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Sample collections

There are transport services that collect samples and delivers consumables as required from surgeries and clinics across the county. It is important that you ensure any samples taken are picked up on the first possible collection and not left until the end of the day before being sent to the laboratory.

It is important that when samples are transported this is done safely and legally. Any queries regarding the safe transport of specimens can made directly to the appropriate laboratory.

For more information regarding sample transport please refer to the Pathology Transport Policy, which can be downloaded by clicking on this link.

For blood transfusion specimens; drivers will transport blood to community hospitals on their routine rounds. All other collections require the community to arrange for Taxi collection between the hours of 09:00 and 17:00 and arrivals outside of these times will be turned away.

Tube guide and recommended order of draw:

Sample

1. Minimum Acceptable Patient Identification Criteria for Samples and Request Forms

Stringent procedures, informed by guidance from professional bodies, for the receipt of samples and request forms exist to ensure the safety of the patient (to ensure that the right investigation(s) is performed on the right sample(s) and the results assigned to the correct patient).

The responsibility for requesting a laboratory service/test lies with an authorised practitioner (normally a clinician). It is the responsibility of the requester to ensure that samples are correctly labelled and request forms completed to the agreed standard. Before accepting a clinical specimen, laboratory staff competent in this task must ensure certain minimum criteria for sample identification are met.

To ensure the unequivocal identification of patient and sample certain information is required on all request forms and samples. Sample and request form information must be compatible. Additional identification is required for blood transfusion:

* Note 1: ‘Date and time collected’ is usually essential for Biochemistry samples – see Pathology handbook for information as to circumstances when this is the case

** Note 2: For patients who have been allocated a unique coded identifier for confidentially purposes (e.g. Sexual Health Clinic patients), the NHS number should not be quoted.

*** Note 3: Nature of the sample (e.g. left, distal etc.) is essential for Cell Pathology

**** Note 4: For Blood Transfusion, the only exceptions to these rules are: Samples taken from patients for emergency transfusion testing, who are unconscious in the A&E department. In these cases the sample MUST have a handwritten hospital number or A&E emergency number as a minimum. The specimen should also have:

• Patient gender
• Source of the sample
• Date and time of collection
• Signature of specimen taker

Printed sample labels

It is preferable for information on all samples to be handwritten for the following reasons:

• To reduce the risk of the wrong label being attached.
• Printed patient labels on blood tubes obscure the sample contents and may have to be removed prior to serum separation.
• Printed labels can cause issues with instrumentation used to analyse these samples.

Microscope slides (e.g. FNAS) must have the patient’s forename, surname and date of birth written in pencil. Bone marrow slides MUST be labelled with 3 points of identification for the patient and it is desirable to have the date taken

Major Incidents – In the event of a major incident the 10 digit Majax number MUST be used in place of an NHS number.

Samples or request forms received without the minimum essential identification criteria stated in this policy may not be processed. Samples received without a request form may also be rejected.

The action taken subsequently may reflect the purpose for which the specimen was intended but might include:-

• Processing the sample and withholding results.
• Sealing the sample and storing it.
• Requesting a fresh sample and request form.

In cases where an inadequately labelled request form/sample is received from a patient who is not easily accessible for a repeat, then, at the discretion of senior laboratory staff, the sample may be processed and the report will show a clear disclaimer detailing the shortcomings of the sample and/or request. The disclaimer will alert the requesting practitioner to take responsibility for the results and for any action taken as a result of the report.

2. Further Acceptance and Rejection Criteria

The quality of laboratory test results depends on the proper collection and handling of the specimen. Correct patient preparation, specimen collection, packaging and transportation are essential factors in obtaining timely and valid test results.

Particular note should be taken of:

• The need for prior notification of request to laboratory.
• Specimen integrity; e.g. special transport (including urgent transportation) and packaging requirements.
• Sample size requirements. When only a small amount of sample is obtained, indicate which test(s) are clinically most important.
• Use of preservatives/transport media.
• Time critical specimens (e.g. antibiotic assay, U & E, cortisol).
• Correct tubes/appropriate containers i.e. ONLY those provided/approved by laboratory (refer to Pathology Website).
• Correct sample(s) for request/test(s).
• “Order of Draw” chart for BD Vacutainer System to avoid sample contamination.
• Correct mixing of the sample post collection
• Delivery to correct laboratory in a timely fashion.

Samples should be sent to the laboratory with minimal delay. Samples received following an excessive period of time may be rejected.

Specimens sent in an unsafe manner that pose handling and health hazards may be rejected.

Specimens received that are not appropriate for the investigation requested will be rejected.

Requests for inappropriate investigations will be rejected (e.g. Hepatitis C virus quantification without prior positive diagnostic serology).

Request forms received without a sample will be rejected.

Requester will be notified verbally or via the reporting process in accordance with local procedures.

Urgent requests

Requests for truly urgent investigations to be carried out by the Haematology/Blood Transfusion, Biochemistry or Microbiology departments during routine working hours should be pre-notified to the relevant laboratory. The results to these investigations will be made available as soon as possible. Urgent samples sent from outside the Hospital MUST be placed in the ORANGE urgent bags specifically designed for this purpose so that they are readily identifiable when received in the laboratory and can be delivered directly to the urgent bench.

Thrombolysis Patients

Please bleep the haematology laboratory on 848 immediately with the patient’s details. The FBC and clotting screen samples should be sent to the laboratory immediately via pod or porter.

Anticoagulant monitoring samples

INR samples for anticoagulant monitoring sent from outside the Hospital should be sent on the specifically designed BLUE anticoagulant bags. This enables them to be delivered directly to the Coagulation Department.

Add on requests

Occasionally it is necessary to request further tests either because they were missed or the results indicate further testing is required. We will always endeavour to facilitate this but if a verbal request is made for an add on test we MUST insist that this is followed up by a written request in order to maintain accurate and full records.

Results reporting

Most reports are now only issued electronically via the Sunquest ICE system. Urgent results issued by Haematology/Blood Transfusion, Biochemistry or Microbiology will be telephoned to the requesting clinician/location as will any grossly abnormal result which indicates that the patient may require urgent clinical intervention irrespective of whether the sample was marked urgent.

Clinical Advice

Advice on all matters relating to the provision and interpretation of results is available from the Consultant staff in the relevant department. Outside routine laboratory opening hours, clinical advice can be obtained by contacting the hospital switchboard, who will connect you with the relevant person.

Confidentiality

There are six areas of Information Governance:

• Common law duty of confidentiality
• Data Protection
• Freedom of Information
• Information Security
• Record Management
• Data Quality

All NHS employees are bound by the Common Law Duty of Confidentiality, placing a legal duty on all staff working for the Trust to keep all information provided to the Trust and themselves as employees of the Trust by its patients completely confidential. This legal obligation is further enforced through the codes of practice of staff respective professions and by virtue of their contract with the Trust.

All staff have a legal obligation to ensure that any confidential information they come into contact with is kept secure and confidential at all times. Where a member of staff receives a request for information relating to an individual, staff must ensure that any disclosure of confidential information is fully justified and in compliance with the Data Protection Act 1998 or Common Law Duty of Confidentiality.

All Worcestershire Pathology Services staff undertake annual mandatory Information Governance Training to ensure they are familiar with the legislation and Trust and departmental policies.

Where necessary the laboratory will have information available for patients and users that includes an explanation of the clinical procedure to be performed to enable informed consent.

The importance of provision of patient and family information, where relevant for example for interpreting genetic examination results, shall be explained to the patient and user.

Changes to Andrology Service

The WRH laboratory no longer accepts semen samples for analysis.

Andrology referrals should be directed to the Birmingham Womens Hospital.

Laboratory supplies

Routine biochemistry, haematology and microbiology laboratory consumables e.g. blood tubes, urine containers, are ordered, with the appropriate requisition form, either from the laboratory at Alexandra Hospital (in the case of Kidderminster Hospital, Alexandra Hospital, Princess of Wales Hospital, Redditch and Bromsgrove CCG and Wyre Forest CCG) or the loading bay at Worcestershire Royal Hospital in the case of Worcestershire Royal Hospital or South Worcestershire CCG.

To order from the Alexandra Hospital, please contact the laboratory using the email wah-tr.pathology.orders@nhs.net

For WRH please contact loading bay: jill.mayne@engie.com, stuart.hadlington@engie.com, rachael.hammett@engie.com

Specialist supplies are ordered direct from pathology. For 24h urine bottles and FIT patient packs please email wah-tr.dutyBMS@nhs.net. For blood culture bottles, please contact microbiology.

Specimen Containers (excluding universal containers) for all Histology and Cytology investigations can be ordered by contacting the cellular pathology department directly.

Enquiries

For further general information about any aspect of the service, please contact the Pathology Services Manager on 01905 763333. For clinical and technical advice please refer to the individual specialities.