio PSA Renal Profile Na K Urea Creat Salicyl
133. l Swab YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours Cervical Swab YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours Vaginal Swab YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours Intrauterine Contraceptive Device IUCD Send entire device YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours Fluids amp Pus At least imlina sterile universal container YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours Tissue amp biopsies Placed in a Sterile universal container YES Mon Sat 4 30pm Mon Fri 11 30 Sat Culture 16 72 hours Page 123 of 157 123 Chlamydia detection Abbott Multi Collect Transport Tubes and sampling protocols are available on request from the Microbiology Laboratory The specimen collection kit instructions are available from the laboratory or at the following location http www abbottmolecular com static cms workspace pafs US AL1036 2 PI mw004 US Final v2 pdf Please send vesicle ulcer viral swab for herpes simplex investigation these specimens are referred to the National Virus Reference Laboratory Viral transport swabs are availa
134. labelled at the patient bedside See Sample Labelling below Adhere to standard infection control precautions Management of Infection Prevention and Control ENV GUI 13 Wear personal protective clothing as required 7 8 SAMPLE LABELLING Once the sample has been taken the tube must be labelled immediately at the patient s bedside by the person who took the sample All samples must be hand labelled and signed Note Please do not label samples with fine felt tip pens as these tend to smudge e Sample tubes must not be pre labelled e PIMS Addressograph or Key Order Coms labels must not be attached to the sample The sample MUST be labelled with the following essential information taken from the identity bracelet e Patients Surname and First name do not use abbreviations e g Mgt instead of Margaret e Medical Record Number Hospital number e Date of birth and e Signature of person taking the sample In addition gender date and time of collection and location should be entered Information on patient s identity bracelet and sample must be identical All writing on sample must be clear and legible Note Samples not meeting these minimum requirements will not be accepted Corrections cannot be made to the labelled sample Fig1 Label on tube used for Group amp Crossmatch Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 SUR Ta
135. lable in 3 weeks approximately 10ml clotted Blood sample Page 78 of 157 SERVICE WHEN SAMPLE TURNAROUND TIMES PRODUCT AVAILABLE REQUIRED NOTES SPECIAL REQUIREMENTS IBTS Reference Weekdays 10 ml EDTA Samples with complex serological Centre Blood patterns are referred to IBTS Results or Serological sample blood are available in one to two days Investigation but can take longer depending on and or complexity Please send samples to Crossmatch Blood Transfusion Laboratory as early as possible Tissue Typing 20mls External Lab Test amp Virology minimum Beaumont Hospital Testing for Citrated Results not returned to Tallaght Hospital Organ Blood Donation sample Renal Transplantation 2x10 ml clotted Blood sample M S B O S Maximum Surgical Blood Ordering Schedule The Blood Transfusion Department complies with the International Standard ISO 15189 Registration Number 213 MT and the regulations policies and terms and conditions of the Irish National Accreditation Board INAB and requirements of Irish Medicines Board which is the competent authority for Blood Transfusion The Irish National Accreditation Board INAB is the national body with responsibility for accreditation in accordance with the relevant International Organisation for Standardisation ISO 17000 series of standards and guides and the harmonised EN 45000 series of European standards 7 3 1 Emergency Blood Management Group
136. lection and the specimen type MRSA Nasal amp groin Refer to YES Mon Sat 4 30pm Culture Screen Infection Mon 48 72 hours Culture Control Fri manual 11 30 Sat VRE Screen Faeces 1 29 of Refer to YES Mon Sat 4 30pm Culture Culture amp faeces Infection Mon 48 72 hours sensitivity Control Fri Manual 11 30 Sat CRE Screen Faeces YES Mon Sat 4 30pm Culture Culture amp Rectal swab Mon 48 72 hours sensitivity Fri 11 30 Sat Environmental Pharmacy Plates NO Mon Friday 4 30pm 48 hours samples Swabs Culture Culture amp YES Mon Sat 4 30pm Culture sensitivity Mon 16 72 hours Fri 11 30 Sat Culture Settle plates NO Mon Sat 4 30pm 48 hours Mon Fri 11 30 Sat An MRSA screen consists of a nasal swab and a groin swab only Use one swab only for left and right nostrils Page 127 of 157 127 9 8 10 Blood Culture Blood cultures are continuously monitored on analyser and processed on a 24 hour basis The blood culture bottles and system in use are the Bac T Alert Biomerieux system There is an expiry date on each bottle and they should not be used after this date Please label all samples clearly with the patient s name DOB or Hospital number date and time of collection and the specimen type DO NOT place addressograph label over the Bar Code on bottle Blood culture bottles may be transported in
137. linical information including known infection risk with each request Any spills must be dealt with in accordance with hospital spill procedure Please ensure that you are familiar with the Infection Control and Prevention Guidelines pertinent to spill management which are available on QPULSE see hospital intranet website On 1 7 2 Radiation Safety The procedure for managing hot samples from patients who have received a radioactive imaging material or radiopharmaceutical material is available in lonising Radiation Local Rules ADM POL 5 located on the hospital QPULSE system 1 8 SPECIMEN TRANSPORT During the process of transporting patient samples to the laboratory it is essential that samples are transported safely and efficiently in order to 1 Ensure safe custody and integrity of the sample which must reach the laboratory in proper condition and as quickly as possible 2 Ensure the safety of staff transporting samples 3 Ensure the safety of other staff patients and members of the public Please Note THE PNEUMATIC TRANSPORT SYSTEM PTS IF APPROPRIATE TO THE SAMPLE TYPE S THE PREFERRED METHOD OF DELIVERY OF SAMPLES TO THE LABORATORY Some useful hints for getting your specimens safely to the laboratory 2015 03 20 12 2 Due for review on 03 Jul 2016 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Print Authorised on 23 Nov 2015 Authorised by Ann L Author s Gerard O Connor Pag
138. ltative service is available through the Microbiology Registrars and Consultants during routine hours at the above numbers and by the Consultant Microbiologist out of hours via the On Call Medical Scientist or Hospital switch 9 6 ROUTINE RESULTS AND REPORTING Where VDUs are available reports for both routine and emergency requests will be on screen in your ward as soon as they are validated by laboratory personnel Please make use of this facility Non urgent phone calls create a significant workload and cause unnecessary delays in processing samples All positive CSF specimens all Skin Scrapings positive for Meningococcal disease all positive Blood cultures Mycobacteria Salmonella Shigella Campylobacter Group A Streptococcus C difficle toxin HIV Hepatitis Legionella and pneumococcal urinary antigen results are telephoned In addition isolates from normally sterile sites which are deemed significant by the Microbiology Registrar are telephoned Individual paper reports are issued for some sections Results are also available electronically 9 7 GUIDELINES FOR MICROBIOLOGICAL SPECIMENS The value and reliability of the results of many diagnostic bacteriological tests is largely dependent on correct procedures being followed when tests are requested Microbiology results depend critically on the type and quality of the material received Therefore this material should be representative and fresh All specimens of infectious material s
139. m the Laboratory at SJH via MediBridge Following review amp authorisation they transfer to the Order Communications System KEY and are available as part of the electronic patient record for laboratory results If you have any queries regarding the Immunology service please contact Dr Gerard O Connor at 3905 in Laboratory Medicine or another senior member of the Laboratory Staff 1 10 5 Protocol for Requesting Urgent ANCA and Anti GBM Requests and Monitoring Patient Post Plasmapheresis The Immunology Department St James s Hospital provides a diagnostic laboratory service for the investigation of patients with disorders affecting their immune system This service is currently available Monday Friday 09 00 17 00 Hrs In patients with suspected organ threatening ANCA associated vasculitis or anti GBM mediated disease early diagnosis is crucial in support of prompt and appropriate treatment The Immunology Department contributes to the prompt diagnosis of these disorders by providing an urgent out of hours service for ANCA and Anti GBM testing The turnaround time from receipt of samples will be approximately two hours Procedure Monday Friday 09 00 15 00 The consultant or senior registrar must phone 01 4162924 and ask for the medical scientist responsible for urgent ANCA and GBM requests All other times The consultant in charge must contact the following individual to organise the service Dr Jean Dunne 087 9963263 Chief M
140. meetings Clinical liaison Hospital groups and committees Ward rounds by Laboratory Clinicians Response to user complaints Review analysis and monitoring of incidents and complaints Communication with users is achieved by various means FT Laboratory Medicine User Manual Laboratory Web page on AMNCH Intranet GP Newsletter Lectures and seminars Grand Rounds User focus groups e g GP Liaison Committee Multidisciplinary team meetings Clinical liaison Hospital groups and committees Ward rounds by Laboratory Clinicians Page 149 of 157 149 APPENDIX 2 PNEUMATIC TUBE SYSTEM PTS Brief Operating Instructions are located on laminated cards at each Ward PTS station Refer also to Interim Operational Policy Pneumatic Tube Transfer System 2008 available at G PTS PTS Operational Policy master doc version 2 2 1 SYSTEM OPERATION Follow the summary operation instructions attached to each PTS station Codes and Names of Departments on the system can be accessed via the station s keypad and the directory Correct usage of the PTS system is essential in order to optimise its performance Porters when collecting pods should only collect the 2 3 pods assigned to their particular ward 2 2 CARRIER DISPATCH Summary Instruction Place the article correctly in the appropriate container and close the top Enter the destination station code Open the station door insert carrier CHECK AGAIN THAT THE DESTINATION
141. n A printed copy of the report is also generated and sent to the relevant clinical area team For enquiries about reports please phone the Cellular Pathology office Ext 3928 3929 2985 8 8 1 Turnaround times The following are target turnaround times national guidelines are currently being established and are subject to the factors outlined below and the impact of various resource issues These target turnaround times have been agreed following consultation with the users of our service gt Small biopsies o Inpatient 5 working days o Outpatient 10 working days gt Non biopsy specimens 7 working days gt Cytology specimens o 5 working days o Semen analysis and post vasectomy 10 working days Turnaround times refer to the availability of an authorised report for 80 of uncomplicated specimens turnaround time may vary according to the type of specimen to be processed including requirement for decalcification the optimum fixation time required and complexity of the case Certain additional investigations such as special stains immunohistochemistry etc will impact on turnaround times 8 8 2 Turnaround times TATs for samples that are referred out Referral centre TAT Molecular testing Cancer Molecular Diagnostics Laboratory SJH 3 weeks HER2 status Histopathology SJH 3 weeks Muscle and nerve biopsies Neuropathology Beaumont Hospital 3 weeks dates 3 weeks for Renal biopsies Renal
142. n to allow clinicians to use them as guidance should further sessions be required Therefore once a decision has been made to start a patient on a course of plasmapheresis please liaise with the lab by ringing 01 4162924 to advise regarding the number of sessions planned and the completion date Samples should also be labelled in relation to the plasmapheresis session e g post 4 plasmapheresis sample 1 11 GENETIC TESTING 1 11 1 Introduction The laboratory offers a comprehensive programme of referral genetic testing to clinical departments This is provided as a number of distinct process streams Each Department in the Laboratory provides specific genetic testing pertinent to their scope and profiles Users should refer to the appropriate User Manual sections for relevant instructions Test for Hereditary Haemochromatosis should be directed to the Haematology laboratory where they are referred to an independent facility for analysis Note that this service is expensive For constitutional cytogenetic testing and molecular genetic testing the Laboratory refers these as follows o Constitutional karyotype Chromosome FISH testing is referred to the National Centre for Medical Genetics NCMG www genetics ie if the request meets the following criteria New borns and children lt 5 yrs old for chromosome analysis Microdeletion syndromes for FISH only analysis no age restriction On going family
143. n Sat 4 30pm Culture 1mlina Mon Fri 16 72 hours sterile 11 30 Sat leak proof container Bile 1 2ml Ina YES Mon Sat 4 30pm Culture sterile leak Mon Fri 16 72 hours proof 11 30 Sat container t All pleural fluids are sent for TB culture and sensitivity Requests for crystal examination on joint aspirates are performed by the Cellular Pathology department Ascitic fluid may be inoculated into Blood Culture bottles in acute peritonitis cases Notes on transport Specimens should be transported and processed as soon as possible The volume of specimen influences the transport time that is acceptable Large volumes of purulent material maintain the viability of anaerobes for longer however the recovery of anaerobes is compromised if the transport time exceeds 3 hours If processing is delayed refrigeration is preferable to storage at ambient temperature Delays of over 48 hours are undesirable 125 Page 125 of 157 9 8 8 Tissues Biopsies amp Bone Specimens Chest Drain tips Please label all samples clearly with the patient s name DOB or Hospital number date and time of collection and the specimen type SPECIMENS RECEIVED IN FORMALDEHYDE ARE NOT SUITABLE FOR CULTURE Culture amp sensitivity Tissue In a sterile N B Do not YES Mon Sat 4 30pm Culture leak proof add Mon Fri 16 72 hours container formaldehyde 11 30 transported as this will Sat to the lab kill any
144. n the Clinical Chemistry Laboratory Cases of suspected interference should be discussed with the laboratory Some important Drug Interferences are listed in the Table below THIS IS NOT A COMPLETE LIST CONTACT CLINICAL CHEMISTRY FOR FURTHER INFORMATION Test Interfering Substance s Details Source Ammonia Sulfasalazine Sulfapyridine No result produced CCFSN_04 15 10 06 2015 AST Sulfasalazine Sulfapyridine Interference V Results CCFSN_04 15 10 06 2015 ALT Sulfasalazine Sulfapyridine Interference y Results CCFSN_04 15 10 06 2015 BILT Cyanokit Interference y Results Roche Safety Notice CCA_11_14 October 2015 Creatinine N Acetyl Cysteine gt 333mg L Interference y Results Roche Safety Enzymatic Notice CCFSN 03 15 Rifampicin May auis L evodop Interference y Results Dexi HPRA SN2015 09 elem Issue Date 21 May 2015 Digoxin Certain drugs including Interference y Results Method hydrocortisone therapy uzara information sheet and triamterin may cause falsely elevated digoxin levels Also spironolactone and similar drugs at high doses IGE Xolair Do not use samples from Method patients under treatment information sheet with XolaiR FOR IGE analysis Lactate N Acetyl Cysteine gt 1497mg L Interference y Results Roche Safety Notice CCFSN 03 15 May 2015 HPRA SN2015 09 Issue Date 21 May 2015 Lipids Chol Trig N Acetyl Cysteine Interference y Results Roche Safety HDL LDL Notice CCFSN 0
145. ncnnccnnanannns 28 4 4 PROCEDURE FOR TEST ORDERING FOR ST LOMANS coooccciocccoccconcccnononancconnconncnnncnnnncnnncns 28 4 5 REQUEST FOR PATIENT ON CLOZARIL MEDICATION coooccnncccnoccconcconnconncnnnncnnnconncnanccnnncnnncos 29 4 6 GP PHLEBOTOMY SERVICE FOR ADULTS dr eos 29 4 7 BLOOD COLLECTION ORDER OF DRAW scc5 c2 5 055 tanta idilio 30 4 8 ADULT PHLEBOTOMY DEPARTMENT STARTING TIMES HOURS OF SERVICE 31 5 0 CLINICAL CHEMI OTR Y coil ME ana 32 Sl INTRODUCTION 0 iaa ne oe ea ed Se Sd AORO tia iaa 32 5 2 CLINICAL CHEMISTRY PERSONNEL wit 3 cesses hei ted 32 5 3 REQUESTING ING ESI PION Soe it codec chs Renae cote octal o o 32 5 4 NORMAL HOURS AND DEADLINES FOR ROUTINE ANALYSIS o e 34 5 57 SPECIAL PROCEDURES ice e te il dd A cert ute De cute chant 34 5 67 RESUETS AND ENQUIRIES lt 00000 0d a a a arcilla see adeedhdendadetade 34 5 178 TAT LAB EMERGENCY SERVICES caros iban uti salada Re inn 37 5 8 SERVICE AGREEMENTS FOR VARIOUS INVESTIGATIONS ooncoccccocccoccnononncanonancnncnananacnnos 39 5 9 ASSAY FREQUENCY TURNAROUND TIMES SAMPLE TYPE 40 PaO eee ot 7 bh I 10 B cole eer ener Pe ne rere ne rey Ree Peter eee Be a oe rae lo ee a a 43 5 11 ESTIMATED GLOMERULAR FILTRATION RATE EGEFR e ceesceeeceeeeeeeeeeeeeeeeeeeeeeeeneeens 46 542 TUMOUR MARKER SERVICE unas cir t n 49 5 13 THERAPEUTIC DRUG MONITORING TDM oc eeeeeeeceeeeeeeeeeeeeeeeeeeeaeeeaeeeseeseaeeeaeeseeeeaeeneetaes 50 5 14 REFERENCE VALUES tienen d
146. ncy services and services provided outside the core working day The department is located on the ground floor of the main hospital building to the left of the main atrium Access is via security card controlled double doors from the main Hospital Street Phlebotomy is located at two sites as indicated on the diagram Secure access to the Department facility is provided to hospital staff within the guideline of 15015189 5 2 2 a LOCATION OF THE LABORATORY Pastoral Care Huma Resourdes Psychiatric Unit Abcident amp rgency Medical Records A amp E Entrance Phlebotomy Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 9 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 9 of 157 20 LM UI 0010 Printed 23 Nov 2015 03 y Medicine User Manua The Laboratory Medicine Department is the Pathology Diagnostic Department for all clinical activity in the hospital and provides services to the community of General Practitioners supported by the hospital and to other Health Care Institutions There are 5 constituent departments Blood Transfusion Cellular Pathology Clinical Chemistry Haematology and Microbiology The Laboratory Medicine Department also provides core adult phlebotomy services together with external test referral for Immunology amp Constitutional
147. ndividual laboratory websites with reports returned to the clinical teams On the National Centre for Medical Genetics website www genetics ie users are able to access the genetic requesting form including consent details together with guidelines and policies on sample identification and general rules for testing It is best practice in all cases to obtain written consent from patients when genetic testing is being performed In summary the following should be noted There are only 3 acceptable identifiers to the National Centre for Medical Genetics NCMG The full name 7 Date of Birth DOB 7 Hospital Medical Record Number 2 All samples must be clearly labelled with a name according to the criteria for specific sample type with at least one of the other two identifiers Compound names must be present on both sample and referral form see policy on identification details required on samples submitted for genetic analysis at www genetics ie Note that the referral laboratory will reject any requests where there is a mismatch between patient demographics on the request form and sample s 3 The request form must be received with the sample SAMPLE REJECTION CRITERIA Test requests may be rejected if the following situations apply e Sample types not compatible with tests requested Significant difference between patient identifiers on sample and corresponding request form MRN provided does not match the other details on the re
148. ne Deadline for reports by 12 30 Specimens in Lab by 11 30 Antibiotic assay in Lab by 11 00 Routine samples arriving after the cut off times will be analysed during the next working day 9 3 LABORATORY NOTIFICATION OF EMERGENCY WORK DURING ROUTINE HOURS Within routine hours please telephone the Microbiology laboratory Ext 3940 3941 3942 or the Microbiological Secretarial Office 3934 3935 from 12 midday onwards Between 9am and 12 midday please bleep 7280 for urgent requests This is essential to ensure that the specimen is expected and is handled as an emergency test Please note that marking a sample Urgent will not cause it to be handled urgently unless the Microbiology laboratory has been notified CSF specimens skin scrapings and Blood cultures are always processed urgently and should be delivered immediately to the Microbiology Laboratory OUTSIDE OF ROUTINE HOURS The emergency service is available on a 24 hr basis and is restricted to true emergencies Other tests may be requested but these would require validation by the laboratory medical staff on duty Outside normal working hours from 5pm until 8am the following morning the procedure is Contact or bleep the person on call in Microbiology Microbiology Medical Scientist On call Bleep No 7280 which has a voice mail facility information on Patient name Ward Sample must be supplied each time the Medical Scientist is bleeped 9 4 LIST OF TESTS AVAI
149. ne profiles will be available for constituents see table ASSAY FREQUENCY TURNAROUND TIMES SAMPLE TYPE in section 5 9 SPECIMEN COLLECTION AND PACKAGING Specimen collection should comply with requirements stated in the Specimen Guide Specimens together with the Request Form should be placed inside a plastic biohazard bag and dispatched to the laboratory DISPATCH TO THE LABORATORY Specimens should be delivered to the laboratory as soon as possible after collection All specimens should be delivered on the day of collection Blood samples taken for measurement of Potassium should ideally be received in the laboratory within 4 hrs Delays in sample transport can result in falsely elevated values Blood samples for potassium measurement should NOT be refrigerated Use of the phlebotomy service in Tallaght Hospital will ensure prompt delivery to the laboratory Specimens should normally be dispatched to the laboratory using the Pneumatic Tube System PTS See separate instructions HEALTH AND SAFETY Standard precautions should be observed when handling all pathological material Specific instructions for sending radioactive samples are available in the local rules for ionizing radiation 33 Page 33 of 157 5 4 NORMAL HOURS AND DEADLINES FOR ROUTINE ANALYSIS Monday to Friday 08 00 20 00 Deadline Specimens for general chemistry and routine endocrinology requested using the OCS system from inpatients in Lab b
150. ng If in any doubt please contact the relevant department by telephone Brief PTS Operating Instructions are located on laminated cards at each Ward PTS station and a summary is available in appendix 3 NOTE in general the vast majority of samples processed by the Laboratory are Category B However in particular instances such as threatened outbreaks such as EBOLA and Influenza samples may be category A and require packing and transport arrangements appropriate to the transport of category A specimens 1 9 AMNCH MAJOR EMERGENCY PLAN This plan is part of the major accident plan for the greater Dublin area Readers are referred to the Major Emergency Plan for details on how the plan should function This is available on the hospital intranet site http intranet amnch ie 2015 03 20 13 Authorised on 23 Jue for review on 03 Jul 2016 Author s Gerard O Connor Page 13 of 157 gt User Manual 1 10 IMMUNOLOGY REFERRALS 1 10 1 Introduction Requests for immunology other than immunochemistry are referred to the Immunology Department in the Central Pathology Laboratory CPL St James s Hospital The department offers both a comprehensive testing service and clinical advice If you require clinical immunology advice you may contact Immunology Consultant at the following number 01 4162928 If you have technical questions related to the immunology testing service please contact Dr Gerard O Connor in Laboratory Medicine a
151. nown haemoglobinopathy altered red cell survival See Guideline for comprehensive information Glucose Tolerance Testing As a result of these changes we will not be providing an open access service for GTTs All requests for GTT will need to be discussed in advance of ordering with the Chemical Pathology team Intermediate Findings and Areas of Uncertainty As with plasma glucose measurements at present intermediate findings also occur commonly with use of HbA1c for diagnosis Most patients with abnormal glucose or HbA1c values which fall short of diabetes are likely to benefit from lifestyle and other interventions as for existing pre diabetes management Further information and suggested approaches can be found in the Guideline We are also happy to answer any queries you have on these patients by contacting us or the diabetes team 61 Authorised on 23 1 ew on 03 Jul 2016 Page 61 of 157 HAEMATOLOGY 6 0 HAEMATOLOGY 6 1 HAEMATOLOGY PERSONNEL Haematologist Haematologist Haematologist Registrar Haematology 3937 bleep 6258 or bleep 7025 MS DYMPNA MURPHY Chief Medical Scientist AN 3909 Scientist MAHON Scientist Scientist SS a R a Grade V AAA A a ee Insert 01 414 before extension number for direct access from outside or 01 4142000 for hospital switch and ask for extension or bleep number 6 2 NORMAL HOURS AND DEADLINES FOR ROUTINE ANALYSIS Monday Friday 8am 8pm Routine testing on s
152. nsfusion routine transfusion 4hrs for 1 unit of red cells Reason for transfusion current haematology value if available Prescribing doctors signature IMC number and bleep A prescription can be cancelled by drawing a line through it It must be clearly signed and dated by the medical doctor cancelling the prescription Prescriptions are valid for 48 hours DELIVERY OF BLOOD TO THE CLINICAL WARD AREA A designated Blood Porter is available 24hrs a day on bleep 7266 In addition the portering supervisor can be contacted on bleep 7264 To request delivery you will need the following details Patient Name Medical Record Hospital Number a Clinical Ward area Product type e g red cells platelets Your name Speak clearly so there is no confusion about patient details These details are recorded on a telephone request docket If you cannot contact 7266 phone 3964 3965 Mon Fri 09 00 17 00 Sat 09 00 12 30 Bleep 7264 out of these hours Do not order blood to be delivered to the ward unless you have a patient cannula in place Blood will be delivered to the clinical area on a single unit basis as required Requests for more than one unit must be made by contacting the lab 3964 3965 Bleep 7281 on call It is important that the person who orders the delivery of blood blood product is available to receive it at the clinical ward area or in cases where this is not possible a nominated person should be present to r
153. nsfusion intranet page BT M DC 092 91 Page 91 of 157 See Policy on the Administration of Blood and Blood Products in Adults and Paediatrics in Tallaght Hospital PPC HAE POL 009 e All Blood Products Components must be prescribed separately and documented in Blood amp Blood Product Transfusion Record amp Prescription record e All prescriptions are valid for 48hours e Inform the patient of potential risks associated with transfusion e Give the patient a leaflet called Patient Information on Blood Transfusion Patients receiving regular transfusion may not take one every time they are transfused e Itis essential that each unit transfused is properly documented e It is essential for Medico legal reasons that all blood products are traceable and their fates correctly recorded i e transfused unused etc Traceability All hospitals have a legal requirement to trace each individual unit of blood components products whether transfused or disposed of in accordance with the EU Directive 2002 98 EC To meet these requirements Tallaght Hospital have a traceability procedure whereby all blood components products have a traceability label attached to the compatibility label detailing patient s name and Medical Record Number component product details There is a space for signature of the person witnessing the transfusion and the date on which it occurred Once the transfusion has commenced tear the traceab
154. nt intact to the referral laboratory ROUTINE REQUESTS See section 7 4 on Blood Transfusion laboratory opening hours for routine requests Requests on patients receiving ongoing Albumin treatment e g from Dialysis should be written on a blood transfusion request form Order sufficient quantity to cover out of hours weekend Samples from patients who attended Orthopaedic pre assessment Clinic as documented in list sent by CNM in pre assessment and due for surgery on Monday should be received by the Blood Transfusion Laboratory by 19 00 Sunday evening This does not apply on a Bank Holiday Monday If the transfusion or operation has been cancelled or rescheduled inform the blood transfusion Laboratory Otherwise staff will continue working on the request and blood might be wasted Platelets see section 7 3 above Services Products and Turnaround Times 84 Page 84 of 157 7 12 URGENT REQUESTS Urgent means the sample will be processed as soon as possible after receipt and results blood will be available if compatible within 4 hours depends on availability of blood Urgent requests are for unavoidable medical surgical emergency e g patient bleeding However if results blood are required sooner the requesting Medical Doctor must contact the Blood Transfusion Laboratory explaining the urgency e Blood results can be made available in 45 60 minutes or sooner if a Group and Save sample is available in the Blood Transfusion La
155. o familiarise themselves with the Hospital publication Guidelines in relation to obtaining patient consent ORG RM GUI 001 which is available on QPulse Samples submitted for analysis may be used anonymously for quality control purposes following completion of testing All investigations and results produced by the laboratory are of a confidential nature in line with respecting the privacy of the patient doctor relationship and the needs of the Clinical staff providing the care Access to testing information and results should be on the basis of need only Strict access and usage criteria are enforced with prevailing Data Protection Legislation Users are referred to the Hospital Policy Patient Confidentiality ICT ICT POL 003 Page 2 of 157 Table of content LABORATORY MEDICINE DIRECTORY OF SENIOR STAFF cccseceeceeceeeeceeseeeereeaeeeeerseaeeneeseenaeeaeenees 8 PABORATORY MEDIGIN Eis sacs sex isestccestucceay ion a E a a 9 1 0 LABORATORY MEDICINES ren nar Ai rn 9 TI INTRODUCTION aaa a eee atra te TEE dl ciate as 9 1 2 QUALITY MANAGEMENT SYSTEM conca tdi ted ted es ded ded ere eae tie 10 1 3 USER SATISFACTION COMMENTS AND COMPLAINTS 0 0 eee ee eee teeter teeter eeeeeeee 10 1 4 IMPORTANT ISSUES WHEN USING THE LABORATORY MEDICINE SERVICE 11 Ae RECEPTION ia aaa tanta mute ters eect 11 TO REPORT DELIMERY xii saeco sia ace sa te Se ee re ee mae Bic ena Se a meine a cits see a lt ites 11
156. o screening CA125 Daily on arrival 72 hrs Requests subject to screening Caeruloplasmin Daily on arrival 24hrs Calcium y Daily on arrival 4hrs Bu i os Send to laboratory within 15 Calcium lonised y yring Daily on arrival 15 mins mins max Carbamazepine y Daily on arrival 4hrs Carboxyhaemoglobi n y Daily on arrival 15 mins CEA Daily on arrival 72 hrs Requests subject to screening Chloride y Daily on arrival 4hrs Cholesterol y Daily on arrival 4hrs CK y Daily on arrival 4hrs Copper Monthly 4 weeks Cortisol Daily on arrival 24hrs Creatinine y Daily on arrival 4hrs CRP y Daily on arrival 4hrs Laboratory Medicine User Manual Version 8 5 Index LM Ul 0010 Printed 23 Nov 2015 03 20 40 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 40 of 157 Available Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Urgently without Sample Type a Analyte consultation Assay Frequency TurnAround Time Comment Normal Hours 8am 8pm CRP S Daily on arrival 4hrs Contact Ext 4856 heating block Cryoglobulin Daily on arrival 7 da
157. oecimens should be transported and processed as soon as possible If processing is delayed refrigeration is preferable to storage at ambient temperature ENT Mouth Swab YES Mon Sat 4 30pm Culture culture amp Mon Fri 16 72 hours sensitivity 11 30 Sat YES Mon Sat 4 30pm Culture Mon Fri 16 72 hours 11 30 Sat YES Mon Sat 4 30pm Culture Mon Fri 16 72 hours 11 30 Sat YES Mon Sat 4 30pm Culture Mon Fri 16 72 hours 11 30 Sat YES Mon Sat 4 30pm Culture Mon Fri 16 72 hours 11 30 Sat Bordetella A Bordetella 4 30pm Culture pertussis pack is NO Daily Mon Fri 7 days available 11 30 Sat Perinasal Swabs from the Laboratory Note A nasal swab is not useful for the investigation of sinusitis Antral lavage or pus from sinus should be sent if acute maxillary sinusitis is suspected Nasal swabs are useful for the investigation of carriage of Staphylococcus aureus and Methicilin Resistant Staphyloccus aureus MRSA Specimens for Acanthamoeba investigation are referred to the Royal Victoria Eye and Ear hospital Dublin Page 119 of 157 Swabs for investigation of Diphtheria should be clearly stated in the clinical details Specimens for Chlamydia trachomatis investigation are referred to the National Virus Reference Laboratory Please contact the Microbiology Laboratory for the appropriate swab required for this inve
158. oes not generally issue reports to GP s arising from requests generated by Hospital Consultants If a copy of such a report is required contact the appropriate clinical team 2 3 GP LIAISON GROUP There is an active GP Liaison Group at AMNCH 2 4 INFORMATION FOR GP S ON AMNCH INTERNET SITE There is an information section including this user manual for GPs on the hospital internet site at www amnch ie 2 5 SAMPLE TYPE SAMPLE VOLUME AND REQUIREMENTS FOR PARTICULAR TESTS Please refer to individual department sections for complete instructions on sample types and collection containers and any other specific instructions ALWAYS USE BLOOD COLLECTION TUBES THAT ARE IN DATE BLOOD TAKEN INTO EXPIRED COLLECTION TUBES MAY RENDER THE SAMPLE UNSUITABLE OR IMPACT THE RELIABILITY OF THE RESULT If in any doubt please contact the relevant department by telephone We endeavour to provide an efficient and effective service to our GP community and their patients If you have queries or questions relating to the laboratory service please contact Dr Gerard O Connor at 3905 or a senior member of the Laboratory team 25 nual Version 8 5 Index LM Ul 0010 P s Gerard O Connor Page 25 of 157 ORDER COMMUNICATIONS SYSTEM KEY 3 0 ORDER COMMUNICATIONS SYSTEM KEY It is the policy of the department that OCS is the primary means by which tests other than blood transfusion and cellular pathology are requested We maintain a man
159. of 157 ADDITIONAL ENZYMES LDH serum AST plasma Amylase plasma M lt 35 IU L F lt 30 IU L 135 220 U L lt 100 IU L IONISED CALCIUM Calcium lonised Balanced Heparinised Syringe CARDIAC MARKERS CK plasma Troponin T BNP BLOOD GASES Ph Hydronium on concentration PCO2 PO2 Actual Bicarbonate Standard Bicarbonate Base excess Oxygen saturation Carboxyhaemoglobin as Hb TUMOUR MARKERS 1 15 1 30 mmol L M lt 190 IU L F lt 170 IU L lt 14 ng L lt 300 pg ml Ruleout 7 35 7 45 35 45 4 5 6 0 kPa 11 15 kPa 22 28 mmol L 21 27 mmol L 2 to 2 mmol L 94 100 lt 1 in non smokers Up to 9 in smokers gt 20 Toxic Source Tietz Caucasian 40 49 yrs 0 2 5 50 59 yrs 0 3 5 60 69 yrs 0 4 5 CA 19 9 lt 39 U mL 0 5 IU L TOXICOLOGY Adult Decision levels Paracetamol plasma Refer to IMB Guidelines Salicylate plasma Ethanol plasma Therapeutic levels usually 150 300 mg L Minor Toxicity 301 450 mg L Moderate Toxicity 451 700 mg L Major Toxicity gt 700 mg L Up to 100 mg dL euphoric changes some impairment expected 100 300 mg dL drowsiness confusion gt 300 mg dL impaired consciousness coma 57 Page 57 of 157 TSH plasma Free T4 plasma Free T3 plasma Thyroperoxidase Antibody TPO Ab Cortisol free 24 hour urine Cortisol plasma at midnight FSH and LH plasma IU L Follicular Mid cycle Luteal Postmenopausal Mal
160. ology Screening ON CALL INVESTIGATIONS REQUIRING CONSULTATION Page 37 of 157 23 Nov 2015 03 20 Printed 10 LM UI 00 Index L 8 5 1 y Medicine User Manual Versior ator aborator Li Therapeutic Drugs digoxin theophylline lithium anticonvulsants methotrexate ciclosporin etc Urine Chemistries not mentioned above Other Chemistries not mentioned above Planned investigations occurring out of hours or over weekends should be discussed in advance with the Clinical Chemistry medical team ON CALL INVESTIGATIONS AVAILABLE The Emergency Service cannot accommodate routine investigations These will be analysed on the next working day Common unrestricted investigations are shown above Investigations in the Requiring Consultation category must be discussed in the first instance with the on call Medical Surgical or Paediatric Registrar who should then contact the Chemical Pathology Registrar or the Consultant Chemical Pathologist Further details can be obtained from the on call scientist 38 Authorised on 23 Page 38 of 157 EMERGENCY TOXICOLOGY Most requirements for emergency toxicology can now be met locally e g salicylate paracetamol ethanol and urine toxicology screen Certain other poisons e g iron overdose in children are available as emergency tests on site Please note that toxicology testing for medico legal purposes is not currently available including ethanol for
161. on Microscopy 2mlina O Wednesday amp day of On day of sterile Friday processing processing universal Culture container Negative 132 Page 132 of 157 TB Culture amp 8 weeks sensitivity Positive Telephoned on day of detection Pus In a sterile Y Monday By 9am on Microscopy universal E Wednesday amp day of On day of container S Friday processing processing Culture Negative 8 weeks Positive Telephoned on day of detection Skin In a sterile Y Monday By 9am on Microscopy tissue universal E Wednesday amp day of On day of biopsies container S Friday processing processing Culture Negative 8 weeks Positive Telephoned on day of detection Bone In a sterile Y Monday By 9am on Microscopy universal E Wednesday amp day of On day of container S Friday processing processing Culture Negative 8 weeks Positive Telephoned on day of detection Blood Please N Processed at the 12pm on day 7 weeks contact the O Irish of collection laboratory Mycobacterium as samples for the Reference must be appropriate Laboratory St transported blood culture James s Hospital to St bottles IMRL James s Hospital Bone Please N Processed at the By 12am on 7 weeks Marrow contact the O Irish day of laboratory Mycobacterium processing for the Reference appropriate Laboratory St blood culture James s Hospital bottles IMRL This test is fora respiratory
162. or nara By 4 30pm Quantiferon Blood Please ssioh Y On request only Monday to Assay contact the screen only E Processed atthe Thursday laboratory Please S TB Laboratory for the contact Microbiology appropriate Clinical Dept Mater blood microbiology Misericordiae collection team for any Hospital tubes queries Specimens should be transported and processed as soon as possible Sputum may be refrigerated for up to 2 3h without an appreciable loss of pathogens If routine culture is required a separate specimen and request form are required 133 Page 133 of 157 Version 8 5 Index LM Ul 0010 Printed 23 Nov 2015 03 20 gt User Manual sin t TB testing is only carried out on urines at the request of the urology or respiratory services following discussion with the Consultant Medical Microbiologist Please contact the laboratory prior to sending Gastric Lavage specimens Specimens can be referred for PCR molecular techniques for the detection of mycobacteria following discussion with Microbiology Medical Team These specimens are referred to an external laboratory Royal Victoria Hospital Belfast Lab Quantiferon Specimen Collection Quantiferon TB gold IT uses the following collection tubes Nil control grey cap TB antigen red cap Mitogen control purple cap Antigens have been dried onto the inner wall of the blood collection tubes so it is essential that the contents
163. ospital Belfast Lab Please label all samples clearly with the patient s name DOB or Hospital number date and time collected and the specimen site Allergic Alveolitis Screen Clotted blood sample EDTA sample 1 10ml ASOT Clotted blood sample 1 10ml Aspergillus M faeni serology Clotted blood sample 1 10ml Brucella serology Clotted blood sample 1 10ml Legionella serology Clotted blood sample 1 10ml Mycology Nail clippings culture Nail Clippings in a sterile universal container Typhoid amp Paratyphoid serology Widal test Clotted blood sample 1 10ml Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Note Specimens are sent to the Royal Victoria Hospital Belfast Lab Monday Thursday Specimens for referral to the Royal Victoria Hospital Belfast Lab need to be in the Microbiology Laboratory by 3pm on these days For specific details on any requirements of the Belfast laboratory please refer to http www belfasttrust hscni net pdf 130107_ BTL UserManual pdf Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 140 of 157 140 5 03 20 9 9 3 List of Tests referred to the Irish Meningococcal and Meningitis Reference
164. patient may have been moved to different ward since the original Group and Save request was sent to Blood Transfusion Blood Component Product amount required date and time required reason for transfusion any special requirements e g CMV irradiated Name of requesting medical doctor printed and signed IMC and bleep number Please note In the event of a massive transfusion a single add on request form which contains the patient details as described above and states Add On Massive Transfusion and includes the requesting doctors signature IMC and bleep number is sufficient to cover all orders for that patient made by telephone to the lab 7 14 PRESCRIBING BLOOD COMPONENTS AND PRODUCTS All blood components and products must be prescribed on the Blood and Blood Product Transfusion Record and Prescription Record Purple Document e The prescription must contain the following patient identification details minimum Full name Date of Birth Medical Record Number 86 Page 86 of 157 0010 Printed 23 Nov 2015 03 20 8 5 Index LM Ul 1 er Manual Version Us atory Medicine abor Li Authorised on 23 Nc Gender The prescription must be completed by a medical doctor It must specify the following details Date on which the transfusion is to commence The component product required Special requirements e g CMV or gamma irradiated Number of units required Rate of tra
165. pg 27 0 34 0 MCHC g dl 31 0 36 5 RETICULOCYTE X109 I 35 2 122 8 PLATELET COUNT X109 150 450 WHITE CELL COUNT X109 4 0 11 0 NEUTROPHILS X10 I 2 0 7 5 LYMPHOCYTES X109 1 5 4 0 MONOCYTES X109 0 2 0 8 EOSINOPHILS X10 I 0 04 0 4 BASOPHILS X10 I 0 00 0 1 ESR mm hr M 1 10 F 1 15 72 Page 72 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 PARAMETER UNITS ADULT REFERENCE RANGE PT Seconds TOSE APTT Seconds 20 8 30 8 FIBRINOGEN g i Toman lt 0 42 normal reference range D DIMER ug ml lt 0 40 cut off for exclusion of DVT in conjunction with Wells Score FACTOR II C 1U ml ee FACTOR V C 1U ml od FACTOR VII C 1U ml OMe Ne FACTOR VIII C IU ml em a FACTOR IX C IU ml 02 126 FACTOR X C 1U ml dd FACTOR XI C 1U mi DS Ear FACTOR XII C 1U ml Otte ANTI THROMBIN IU ml a PROTEIN C 1U mi ema M0 76 1 2 PROTEIN S Free Antigen IU ml F 0 64 1 20 NOTE For all other special coagulation assay reference intervals please contact Coagulation laboratory at ext 3963 PARAMETER UNITS ADULT REFERENCE RANGE SERUM FOLATE ng ml o EE RED CELL FOLATE ng ml eo FERRITIN ug ml i VITAMIN B12 pg ml Bee peg Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2018 03 20 73 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Refer
166. quest form Samples that do not have at least two acceptable identifiers Sample volume is inappropriate for test request Samples which are past the recommended time from phlebotomy to analysis Samples taken over weekends or public holidays Specimen taken into expired sample collection tubes Where sample quality would effect analysis e g haemolysis Any samples not meeting minimal acceptable criteria will not be tested until appropriate steps have been taken by the requester in line with NCMG Biomnis policy 1 11 2 Turn Around Times It may take gt 12 months for results of genetic testing to be returned In general however routine cytogenetic tests are reported within 8 10 weeks and most molecular genetic testing is available within 4 months 1 11 3 The Process for Reporting constitutional amp molecular genetic is as follows gt The original signed report is issued from the referral laboratory to the requesting clinician A copy of the report is often sent to the Laboratory Medicine Department at AMNCH for review amp storage 20 rsion 8 5 Index LM UI 0010 Page 20 of 157 gt The reports from the referral laboratory contain a key laboratory number assigned by them together with relevant clinical details sample identification family details and date of receipt of the sample In addition the critical PID details on the patient are listed together with mutations identified additional mutations sought and the final
167. r atypical pneumonia screen on clotted blood sample including Chlamydia Mycoplasma Q fever and Legionella are only performed when a convalescent serum is sent 14 days after the acute blood sample has been taken Mycoplasma serology testing is not available in patients gt 20 years Specimens must be collected in appropriate plastic leak proof containers with a screw top lid Virology swabs Mt et and salivary collection system for measles are available from Microbiology jae Chlamydia swabs for eyes are also available See below White top only Viral PCR on blood samples A minimum of 1ml of either serum or plasma separated from whole blood and frozen within 6 hours is required to perform the test Please send blood to the microbiology department within 2 hours of taking Arrange with Microbiology laboratory during routine working hours Notify the scientist out of routine hours on bleep 7280 if you are sending a sample Clotted Blood For serological investigations serum samples gt 1ml or 1 x 5 to 10ml container of clotted blood should be sent to the NVRL EDTA whole blood for CMV pp65 detection Antigenaemia WHr Whole blood for CMV pp65 detection must be collected in an EDTA tube and received at the NVRL within 6 hours of collection Laboratory Medicine User Manual Version 8 5 Index LM Ul 0010 Printed 23 Nov 2015 03 20 1 38 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815
168. r blood or blood products Product Amount and Special Requirements Record the number of units required and product type It must be clearly stated on the request form if CMV Negative or Irradiated products are required for particular patients Routine Routine means the sample will be processed the same day if received before 15 45 or next working day if after 15 45 Page 81 of 157 Urgent Urgent means the sample will be processed as soon as possible after receipt and results blood will be available within 4 hours depends on availability of blood If results blood is required sooner the requesting Doctor must contact the Blood Transfusion Laboratory explaining the urgency If required results blood can be made available in 45 60 minutes If already on Group and save blood can be available in 35 45 minutes Frozen plasma and other blood products can take up to 50 minutes Date amp Time Required Record date and the time of start of operation Be aware that if sample is received after cut off time blood may not be ready at the time required If not for a procedure record the time you want to commence transfusion The use of terms such as ASAP and STAT are not recommended unless followed by speaking to a Medical Scientist Requesters Signature Doctor or authorised Nurse must sign the request otherwise the request form is rejected awaiting correction or new form
169. requests All non OCS specimens sent to the laboratory should be accompanied by a legible fully completed and signed request form YELLOW Information on all request forms should include 1 Full patient identification data name sex date of birth and hospital number 2 Brief clinical details and history including date of onset 3 Time date taken and nature and source of specimen including ward and consultant or GP name and address and GP code 4 Recent and current antibiotic therapy 5 Investigation requested 6 Name and bleep number of requesting doctor It is essential that all the above information is provided on a legible fully completed and signed request form in order to maximise patient benefit Failure to provide sufficient information may delay reporting and or lead to inappropriate investigation SPECIAL INVESTIGATIONS All specimens undergo routine culture and sensitivity C S if other specific investigations are required please contact the Microbiology Laboratory REPEAT EXAMINATION DUE TO ANALYTICAL FAILURE A repeat sample may be requested A comment will be added to report form The lab will also contact the source by telephone to inform them that a repeat sample is required REQUESTING ADDITIONAL TESTS Bacteriology Samples Due to the instability of bacteria over time and the processing undertaken for some samples it is advisable that requesting additional tests on submitted samples are made as clo
170. required Samples for electron microscopy eg nasal or bronchial brushings 2 5 Glutaraldehyde in 10ml bijou bottle supplied by Cellular Pathology Please fill out Southampton PCD diagnostics Service form available from laboratory Skin biopsy for Glutaric Acidaemia Type 1 Fresh skin biopsy in tissue culture medium supplied by the lab Laboratory must be notified in advance ext 3973 so that tissue culture medium can be sourced These samples are referred out to external institutions 107 r s Gerard O Connor Page 107 of 157 Printed 23 No A Ul 0010 8 5 Index LN 8 7 2 Cytology All non gynae cytology samples must be received unfixed To avoid cellular deterioration samples must be delivered to the laboratory during routine hours 09 00 16 30 Samples which cannot be transported to the lab during working hours must be refrigerated there is a specimen fridge in the cytology lab Specimen and completed request form should be submitted to the laboratory in a plastic biohazard bag please ensure that container lids are screwed tightly onto the body of the container Sample type Sample requirements Comment Cervical smear samples ThinPrep liquid based sample vials Referred out to the Coombe Hospital Samples may be air dried or fixed immediately using a Patient name and MRN must be clearly written in pencil on the frosted end of the slide Distinguis
171. riate Crossmatch Report Register Copy in the Sign out folder Take the Chart copy with you and place in patients chart This applies to the first unit only as for subsequent units the chart copy will already be in the chart Check expiry date of the unit product Use the unit product with the earliest expiry date first All other blood components and products e g platelets plasma factors are signed out from the laboratory and delivered to theatre as required They are accompanied by only the chart copy the register copy remains in the laboratory It is important that transfusion of blood components products does not continue past the stated expiry date time on the unit Therefore the transfusion of a blood component product due to expire at 12 midnight must not commence unless it can be completed or the transfusion stopped before 12 midnight Only blood out of the fridge for less than 30 minutes can be re refrigerated Use EBTS to return unit to fridge Blood which is out of the fridge for greater than 30 minutes and which will not be used must be returned to the Blood Transfusion Laboratory to ensure traceability Return to theatre fridge using EBTS and contact Blood Transfusion to arrange transport back to laboratory Blood is removed from Theatre Blood Fridge by blood porter and returned to Blood Transfusion Laboratory at 08 00am seven days a week and also at 20 00 Monday Friday 7 17 TRANSFER OF BLOOD COMPONENTS PRODUCTS TO
172. ridge and scan barcode e Log Out e Take corresponding Crossmatch Report Chart Copy with you to be placed in patient chart In order to return a unit to the fridge Scan 2D barcode on swipe card e Select Putting in e Scan unit number and place back into the fridge e Log out There is an Emergency Access function available on the EBTS kiosk This should only be used when you cannot gain access to the fridge using a swipe card in order to remove units in an emergency situation If the Emergency Access is used contact the Blood Transfusion Laboratory as soon as possible The EBTS will alert the user when an established rule for a unit has been violated e g when a product is out of controlled storage for too long Please contact the Blood Transfusion Laboratory if an alert is observed Units are accompanied by a Crossmatch Report Chart Copy which is placed in the plastic pocket attached to blood fridge door and a Crossmatch Report Register Copy which is placed in the Sign out Register folder small blue folder located on a shelf in the 89 Authorised on 23 1 Page 89 of 157 fridge The purpose of this is to record date and time of removal from fridge and who took the blood out in the event that the EBTS is not working If EBTS is not working units can be signed out manually as follows When removing Red Cells from the theatre fridge sign date and document time of removal for each unit taken on the approp
173. rossmatched blood Crossmatch available within 10 mins INAB Accredited If a departure from M S B O S is Test required a telephone request must be made by a member of the surgical team to a member of the blood transfusion staff AVAILABILITY OF CROSSMATCHED BLOOD WITHIN THE STATED TIME FRAME DEPENDS ON COMPATIBILITY TESTING AND AVAILABILITY OF COMPATIBLE BLOOD Note Expiry date on pack In some instances this may be the same day it was ordered for Platelets Routine 6ml EDTA Can take at least 1 2 hours or longer to Urgent Blood get Platelets from the IBTS sample Phone request well in advance of time unless required Only ordered on named patient valid sample basis No in house stocks Usually in lab expires at midnight on day it was ordered for Frozen Plasma Routine 6ml EDTA Available within 50 mins Check suitable Urgent Blood sample is available in laboratory Has sample expiry of 8 hours once thawed unless valid sample in lab Page 76 of 157 SERVICE WHEN SAMPLE TURNAROUND TIMES PRODUCT AVAILABLE REQUIRED NOTES SPECIAL REQUIREMENTS Cryoprecipitate Issue of Coagulation Factors Concentrates e g Fibrinogen Concentrate Prothrombin Complex Concentrate Cold Agglutinin Screen Direct Coombs Test INAB Accredited Test Routine Urgent Not routinely available Routine Urgent Routine Urgent none 6ml EDTA Blood sample unless valid sample in lab
174. rothrombin Complex Concentrate Octaplex 500iv Human Factors Il VII IX X Rapid Reversal of Warfarin effect where indicated Consult with Haematology Team Cryoprecipitate not routinely available ABO amp Rh D Specific Pooled Product Not routinely available Suitable for use in intrauterine transfusion neonates and infants under one year CMV Fibrinogen is now used in most cases instead of Cryoprecipitate Granulocytes Apheresis or Pooled red cell reduced Special order from NBC CMV Anti D Immunoglobulin Rhesonativ 1250 units Human Plasma derived SD Treated Anti D for IM use only Most effective when given within 72 hours of sensitizing event Check Rh D group and antibody screen Recombinant Factor Vila Recombinant F Vila Used for Haemophilia A with inhibitors Factor VII deficiency In massive haemorrhage can be used to treat bleeding which persists despite blood product replacement Use in consultation with Haematology Team Recombinant Factor Vill Recombinant Factor VIII Treatment of Haemophilia A Contact Haematology Team Recombinant Factor IX Recombinant Factor IX Treatment of Haemophilia B Contact Haematology Team Von Willebrand Factor Factor VIII Von Willebrand Factor Factor VIII Heat treated Human Plasma Treatment of Von Willebrand Disease and Contact Haematology Team Haemophilia A
175. rple Hypo Coagulation 12 weeks Screen Intrinsic amp Extrinsic screens ee ee Assays Factor EN AS HU Inhibitor Assays ES Platelet Function 12 weeks Investigations Heparin Induced 4T score form MUST be 4 hours Thrombocytopenia filled out contact Coag lab 12 weeks if further Screen for a copy of this form investigations required H 1 T S Anti Factor Xa Contact Consultant Haematologist before requesting this test Protein C levels in 4 hours Meningococcaemia Antithrombin levels in 4 hours L Asparaginase therap 70 Page 70 of 157 6 8 4 SPECIAL HAEMATOLOGY LABORATORY For more details on availability and special considerations for referral tests including turn around times please contact the special haematology lab 3960 Fa Sample Type Special Conditions O EDTA Yes 3 weeks Purple Or Bone Marrow Bone Marrow Label slide with PENCIL only Full No 12 weeks Examination spread on glass name and MRN required slides Immuno RPMI and In consultation with Haematology 48 hours _ phenotyping for Heparin team or laboratory s Lymphoma 2 Leukaemia diagnosis monitoring i RPMI EDTA CSF analysis for CSF in sterile In consultation with Haematology e lymphoma leukaemia container team or laboratory Sample should monitoring ado tivo arrive in lab before 4 45pm PNH In consultation with Haematology i eal 3 ona team or laboratory Purple E Red Cell Folate EDTA Not
176. rt require a Endocrinology Tests tube 5 10 FASTING times sample 454041 3ml 5 EDTA FBC HBA1C Haemoglobinopathy After blood investigation Malaria Parasites collection invert Sickle Cell Reticulocyte Count tube 8 10 Coombs Test Ciclosporins times Tacrolimus Immunophenotyping Silrolimus PTH HbA1c Ammonia HCY Renin ACTH DNA Analysis 456093 6ml 6 N EDTA Group amp Screen Group amp After blood Handwritten Crossmatch Direct Coombs Test collection invert Details only i Bone Marrow Workup tube 8 10 must be signed times NO Addressograph NO exceptions 454091 4ml 7 Sodium Blood Sugar Glucose Levels After blood State time on I Fluoride Glucose Tolerance Tests collection invert sample and Hi Potassium Lactate tube 5 10 state whether Oxalate times sample is FASTING or RANDOM SOME PROFILES REQUIRE A COMBINATION OF SAMPLES CONTACT THE RELEVANT LABORATORY FOR INFORMATION FURTHER INFORMATION CONTACT Blood Transfusion 3965 Haematology 3961 Biochemistry 3994 3995 Histology 3971 Microbiology 3940 aboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 30 Authorised on 23 Nov 2015 Authc d SOP U 58815032 Due for review on 03 Jul 2016 1 by Ann Leor Author s Ger Conr Page 30 of 157 4 8 Tues S un amp Bank Hols ADULT PHLEBOTOMY DEPARTMENT STARTING TIMES HOURS OF SERVICE AE E Z as
177. s Gerard O Connor Page 7 of 157 LABORATORY MEDICINE DIRECTORY OF SENIOR STAFF Clinical Director of Diagnostic Services Dr Michael Jeffers 3921 Chief Scientist Dr Ann Leonard 3905 Laboratory Manager Acting Laboratory Administration Officer Ms Breda Roberts 3918 Phlebotomy Manager Ms Meg Lawlor 3040 3041 Laboratory IT Officer Mr Tony Moulton 3967 Point of Care Test POCT Manager Ms Jane Fogarty 3609 Quality Manager Dr Ann Leonard 3968 Clinical Chemistry Consultant Chemical Pathologist Dr Gerard Boran 3911 Chief Medical Scientist Mr Michael Kelly 3908 Registrar 3930 Haematology Consultant Haematologist Adult Prof Helen Enright 3912 Consultant Haematologist Adult Dr Johnny McHugh 3913 Consultant Haematologist Adult Dr Ronan Desmond 4132 Chief Medical Scientist Ms Dympna Murphy 3909 Senior Registrar 3937 Adult Haematology Bleep 7025 Registrar 3937 Adult Haematology Bleep 6258 Blood Transfusion Consultant Haematologist Prof Helen Enright 3912 Adult Consultant Haematologist Dr Johnny Mc Hugh 3913 Adult Consultant Haematologist Dr Ronan Desmond 4132 Adult Chief Medical Scientist Mr Gerry Judge 3910 Registrars 3937 7025 6258 Cellular Pathology Histopathology and Cytopathology Consultant Histopathologist Dr Barbara Loftus 3914 Consultant Histopathologist Dr Michael Jeffers 3921 Consultant Histopathologis
178. s should be discussed with the transplant team Early post transplant range 100 150ng mL Maintenance therapy range 50 100ng mL LITHIUM Atleast 12 hours 7 days maintenance after last dose or Daily Routine Hours 0 2 1 0 mmol L before next dose Manic phase if BD dosing 0 6 1 0 mmol L THEOPHYLLINE Trough pre dose SR preparations 3 6 days 10 20 mg L IV infusion 15 hours Daily Routine Hours PHENOBARB Not critical 3 4 weeks 10 40 mg L Daily Routine Hours PHENYTOIN Not critical but Make take up to three weeks 10 20 mg L pre dose to reach new steady state after Daily Routine Hours recommended dose change Re measure 7 14 days after dose change 50 Page 50 of 157 Carbamazepine 4 10 mg L Adjust dose according to response rather than to plasma level Tacrolimus FK506 Therapeutic ranges vary depending on transplant type and timing of sample post transplant Target levels and dose adjustments should be discussed with the transplant team Early post transplant range 8 12ug L Maintenance therapy range 5 8ug L VALPROATE 40 100 mg L Pre Dose morning Pre dose trough 3 4 days after dose change or 2 weeks after initiation Levels should be monitored regularly when interacting medications are added Daily Routine Hours Tuesday PM Wednesday PM Blood levels are not particularly useful in adjusting the dose but they may be useful for checking
179. se to date of collection of sample as possible Please phone relevant section in Laboratory with additional request Requestor will be advised as to possibility of additional tests requests An additional form is required This is available from the Microbiology Laboratory Serology Samples The time limit for testing blood samples for various antibodies antigens is variable Please contact the Microbiology Laboratory for further information The following pages contain guidance on the taking and submission of samples for the most frequently requested bacteriological investigations In addition advice is always available from medical and or scientific staff of the department both regarding tests described and others which may occasionally be required Please read these notes and follow the advice given 117 Page 117 of 157 Turnaround times Stated averaged turnaround times cover normal working days Monday to Friday excluding bank holidays The stated turnaround times may be extended outside these times 9 8 SPECIMEN REQUIREMENTS Please label all samples clearly with the patient s name DOB or Hospital number date and time collected and the specimen site 9 8 1 Urinary Tract Infection Urine culture MSU At least Daily 4 30pm Microscopy amp sensitivity 1mlina YES Mon Fri by 5pm on Urgent sterile 11 30 day of receipt Microscopy urine Sat Culture requests container 16 72 hours must be CS
180. ssive blood concentrations when the drug is known to be toxic especially if the patient has impaired renal of hepatic function or in neonates whose renal and hepatic handling of drugs is imperfectly developed Sample required A minimum of 1ml clotted blood in a sterile screw capped bottle Teicoplanin assays are referred out to The Antimicrobial Reference Laboratory Southmead Hospital Bristol England Serum samples need to be in the laboratory by 2pm Monday to Thursday Results are available by 5pm the following day OPTIMAL TIME OF SPECIMEN COLLECTION Trough Level Trough levels should be taken immediately prior to the administration of the next dose Peak Level Not routinely recommended If required take 1 hour after the end of administration of antibiotic dose Details of dose and timing should be recorded on the request form Random levels are difficult to interpret If taken to determine whether another dose should be given they should be considered trough levels and the time from last dose recorded on the request form Causes of inaccurate sometimes patently pharmocokinetically impossible results include 1 Mistiming of dosing levels 2 Omission of dose 3 Administration of dose into a slowly flowing infusion 4 Drawing a blood sample back down an IV cannula used for administering antibiotics THERAPEUTIC DRUG LEVEL MONITORING REFERENCE RANGES Single Daily Dose Multiple Daily Dose Gentamicin Trough lt 1 Trough
181. stigation 9 8 3 Respiratory Tract Infection Please label all samples clearly with the patient s name DOB or Hospital number date and time of collection and the specimen type Salivary samples are unsuitable Purulent or mucopurulent samples should ideally be collected before anti microbial therapy where possible Specimens should be transported and processed as soon as possible Soutum may be refrigerated for up to 2 3h without an appreciable loss of pathogens Any delay beyond this time may allow overgrowth of certain organisms If the patient has difficulty in producing sputum a physiotherapist can help in sputum collection or sputum may be induced by saline inhalation Sputum At least Please YES Mon Sat 4 30pm Culture culture amp 1mlina send a Mon Fri 16 72 hours sensitivity sterile separate 11 30 universal specimen Sat container for TB culture Cough Swab YES Mon Sat 4 30pm Culture Mon Fri 16 72 hours 11 30 Sat Broncho Alveolar As large a YES Mon Sat 4 30pm Culture lavage BAL volume as Mon Fri 16 72 hours possible 11 30 Sat Bronchial Aspirate At least YES Mon Sat 4 30pm Culture 1imlina Mon Fri 16 72 hours sterile 11 30 universal Sat container Tracheostomy At least YES Mon Sat 4 30pm Culture Aspirate 1imlina Mon Fri 16 72 hours sterile 11 30 universal Sat container Bronchial Brushes Placed in YES Mon Sat 4 30pm Culture a sterile Mon Fri 1
182. stopathologist 3914 Dr Michael Jeffers Consultant Histopathologist 3921 Dr Paul Crott Consultant Histopathologist 3915 Dr Stephen Crowther Consultant Histopathologist 3991 A 01 4096100 Our Lady s Dr Maureen O Sullivan Consultant Paediatric Histopathologist Children s Hospital Crumlin Dr Francesca Brett Consultant Neuropathologist 3929 Dr John O Loughlin Chief Medical Scientist 3992 Enquiries Cellular Pathology Office 3929 3928 3985 Specimen Reception IAS Main Laboratory CIB Cytology Laboratory OTT Histopathology Registrars IAA Mr Anthony O Toole Mortuary Manager 2593 Mr Patrick Redmond ll 2593 Bleep 7079 Ms Bernadette Murray ecnnicians 8 2 ROUTINE HOURS Monday to Friday 09 00 17 00 Deadline for receipt of specimens in lab 16 30 Saturday AM 09 00 12 30 Deadline for receipt of specimens in lab 12 00 Page 102 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 8 3 SUPPLIES AVAILABLE FROM CELLULAR PATHOLOGY The following are available from Cellular Pathology Specimen Reception Ext 3925 A minimum of 24 hours notice is required Specimen containers various sizes 10 neutral buffered formalin in pre filled 40m containers 2 5 Glutaraldehyde in pre filled vials Glass slides Plastic slide mailers Hanks balanced salt solution for FNA Post vasectomy and semen analysis kits 8 4 SPECIMEN COLLECTION AND DELIVERY
183. t 3905 1 10 2 Specimen Requirements In general for immunology requesting 2 clotted samples red cap must be provided Requests should be made on the KEY OCS system or written out on the Immunology request form and accompanied by the appropriate number of correctly labelled clotted samples Ensure that sample date and time are recorded on tube Please send to the Laboratory Medicine Department AMNCH Immunology Requests are processed each weekday morning and dispatched to the CPL by lunch time on that day SAMPLE REJECTION CRITERIA Test requests may be rejected if the following situations apply Sample types not compatible with tests requested No serum sample provided Significant difference between patient identifiers on sample and corresponding request form MRN provided does not match the other details on the request form Samples that do not have at least two acceptable identifiers Sample volume inappropriate to test requested Samples which are past the recommended time from phlebotomy to analysis Specimens taken into expired sample collection tubes Where sample quality would affect analysis e g haemolysis 1 10 3 Standard Tests TEST ABBREVIATION NOTES Anti nuclear Antibodies ANA Levels of anti nuclear antibodies may increase with age infection malignancy therapy with certain drugs and a range of inflammatory disorders As an approximate guide higher levels of antinuclear antibodies are more likely to be associ
184. t Dr Paul Crotty 3915 Consultant Histopathologist Dr Stephen Crowther 3991 Consultant Histopathologist Dr Maureen O Sullivan 3929 Paediatric Consultant Neuropathologist Dr Francesca Brett 3929 Consultant Histopathologist On Call Contact Switch Chief Medical Scientist Dr John O Loughlin 3992 Microbiology Consultant Microbiologist Prof Philip Murphy 3919 Consultant Microbiologist Dr Susanna Frost 3920 Consultant Microbiologist Dr Deirdre Brady 3920 Chief Medical Scientist Mr Eddie Mc Cullagh 3906 Microbiology Registrar 3936 Bleep 7372 Infection Prevention amp Control CNM Ms Dympna Mc Donnell 3938 Page 8 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 LABORATORY MEDICINE 1 0 LABORATORY MEDICINE 1 1 INTRODUCTION This user manual is intended as a guide to services provided by the Department of Laboratory Medicine Tallaght Hospital AMNCH and is available on the hospital internet at www amnch ie It is also available on the Hospital intranet page Each Laboratory Discipline maintains a section in the manual which describes Services offered Test turnaround time TAT Specimen types Reference ranges Test specific information including patient preparation Transport conditions for samples Contact requirements in advance of particular test requests Referral tests Information on out of hours emerge
185. t may be issued within 3 days A final report including results of histology will be issued within 6 weeks Cases requiring neuropathological or toxicological examinations may take 10 12 weeks for completion If there is any doubt as to whether a case requires a Coroner s or non Coroner s post mortem the case should be discussed with the consultant pathologist on call who may recommend discussion with the coroner This should be done prior to requesting permission for the post mortem from the family In addition scheduling of the post mortem will depend on work load within the mortuary and the cellular pathology department Therefore the family should not be informed of a time that the autopsy will be performed prior to discussion with the consultant pathologist on call If a Post Mortem Coroner s or House case is required the clinical staff must also inform the Anatomical Pathology Technicians Mr Patrick Redmond and or Ms Bernadette Murray extension 2593 bleep 7079 8 9 1 PAEDIATRIC POST MORTEMS For the National Children s Hospital NCH post mortems will routinely be carried out at Our Lady s Children s Hospital OLCH Crumlin The pathologist on call at OLCH must be contacted through OLCH switch board on 01 4096100 without delay when a death has occurred In non coroner s cases the pathologist conducting the examination will discuss the extent of the procedure with the family 113 Page 113 of 157 MICROBIOLOGY 9 0 M
186. t this other evidence a GFR gt 60 ml min does not indicate CKD FACTS ABOUT THE MDRD eGFR eGFR will be reported in mL min 1 73m Since the MDRD formula underestimates GFR in patients with normal or near normal kidney function eGFRs of 290 mL min 1 73m will be reported as gt 90 mL min 1 73m eGFR is not valid in patients with rapidly changing renal function e g acute renal failure Plasma creatinine should be monitored in these patients The MDRD eGFR calculation was validated in Caucasian and Afro Caribbean patients with renal disease in the USA Patients of Afro Caribbean origin have a higher muscle mass so the eGFR should be multiplied by 1 21 for black patients Although it has not been validated for all ethnic or population groups the eGFR has been accepted for use in white and South Asian populations MDRD eGFR has NOT been validated for calculating drug doses Creatinine clearance with timed urine collections is still required for measuring GFR in certain circumstances o Extremes of body size and age e g severe malnutrition or obesity elderly children lt 18 years o Pregnancy Vegan diet Creatine supplements o Skeletal muscle disease e g muscular dystrophy paraplegia quadriplegia amputee o Prior to dosing with nephrotoxic chemotherapy drugs Microalbuminuria is still the gold standard for detecting early renal disease in patients with diabetes mellitus eGFR formula varies slightly depending on the method us
187. tients Page 47 of 157 CHRONIC KIDNEY DISEASE Stage eGFR Associated Metabolic Disturbance Interpretation Minimum Frequency mL min 1 73m of Monitoring Renal Function 1 gt 90 e Hypertension more frequent than in Normal GFR Yearly if patient has patients without kidney disease Not CKD unless there is other evidence of chronic kidney damage e g evidence of CKD e persistent microalouminuria proteinuria and or haematuria not urological e radiological diagnosis e biopsy proven chronic glomerulanephritis 22 60 89 In CKD patients Mild impairment if there is other evidence of CKD see above Yearly if patient has S e Hypertension Mild decrease in GFR is common in 30 of healthy adults evidence of CKD a e PTH starts to increase 23 30 59 e Hypertension is frequent Moderate impairment Yearly if stable a e Calcium absorption and phosphate Treat complications excretion decrease Monitor progression e PTH increases is more marked 6 monthly if just e Onset of Malnutrition Referral to a Nephrologist if diagnosed or Z e Onset of Anaemia erythropoietin e condition progressive more than 20 deterioration in eGFR or plasma progressive deficiency creatinine e Onset of LVH e Microscopic haematuria present e Urinary microalbumin creatinine ratio gt 3 5 or protein creatinine ratio 245 e Unexplained anaemia e Abnormal K Ca or Phos e Uncontrolled BP gt 150 90 34 15 29 e As for stage 3 but more pronounced Se
188. to establish the diagnosis of diabetes B Laboratory Data Diagnostic Cut points for diabetes WHO 2011 IFCC HbA1c 2 48 mmol L 6 5 Fasting Venous Plasma Glucose 2 7 0 mmol L Random Venous Plasma Glucose 2 11 1 mmol L HbAic For HbAic a value of 2 48 mmol mol 6 5 in the old units using an IFCC standardised method as pertains in any accredited laboratory in Ireland is recommended as the cut point for diagnosing diabetes A number of exclusions apply where HbA1c measurement is not suitable see list however in the vast majority of cases the diagnosis of diabetes can be established on the basis of plasma glucose measurements without recourse to Glucose Tolerance testing List of exclusions do not rely on HbA1c testing for diagnosis All children and young people Patients of any age suspected of having Type 1 diabetes Patients with symptoms of diabetes for less than 2 months 60 Page 60 of 157 d 23 Nov 2015 03 20 10 Printe 0010 Index LM UI 8 5 1 er Manual Version y Medicine Us ator abora Li Patients at high diabetes risk who are acutely ill e g those requiring hospital admission Patients taking medication that may cause rapid glucose rise e g steroids antipsychotics Patients with acute pancreatic damage including pancreatic surgery n pregnancy Presence of genetic haematological and illness related factors that influence HbA1c and its measurement e g k
189. ual requesting process for backward compatibility only and it is being presently phased out The Order Communications System between Clinical areas and the Laboratory is in place for both routine and urgent requesting Electronic result reporting from Disciplines in the Laboratory to all clinical areas is operational Thus any report that is generated electronically on the Laboratory computer system will be available after authorisation on the OCS system provided it is not a restricted test or that the sample originates in another hospital Significant advantages accruing from electronic ordering include e Replacement of the need to write request forms for those tests and disciplines that are using electronic ordering Clinical Chemistry Haematology and Microbiology e Availability of a pre printed specimen barcode label that removes the need to write on specimen tubes e Status indicators for outstanding requests these are available on line e The system contributes substantially to improved patient safety by reducing sample and request identification errors For full details of the operational policy for the OCS system please refer to the ICT policies on QPULSE hospital users only REMEMBER Patient identity MUST always be confirmed before a sample is taken Samples must be labelled at all times Log off when leaving the computer For training fault logging etc please contact the ICT Helpdesk extn 2041 2042
190. ults adrenaline nor adrenaline dopamine Catecholamines Paeds Send to laboratory adrenaline nor adrenaline immediately dopamine LR A yr 24hr preferred Electrophoresis BJP At least 20ml early morning urine HMMA also VMA Homovanillic acid Phosphate inorganic Mercury Metanephrines Oxalate refrigerate 24hr preferred Porphobilinogen PBG Spot for emergency PBG screen Protect from light Porphyrins as Protect from light Potassium refrigerate Protein Creatinine Ratio Protein refrigerate Protein creatinine ratio see above is the recommended test Sodium refrigerate required for a full Stone Screen Plain Acid Urate Donotrefrigerate i Urea refrigerate HE EN Ce ee Pp po fe I ee Osmolality Organic acids freeze 45 Page 45 of 157 20 LM UI 0010 Printed 23 Nov 2015 03 ry Medicine User Manua borate Lat 5 11 ESTIMATED GLOMERULAR FILTRATION RATE EGFR INTRODUCTION OF eGFR The Irish and the UK guidelines on classification and monitoring of chronic kidney disease CKD recommend assessing renal function based on an estimated glomerular filtration rate the eGFR CKD has been classified into 5 stages based on the patient s eGFR and other evidence of renal impairment such as proteinuria The Clinical Chemistry Department Adelaide and Meath Hospital in association with the Consultant Nephrologists is introducing a protocol whereby an eGFR will be
191. usceptibility testing Please refer to links for the laboratory user manuals for the Microbiology Laboratory at St James Hospital at the following link http search stjames ie Labmed Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 142 of 157 142 LM UI 0010 Printed 23 Nov 2015 03 20 Index Version 8 5 anua Ma 9 9 5 List of Tests sent to other Referral Laboratories Please label all samples clearly with the patient s name DOB or Hospital number date and time collected and the specimen site Acyclovir Levels Chloramphenicol levels Colistin Colomycin levels Ganciclovir Septrin Levels Streptomycin levels Clotted blood sample 1 10ml Amphotericin levels Candida titres Flucytosine Levels Galactomannon Levels Itraconazole Levels Voriconazole levels Coccidioides Coccidiodes immitus serology Clotted blood sample 1 10ml Ameobiasis serology Echinococcus serology Fascioliasis Fasciola Hepatica Filaria Leishmaniasis Schistomiasis Toxicariasis Trichinella spiralis Trypanosomes Babesiosis microti microscopy Babesiosis microti serology Clotted blood sample 1 10ml Fresh EDTA sample Clotted blood sample 1 10ml Anaerobes Identification and Typing
192. ut and remove each sample Place each sample in a separate sterile container and label appropriately Specimens should be transported without delay Scabs or biopsy material for electron microscopy should be sent in a dry bottle Rapidly frozen tissue may also be sent for electron microscopy Oral fluid Saliva specimens Oral fluid Saliva specimens should be collected using a foam swab supplied by the NVRL or using commercially available collection devices Please contact the NVRL laboratory with queries Specimens for Molecular Virology Serum and plasma samples for molecular virology testing should be separated from whole blood within 6 hours of venepuncture and frozen immediately at 20 C to maintain the integrity of the viral DNA or RNA These samples should be dispatched to the NVRL in a frozen state Alternatively Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 39 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 139 of 157 whole blood EDTA or clotted blood can be sent to the NVRL within 6 hours of venepuncture Specimens anti coagulated with heparin are not suitable for PCR Chlamydia trachomatis Ophthalmic specimen Use APTIMA UNISEX SWAB Specimen Collection Kit and instructions available from the Microbiology Laboratory 9 9 2 List of Tests referred to Royal Victoria H
193. utine Haematology within 3 hours of receipt subject to cut off Routine Coagulation within 2 hours of receipt subject to cut off excluding D dimer Haematinics within 8 hours of receipt subject to cut off excluding Red Cell Folate Above tables refer to routine In Patient investigations only Requests from GPs and Out Patients may take longer For specialised assays requests see specific details in following tables Turn around times for examinations referred to external laboratories will be provided by the external laboratory directly Contact ext 3961 3962 for details 67 Page 67 of 157 6 8 SAMPLE REQUIREMENTS CONSIDERATIONS SAMPLE VOLUMES Itis preferable that blood tubes especially those containing preservatives are filled to their stated capacity This avoids any risk of insufficiency or interferences from excess concentrations of preservative This is mandatory for some tests e g Coagulation based tests and ESRs where the increased decreased anticoagulant concentration that results from under over filling would invalidate the test Special paediatric coagulation tubes are suitable for routine coagulation investigations only See following tables for special conditions handling requirements notes for individual tests For more details on availability and special considerations for referral tests including turn around times please contact the haematology lab 4143961 6 8 1 ROUTINE HAEMATOLO
194. vailable to patients in the hospital Please refer to the instructions contained in the Andrology pack A Post Vasectomy Specimens These specimens are processed Monday to Friday by patient appointment only Appointments are made by patients or by clinical staff at 4143971 Packs containing the specimen container request form and instructions are available from the Cellular Pathology Laboratory Packs are also available from the Urology Day Ward B Semen Analysis Specimens These specimens are processed on Wednesday and Thursday mornings and are strictly by appointment Appointments are made by submission of a referral letter containing the following information which must be legible Patient s name Date of birth Address Mobile phone number Clinician s details Send referral letter to The Andrology Department Cellular Pathology Laboratory AMNCH Tallaght Hospital Dublin 24 e On receipt of the letter an appointment will be sent out to the patient with the time and date of their appointment and when they can collect their semen analysis pack from the laboratory e The pack contains the specimen container request form and instructions e It is vital that patients follow the instructions contained in this pack For appointment enquiries please phone 3929 110 Page 110 of 157 8 8 REPORTING ARRANGEMENTS Reports are available for viewing on the Key Order Communications System OCS immediately post authorisatio
195. vere impairment 6 monthly if stable 3 e Triglyceride levels rise e Risk of Hyperkalaemia Suggest referral to a Nephrologist 3 e Hyperphosphataemia 3 monthly if just e Metabolic acidosis diagnosed or 5 e Decreased libido progressive 35 lt 15 e As for stage 4 but more pronounced Established renal failure ERF 3 monthly e Salt retention causing heart failure e Anorexia Suggest urgent referral to a Nephrologist e Vomiting e Pruritis without skin disease Classification of CKD proposed by the US Kidney Diseases Outcome Quality Initiative K DOQI Group Page 48 of 157 48 5 12 TUMOUR MARKER SERVICE Measurement of tumour markers can be useful for monitoring in patients with an established diagnosis of certain tumours Hence a Tumour Marker Assay Service has been provided at AMNCH for use primarily by oncology teams who are managing patients with a cancer diagnosis or with pre malignant conditions With the possible exception of PSA it is not appropriate to screen patients either in primary or secondary care using tumour markers This is due to the low sensitivity of the markers for the detection of malignancy and the unacceptably high false positive rates in the general population which may lead to unnecessary further investigation and concerns and possibly false reassurance In particular the practice of screening patients admitted to hospital with a panel of markers is not appropriate REQUESTS SUITAB
196. witch 0 2 6 ADDRESSES OF LABORATORY PTS STATIONS Clinical Chemistry 001 Haematology 002 Microbiology 003 Blood Transfusion Use Haematology 2 7 SAMPLES WHICH MUST NOT BE SENT VIA PTS The following sample types MUST NOT BE SENT via the Pneumatic Tube Transfer System DISCIPLINE SPECIMEN TYPE Clinical Chemistry 24 hour urines Osmotic Fragility Samples CSF 3 Haematology Immunophenotyping Microbiology CSF Skin Scrapings for Meningococcal Detection Specimen for Transfusion Reaction Investigation HLA Typing No specimens to be sent by PTS Hypercoagulation Screens Hypocoagulation Screens Coagulation Inhibitor Levels Protein C Levels in Meningococcaemia HIT Screens Bone Marrow Samples a tory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 2 151 Page 151 of 157 Amendments Changes to version 8 4 Please ensure that you read the full section that has been changed from the previous version Laboratory Medicine Section 1 0 Page Change General Practitioner Services Section 2 0 Page Change 152 Page 152 of 157 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Authorised on
197. x A B C D ete THIS SECTION MUST BE COMPLETED A C D F DATE and TIME TAKEN DATE OF PATIENTS NEXT APPOINTMENT D O B Sax Signature THIS FORM IS TO ACCOMPANY SPECIMENS FOR SEMEN ANALYSIS To be completed by requesting doctor nurse Relevant Clinical Information please tick PostVasectomy Reversal of Vasectomy Date of Vasectomy if applicable This section MUST be completed by patient Semen sample details O Fertility Studies O Specimen produced on y date A HOUS soceseesee minutes time Was the entire specimen collected into the container Yes O No O Number of days of abstinence from sexual intercourse masturbation to specimen collection days E DEPARTMENT OF CELLULAR PATHOLOGY mp DEPARTMENT OF CELLULAR PATHOLOGY VERSION 2 1 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 1 03 Authorised on 23 Nov 2015 Authorised by Ann Leonard SOP Unique Reference 386 58815032 Due for review on 03 Jul 2016 Author s Gerard O Connor Page 103 of 157 Prir UI 0010 LM Manua dicine Use The following mandatory details must be on the request form and sample container s e Full Patient Name e Date of Birth e Medical Record Number if request is on a registered patient e Sample type site Specimen Type Site must be listed either on the container or request form The following d
198. y 16 00 will be reported by 20 00 Saturday AM 09 00 12 30 Deadline Specimens for general chemistry from inpatients OCS requests in Lab by 11 00 will be reported by 12 30 Routine samples arriving after the stated deadlines will be analysed on the next routine working day 5 5 SPECIAL PROCEDURES Protocols are available from the laboratory Appointments Results Enquiries Glucose Tolerance Tests 3041 Appointments 3952 3954 Results 3952 or 3954 Appointments amp Results enquiries Sweat Tests Requests for urgent appointments must be discussed with the Clinical Chemistry Registrar Diagnostic Endocrinology Clinic For endocrinology dynamic function tests Requests for appointments must be discussed with Clinical Chemistry Registrar at Ext 3930 or Bleep 7285 5 6 RESULTS AND ENQUIRIES Results will normally be reported via the Order Communications System and will be available for viewing on wards shortly after being authorised for release by the laboratory staff Printed reports will also be issued twice daily and are delivered by the Portering staff Clinical Chemistry General Enquiries Helpline 3952 or 3954 All results enquiries should be made to 3952 or 3954 Advice on selection of tests interpretation of results and sampling procedures will be directed to the appropriate person RETROSPECTIVE REQUESTING ADD ON REQUESTS Clinical Chemistry specimens are retained for a period post analysis If
199. y see Clinical Chemistry section on ABG s PROTOCOL FOR BLOOD GAS SPECIMENS for details Glucometry There are 120 glucose meters located throughout the hospital for use in patient monitoring HDA1C analysis POCT instruments are located in adult and paediatric diabetes OPD for monitoring diabetic control Application for New Services Any new POCT services must be approved by the POCT committee Application form is available from the POCT Manager 22 Page 22 of 157 2 0 GENERAL PRACTITIONER GP SERVICES Laboratory Medicine Specimen Reception is available to receive correctly labelled samples and completed request forms directly from patients Patients can collect specific sample containers e g 24hour urine collection containers from specimen reception staff who will also supply instructions verbal and written in the use of such containers SPECIMEN RECEPTION PATIENT SAMPLE DROP IN HOURS OF OPENING Monday Friday 9 00 am to 5 00 pm amp Saturday 9 00 am to 11 30 am GPs may arrange supplies by contacting the general office at 4143918 or faxing in a requisition form available on request to 4143980 We greatly value our service to General Practitioners and continuously seek to improve on it Should you have any queries relating to the service please contact Dr Gerard O Connor at 4143905 or a senior member of the Laboratory Team 1 1 PARTICULAR REQUIREMENTS FOR USE OF COURIER SERVICE FOR SAMPLE COL
200. y checking wristband for the following Full Patient name D O B MRN This information is checked against the details on the OCS label and when verified the label is applied to the sample tube when samples have been taken For manual orders the details are written on the sample tube when samples have been taken All request forms must be left at the agreed location on each ward As samples are obtained they are sent to the Laboratory throughout the morning until rounds are completed If blood sample cannot be obtained due to e g Patient unavailable Phlebotomist unable to obtain sample The phlebotomist will contact the relevant ward and inform them that the sample could not be obtained aboratory Medic Ma Version 8 5 Index LM UI Printed 23 Nov 2015 03 20 27 Page 27 of 157 The relevant team will decide whether to leave requests until the following day or to take them themselves If requests are to be placed on the following day s phlebotomy work list please change the date on request form and leave at the agreed location If it is decided not to proceed with the blood tests the team must discard the request forms or cancel the OCS request When ordering fasting or other tests that require patient preparation please ensure that the patient and nursing staff are informed 4 2 PROCEDURE FOR MANUAL ORDERING FOR OUT PATIENTS Completed and dated request forms must contain the following information Patient Surname an
201. y monitored Urgently processed requests gt 90 within one hour of receipt Routine general chemistry gt 90 within 4 hours of receipt subject to cut off Routine endocrinology gt 90 within 24 hours of receipt subject to cut off Daily cut off time for same day reporting of routine samples is 16 00hrs AFP Daily on arrival 72 hrs Requests subject to screening Albumin y Daily on arrival 4hrs ALP y Daily on arrival 4hrs Alpha 1 anti Trypsin Daily on arrival 24hrs ALT y Daily on arrival 4hrs Aluminium Monthly 4 weeks Contact laboratory in advance Ammonia NH3 y EDTA Daily on arrival 4hrs Send on ice Amylase y Daily on arrival 4hrs Syringe Send to laboratory within 15 Arterial Blood Gas y yring Daily on arrival 15 mins mins max AST y Daily on arrival 4hrs Bicarbonate y Daily on arrival 4hrs Bilirubin Direct y Daily on arrival 4hrs Bilirubin Total y Daily on arrival 4hrs BNP Daily on arrival 72hrs Requests subject to screening Bone Profile Ca Phos Alk Phos y Daily on arrival 4hrs C Peptide Weekly 1 7 days One run per week Monday 2 Batches per C3 week 24hrs 2 Batches per C4 week 24hrs CA 153 Daily on arrival 72 hrs Requests subject to screening CA 199 Daily on arrival 72 hrs Requests subject t
202. yping of transplant patients and family members 7 10mi citrate EDTA 7 10mi citrate EDTA HLA and disease association HLA A _ 8 _ Cw _Jon _Joo Jor HLA Class I typing for HLA matched platelets 7 10m citrate EDTA S 10m clotted Screening for Platelet Alloantibodies 10m clotted 5 Platelet refractoriness antibody screening 5 z kerei ee EDTA citrate Screening for HLA antibodies Platelet crossmatching 10 20m clotted Discuss with IBTS ConsultanvRegistrar HPA Human platelet antigen typing Sm EDTA Neonatal alloimmune thrombocytopenia NAITP S TOmI clotted Smi EDTA maternal EDTA neonatal 5 10m clotted Smi EDTA Post transtusion purpura AS Discuss with IBTS Consuttant Haemovigilance r maen 5 10m clotted Transfusion related acute lung inju TRAU AA J Discuss with IBTS Consuttant Haemovigilance Screening for granulocyte antibodies 5 10m clotted Tick Box to Indicate required investigation s Signed High risk specimen YES Ea NO ES Please telephone urgent requests Date 7 25 KEY ORDER COMMUNICATIONS Order Communications Reporting is currently available for Blood Transfusion Order Communications Requesting is currently not available for Blood Transfusion To view Blood Transfusion Results Reports enter the patient s hospital number and select Find When the correct patient is located choose
203. ys required Cyclosporine Weekly 1 7 days One run per week Wed 2pm Digoxin y Daily on arrival 4hrs 2 Batches per Dependent on additional Electrophoresis week 3 7 days processing Ethanol y Daily on arrival 4hrs 2 Batches per Two runs per week Tues Wed FK 506 Tacrolimus week 1 6 days 2pm Free Light Chains 2 Batches per kappa lambda week 1 7 days One run per week Wednesday FSH Daily on arrival 24hrs GGT y Daily on arrival 24hrs Glucose y Daily on arrival 4hrs Growth Hormone Daily on arrival 1 7 days One run per week Monday Haemoglobin A1c Daily on arrival 1 day HCG pregnancy y Daily on arrival 4hrs HCG tumour marker 72 hrs Requests subject to screening HDL C y Daily on arrival 4hrs One run per week Homocysteine Daily on arrival 1 7 days Send immediately on ice IGA Daily on arrival 4hrs Immunoglobulin only requests 2 Batches per 4 days IGE week IGG Daily on arrival 4hrs Immunoglobulin only requests One batch per IGF1 week 1 7 days One run per week Monday One batch per IGF BP3 week 1 7 days One run per week Monday IGM Daily on arrival 4hrs Immunoglobulin only requests Insulin Weekly 1 7 days One run per week Monday Iron y Daily on arrival 4hrs Lactate y Daily on arrival 1 hour Processed urgently LDH y Daily on arrival 4hrs LH Daily on arrival 24hrs Lipid Profile Chol Trig HDL LDL y Daily on arrival 4hrs 2 Batches per One batch per week Lipoprotein a y week 1 7 days Wednesday Lithium Daily on arr
204. ysed Sample lt 3 5 mmol L Calcium Corrected lt 1 90 mmol l gt 2 90 mmol L Phosphate lt 0 40 mmol l gt 3 00 mmol L Magnesium lt 0 50 mmol l gt 1 80 mmol L Bicarbonate lt 15 0 mmol l gt 35 0 mmol L Plasma Glucose lt 2 8 mmol l gt 20 0 mmol L Urea Creatinine Urea gt 12 0 mmol L with normal creatinine Urea gt 12 0 mmol l with Creatinine gt 200 umol L If first occurrence Ethanol gt 250 mg dl Paracetamol All reportable levels mg L Salicylate All detectable mg L Urine Toxicology screen Phone all positive results Non ICU Total Protein lt 50 g L and gt 100g L If first occurrence Non ICU Albumin lt 259 L Iron gt 60 umol L CSF Glucose Protein All except neurology OPD CK gt 5000 IU L 500 if first time HCGS All Positive T Bili gt 250 umol L first time ALT AST gt 500 IU L if first time Amylase gt 200 IU I Ammonia All umol L ABG s All Lactate gt 5 0 mmol L Osmolality Serum lt 240 and gt 310 mOsm Kg Troponin All gt 100 mg L Urate Laboratory Medicine User Manual Version 8 5 Index LM gt 750 umol L 23 Nov 2015 03 2 35 view on 03 Jul 2016 Page 35 of 157 Table 2 Table of Serum Analytes to be phoned for patients with established CRF Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Printed 23 Nov 2015 03 20 Sodium lt 120 mmol L gt 160 mmol L
205. ysis Note Please ensure samples reach the laboratory in as short a time as possible post phlebotomy as delays may impact on the ability to perform certain analyses please refer to the individual department sections for information specific to tests you may wish to request 2 2 GP REPORTS AND ENQUIRIES Healthlinks is the primary reporting mechanism for GP laboratory reports There are two trigger times in operation at present and authorised reports will be dispatched routinely at 12 00 noon and 4 00 pm Printed reports are posted to GP surgeries or delivered by courier to those availing of that service A number of GP s avail of Key OCS KeyWeb system for patient results Telephone enquiries can be made to individual laboratories at the numbers listed at the beginning of this manual In all cases very urgent results or those of grave clinical significance will be communicated to the practice where possible GP s should endeavour to provide a mechanism whereby contact may Nov 2015 03 20 24 by Ann L L 2 Due for review on 03 Jul 2016 Laboratory Medicine User Manual Version 8 5 Index LM UI 0010 Print Author s Gerard O Connor Page 24 of 157 03 20 2015 23 Nov 010 Printed LM UI O Inde ry Medicine User Manua be made out of hours as required Note If you have an urgent request please contact the laboratory section in advance and tick the urgent box on the request form The laboratory d

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