SOP for the Receiving and Actioning of Laboratory Results into the Out of Hours Service

Transcription

1 SOP for the Receiving and Actioning of Laboratory Results into the Out of Hours Service Reference No: G_CS_38 Version 2 Ratified by: LCHS Trust Board Date ratified: 14 August 2018 Name of originator / author: Yvonne Owen Name of responsible committee / Individual Quality Scrutiny Group Date issued: August 2018 Review date: April 2020 Target audience: Out of Hours Practitioners and GPs Distributed via Website Chair: Elaine Baylis QPM Chief Eecutive: Andrew Morgan

2 Receiving and Actioning of Laboratory Results into the Out of Hours Department Version Control Sheet Version Section / Para / Appendi Version / Description of Amendments Date Author / Amended by 1 New Policy July 2014 Gaynor Edwards 1.1 Etended August 2016 Corporate Assurance Team 1.2 Team Etended January 2017 Corporate Assurance Team Etended September Corporate Assurance 1.4 Etended Feb 2018 Corporate Assurance Team 2 Rewritten policy 1 st May 2018 Yvonne Owen 2 Further rewrite 1 st May 2018 Yvonne Owen Copyright 2018 Lincolnshire Community Health Services NHS Trust, All Rights Reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. 2

3 Receiving and Actioning of Laboratory Results into the Out of Hours Department Version control sheet Policy Contents Policy Statement 4 Page Quality Assurance 5 Introduction 6 Receiving Laboratory Results 7 Equality Analysis 10 3

4 Receiving and Actioning of Laboratory Results into the Out of Hours Service Policy Statement Background The purpose of this policy is to provide guidance to Out of Hours service on managing abnormal Laboratory results received during the out of hours period. Statement This policy recommends safe and effective practice to strengthen the governance arrangements for Laboratory results and subsequent patient follow up. Responsibilities Implementation and compliance with the policy will be the responsibility of all staff Training All managers should ensure that staff are working within their own sphere of competence and that training is provided Dissemination Website Postmaster Resource Implication Availability of GP 4

5 5 Quality Assurance The service will use the following methods to provide assurance that there is compliance with the SOP and that blood results received in the out of hours service are being managed safely. All GPs working in the service have clinical audit undertaken at least yearly. Clinical audit will include the management of blood results received By eception any incidents relating to the management of blood results will be reviewed through the usual Quality Assurance / Clinical Governance processes in place in Urgent Care 5

6 6 Introduction The rural nature of Lincolnshire means that some blood test results will not be available following phlebotomy during the day until after Primary Care has closed and the Out of Hours service commences. Laboratory technicians, using national guidance on abnormal test results, may contact the Out of Hours service regarding specific patients if their result meets the criteria for urgent referral to a Primary Care clinician. The following SOP describes the process that should be followed when abnormal blood results are received by the Clinical Assessment Service (CAS). All local Laboratories will be advised that the service should be contacted via a single number The Lab Technician will advise that there are abnormal blood results and provide patient details. To ensure the results are received, interpreted and actioned appropriately in the OOHs period it has been agreed that the Laboratory will be informed that all results must be received by OOHs by 22.30hours to enable them to be reviewed by a GP and any follow up actions to be agreed. Receipt of blood results alert When a call is received from the Laboratory technician, the Ops Centre despatcher will request the demographic information for the patient and generate a new case on call handling and then pass through to CAS mark case abnormal bloods received, results to be viewed on Web v, and give the case an urgent priority The case should then be managed by a GP, who will access the results on Web V What is the abnormal result reference results accessed and reference number The normal range that the Laboratory utilises in relation to the abnormal blood result Any clinical information that is available Has this patient had previous blood tests? What was the date and result of the last test that this abnormal result relates to? Management of abnormal blood test results The majority of abnormal blood results are received by CAS between 18:30 and 22:30 Mon Fri. Therefore there should always be a GP in a base, or a GP working within the CAS who will pick up these cases. The following process should be followed when assessing and managing an abnormal blood result: 1. View the patient record (if available) to gather as much clinical information as possible previous results; known illnesses and medication; previous results; hospital care being provided etc. 6

7 7 2. If there is insufficient information within the patient record, or if the record is unavailable, the GP should contact the Laboratory that has undertaken the test via Lincoln County Hospital Switchboard and ask to speak with the on-call Lab Technician. The GP should then try to gain as much information as possible form the Lab Technician 3. Having gathered as much information as possible, the GP should contact the patient by telephone (Avaya) to advise them of the abnormal result and to establish: Why was the blood taken? (e.g. routine screening or monitoring ; test because of symptoms/illness ; hospital requested test) What is the patient s current condition and do they have any acute change in their condition? Do they have any symptoms that indicate the need for immediate or urgent intervention? Past medical and drug history Does the patient live alone? 4. Based on the nature and severity of the abnormal result and information gathered from the patient record, the patient and the Lab technician, the GP must then decide whether the patient needs further assessment and/or urgent intervention. This may include an appointment at the PCC, a home visit, referral to the ED (if further diagnostics required) or referral to 999 for ambulance response (if the patient is displaying or is at risk of a life threatening condition) 5. Further advice on whether urgent assessment and intervention is required may be obtained by contacting: The Consultant Biochemist or Haematologist on call both can be contacted via Lincoln County Hospital switchboard ( or ) The Medical Registrar on call at Lincoln, Boston, Grantham, Grimsby, Peterborough or King s Lynn Hospital (depending on patient location) 6. If you are unable to contact the patient by telephone, then the SOP for failed contact should be followed. Assess whether the nature and degree of abnormality of the result warrants a welfare check and who would be most appropriate to carry out this welfare check (HV Practitioner; Police; 999 Ambulance) 7. Consider whether immediate or urgent treatment is required. This may involve admission to hospital, following discussion with the appropriate specialty Registrar on call 8. Abnormal results that require particularly careful patient assessment include: INR > 5 for guidance see: Hb < 7 arrange face to face assessment and/or consider admission if medically at risk due to ongoing bleeding, pancytopenia or if unwell AKI3 discuss with Consultant Biochemist or Medical Registrar after assessing the patient blood glucose > 20 arrange assessment if not known diabetes and/or unwell Positive Troponin I Positive d Dimer Neutropenia Low platelets 7

8 8 9. If the patient does not require immediate or urgent intervention, advise them to consult their own GP the following day and document this advice in their System 1 record. If possible, send a task to the doctors in the Practice to alert them to the abnormal result and the advice that you have given the patient 10. If hospital admission or attendance is necessary, the patient should be encouraged to transport themselves if possible and if their condition does not pose an immediate threat to life. If the patient does not have transport, or if their condition requires ambulance transport, the GP should decide on the degree of urgency. This will generally be either 2 hour transport, or, for life threatening problems where emergency transport to ED is required, the ambulance dispatcher should be requested to code the call as DX011 (emergency transport to ED within 19 mins) 8

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10 10 Equality Analysis Introduction The general equality duty that is set out in the Equality Act 2010 requires public authorities, in the eercise of their functions, to have due regard to the need to: Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act. Advance equality of opportunity between people who share a protected characteristic and those who do not. Foster good relations between people who share a protected characteristic and those who do not. The general equality duty does not specify how public authorities should analyse the effect of their eisting and new policies and practices on equality, but doing so is an important part of complying with the general equality duty. It is up to each organisation to choose the most effective approach for them. This standard template is designed to help LCHS staff members to comply with the general duty. Please complete the template by following the instructions in each bo. Should you have any queries or suggestions on this template, please contact Rachel Higgins, Equality, Diversity and Patient Eperience Lead Name of Policy/Procedure/Function* Receiving and Actioning of Laboratory Results into the Out of Hours Department Equality Analysis Carried out by: Teresa McNally Date: 14 March 2018 Equality, Diversity and Patient Eperience Lead: Rachel Higgins Director\General Manager: Natalie McKee *In this template the term policy\service is used as shorthand for what needs to be analysed. Policy\Service needs to be understood broadly to embrace the full range of policies, practices, activities and decisions: essentially everything we do, whether it is formally written down or whether it is informal custom and practice. This includes eisting policies and any new policies under development. 10

11 11 Section 1 to be completed for all policies A. B. C. D. Briefly give an outline of the key objectives of the policy; what it s intended outcome is and who the intended beneficiaries are epected to be Does the policy have an impact on patients, carers or staff, or the wider community that we have links with? Please give details Is there is any evidence that the policy\service relates to an area with known inequalities? Please give details Will/Does the implementation of the policy\service result in different impacts for protected? The purpose of this policy is to provide guidance to Out of Hours Practitioners when receiving Laboratory results into the out of hour s arena. No No Disability Seual Orientation Se Gender Reassignment Race Marriage/Civil Partnership Maternity/Pregnancy Age Religion or Belief Carers If you have answered Yes to any of the questions then you are required to carry out a full Equality Analysis which should be approved by the Equality and Human Rights Lead please go to section 2 The above named policy has been considered and does not require a full equality analysis Equality Analysis Carried out by: Teresa McNally Date: 14/3/18 Yes No 11