Requesting and Reporting
In order for the correct tests to be applied to the blood samples, the clinical details section of the request form should be completed with as much detail as possible to help with results interpretation or indicate further appropriate testing. Simply stating “unwell” does not provide sufficient information.
All request forms must be completed fully with a minimum of 3 points of identification however; Blood Bank samples MUST have 4 points of identification to be accepted.
The date and time the sample was taken and the signature of the individual drawing the blood sample must be included.
Please use iSoft Clinical Manager (iCM) for all electronic ordering of pathology blood tests that originate within the Derriford site.
INPATIENT/SECONDARY CARE BLOOD TEST REQUESTS
Each request accepted by the laboratory for examination(s) shall be considered an agreement.
For all UHPNT inpatient tests, electronic requests should be made through iCM. For locations with no access to electronic ordering of tests, requests can be made electronically or via paper requests.
For inpatients, upon completion of a request barcode labels will be produced on local printers, no paper request forms are used; the samples must be labelled with printed barcode labels, placed in a bag and sent to the lab.
Paper request forms are available from Pathology Issue Stores.
PRIMARY CARE/EXTERNAL REQUESTS
Primary care test requests are generated using the ICE Sunquest electronic ordering system. Barcoded labels are printed and affixed to the correct blood tubes for the tests requested. The samples are then placed into specimen bags and collected by the transport team for delivery to the appropriate Pathology lab.
BLOOD TRANSFUSION REQUESTS
Important: Samples destined for Blood Bank can have either handwritten or iCM/ ICE labels attached but the label must always be signed by the person bleeding the patient. The request form must also be signed by the individual carrying out the second check. The sample must be accurately labelled with:
These must match on both the sample and the request form. Failure to do so will result in rejection of the blood sample and a delay in providing blood components.
It is the responsibility of the clinical requester to ensure that the patient has been adequately supported to make an informed decision to consent to testing. Provision of a request form and an associated sample to the pathology service is taken as consent to testing. The laboratory will conduct testing according to the information given on the request form. Any additional testing, including reflex testing, will only be undertaken either by direct request via the add-on process (see below) or as authorised by the pathology clinical staff on behalf of the Trust and CCG to support clinical care.
Patient consent is required for the use of tissues removed at surgical procedures for research (with certain exceptions), transplantation or obtaining medical information relevant to another person e.g. genetic information.
Consent is not required for the use of tissue from living patients for the following purposes; clinical audit, quality control, public health monitoring, education or training in relation to human health, although it is good practice to inform patients that their tissues may be used for these purposes via patient information literature, and should any patient specify that they do not want their samples to be kept or used for such purposes, these should be respected. These latter uses of tissue are essential to ensure the high quality of service, which all patients have the right to expect. Wherever possible, samples of tissue used in this way should be anonymised or pseudonymised.
Some locations are treated as priority for sample processing including the emergency department, critical care and the medical assessment unit. Barcoded specimens have the location stated on the barcode and are sorted so that the processing takes place at a dedicated urgent workstation. Other locations and service users may request blood tests to be prioritized by phoning the laboratory reception who may refer the request to scientific or clinical staff before processing if necessary.
Results are not routinely phoned to the requestor. If results are abnormal but do not suggest a significant change in the state of the patient the result will not be phoned but will be made available at the earliest opportunity through iCM for review. If previous results indicate that this is a new presentation or represents a significant change then the result would be communicated to the requestor at the earliest opportunity.
ADD-ONs and REPEAT TESTS
Additional requests can be requested on samples already submitted dependent upon age and nature of sample available as detailed in the test list (hyperlink) and that the sample meets the physical requirement criteria for Acceptance (see below).
Chemistry- Paper add-on (word doc)
Paper add-on (pdf)
Haematology- via telephone or by bleep out of core hours
To complement our own test repertoire over 200 additional assays are available through the laboratory referral service. In these cases we aim to assure the quality of test results through the selection of suitably accredited laboratories that are able to provide efficient turnaround times for our patients’ results. The referred assays are integrated into the in-house test list, with guidance on sample requirements, expected TAT and site they are sent to. When the final report is issued, the reference laboratory will be identified, together with any applicable comments they, or our clinical staff, have made.
ICE/iCM DOWNTIME PROCEDURE
Completing a paper request
Paper requests should be used when the iCM/ICE system is down, or if a requested test is not available on the electronic ordering system. Stock of request forms is held in the Pathology Issue Store and the Laboratory Reception, whilst locations are encouraged to hold a small stock of request forms in case of unplanned downtime. Planned downtime is managed through communications from Pathology to the end user.
Please complete all sections of the correct form (see table below) using a ball point pen (addressograph labels can be used on forms only).
It is essential that you include a summary of the relevant clinical details and therapy, as the laboratory may initiate further appropriate tests on the basis of the results obtained and clinical information provided.
There should be at least three matching pieces of information between the form and the sample and they should be as listed below: