News

Update on the qFIT Screening Service in the Peninsula

August 15th, 2018

Hopefully you should have received your qFIT collection kits and many of you will have already sent samples back to the laboratory here in Exeter. To date we have received 480 samples and detected 67 positive results.

Some Key Learning Points to Date

  • A number of samples are arriving back in the laboratory without the accompanying request form and/or no or insufficient patient details on the specimen. We have a small number of specimens where we are not able to track down the source of the request to return results for these reasons. Please ensure the GPs fill the request form in fully in the surgery, along with the surgery ‘QF’ number, before handing out the kit to the patient and stress the importance of returning the form inside the return envelope with the sample.
  • If you are missing results from patients who have been issued FIT packs, please first check with the patient that they have returned the pack, and then contact us with patient details. It is possible the sample was returned to us with no form/insufficient details for us to be able to track a patient back to the requesting source.
  • A few samples have arrived with the collection device incorrectly or loosely re-assembled and in one case not re-assembled at all, resulting in leakage of the contents and invalidating the test. Please stress the importance of following the collection instructions precisely.
  • A number of samples have been received with no indications ticked on the form. Unfortunately we are not able to process these samples.
  • Unfortunately we are required to strictly adhere to the age limits stated and will not be able to process younger patients.

Electronic Result Messaging

Although we are now confident all results are being transmitted to the DTS electronic Pathology messaging service, a large numbers of practices are still not receiving them into their practice system. To assist this process please consider the following –

  • Check your Pathology Unmatched folder for results, as we will be sending them to your generic DTS address, not a specific GP.
  • Is your clinical system set up to receive Pathology messages from the Royal Devon & Exeter mailbox? Our details are –
    • DTS Address – 69440pm.dts.nhs.uk
    • EDI Trader code – 1100000454
  • Your clinical system provider should be able to assist you in this process.

E-mailed Results

Until we have received assurance from individual GP surgeries that you are receiving results correctly by electronic format, we will continue emailing all your qFIT results. All positive results are still being telephoned to the surgery.

  • All e-mailed results are being sent to the Practice Manager e-mail address (unless you have already advised us of a preferred generic results e-mail), which is the only contact we were provided by the CCG at the outset of the project.
  • If you are missing results, please check with your practice manager first.
  • If you have not already advised us of a generic e-mail, and would prefer results to be sent to that address instead until electronic reporting is working for your surgery, or you have any other queries, please contact us on: rde-tr.bloodsciencesadmin@nhs.net

MOLECULAR GENETICS DEPARTMENT ARE RECRUITING

August 13th, 2018

Band 3 Assistant Genetic Technologist and Administrative Assistant positions available

We are excited to announce that applications are now open for an Assistant Genetic Technologist and Administrative Assistant in our state-of-the-art facilities in the Department of Molecular Genetics providing a high quality, rapid diagnostics service.

These positions are full-time (37.5 hours/week) on 1-year fixed term contracts and the deadline for applications is 31st August 2018. For the Administrative Assistant role, two 20 hour per week posts may be considered.

Please see the RD&E Hospital jobs website links above for full details of the posts, contact details and application information.

New Clinical Chemistry Advice & Guidance E-Referrals Service

June 27th, 2018

We are pleased to announce that the Duty Biochemist team at Exeter Clinical Laboratories are now able to offer non-urgent clinical advice and guidance using the new NHS e-Referral (e-RS) service (more information here: https://digital.nhs.uk/services/nhs-e-referral-service ).

You are more than welcome to continue contacting us by phone or by e-mail in the normal manner, if you need an immediate answer to a question or need to provide additional clinical information in support of a test request.

Faecal Immunochemical Test (qFIT) packs distribution update

June 26th, 2018

We are pleased to announce Exeter Clinical Laboratories will be providing quantitative Faecal Immunochemical Test (qFIT) packs as per NICE DG30 guidance for the whole of the South West Peninsula. We have been working hard with the Peninsula and SWAG cancer networks to bring this service to our local patients.

Patient qFIT packs have now been shipped to the local laboratories in Plymouth, Cornwall, Torbay and North Devon for distribution to individual local GP surgeries. Packs for the Exeter GP locations will be distributed by the end of this month.

For more information, please search for FIT at our website: www.exeterlaboratory.com

Biotin Alert – Potential assay interference

June 15th, 2018

Potential Assay Interference – Biochemistry Immunoassay Tests

The immunoassay methods used in the Biochemistry laboratory at Exeter Blood Sciences use a streptavidin-biotin system in their design. If patients are taking large doses of Biotin (Vitamin B7), there is potential for interference in immunoassays analysed within Biochemistry. Keep on reading!

New Satellite Blood Culture Incubator in Blood Sciences

June 14th, 2018

Microbiology and Blood Sciences have collaborated to set up a satellite BC incubator in the A2 template. This will allow incubation of all  blood culture bottles immediately they arrive in the lab. For our patients, this means:

  • Faster results
  • Shorter turnarounds
  • Earlier optimisation of antibiotic use
  • Less use of potentially nephrotoxic agents (particularly relevant in the Neonatal Unit)

What do you need to do?
Take blood cultures as normal
9am – 5pm:        pod (2900) to Old Path block as you do currently
After hours:       pod (2912) to A2 template, they will be loaded on the satellite unit overnight & repatriated to Microbiology the following morning

Your results will likely come back ~12 hours earlier – we will monitor this.

Update on Rubella Screening in Pregnancy

June 12th, 2018

Prepared from PHE letter by C Auckland; RDE 2018

Antenatal screening for rubella (German measles) susceptibility ended in England on 1 April 2016. The decision to stop screening followed a review of evidence by the UK National Screening Committee (UK NSC) in 2003 and 2012 which on both occasions found that screening for rubella susceptibility during pregnancy did not meet the UK NSC criteria for a screening programme.

The epidemiology of rubella in the UK has changed due to the high uptake of the Measles, Mumps and Rubella (MMR) vaccination in the UK population, both boys and girls. Women are now unlikely to be exposed to rubella in pregnancy. The few cases that occur are usually imported from other countries.

The rationale to end screening for rubella susceptibility includes:

  • rubella infection in the UK is at a level defined as eliminated by the World Health Organisation
  • screening for rubella susceptibility in pregnancy does not give any protection to the unborn baby in the current pregnancy
  • the test may falsely reassure some women that they are not susceptible to rubella infection in the current pregnancy
  • stopping antenatal screening is unlikely to result in increased rates of congenital rubella. There were 12 cases of congenital rubella reported in the UK between 2005- 2015. None of these could have been prevented by the screening programme. We will continue to monitor cases following the cessation of rubella susceptibility screening
  • the MMR vaccine is effective in protecting women against rubella in pregnancy

The MMR section 7A service specification sets out that providers are required to make the MMR available to women of child bearing age who are unvaccinated or partially vaccinated for rubella and other adults and children who have no history of MMR vaccination, or incomplete immunisation status.

Existing opportunities should be taken for checking the status and administration of MMR vaccination (two doses if needed) for:

  • all children and young adults who have not been vaccinated
  • new entrants to the UK at General Practice registration consultation
  • postnatal women through health visiting assessments and six week maternal checks
  • women accessing preconceptual; fertility or miscarriage and termination services

What you can advise patients

If pregnant women request Rubella testing, they should be advised that it is no longer part of the NHS antenatal screening programme; that they should check whether they have had 2 x MMR vaccinations, and if they have not, book an appointment to have a MMR vaccination at the 6 weeks post-natal check.

Check all new entrants from EU have had x2 MMR

PHE have published the following resources which can be given to patients:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/696849/Screening_tests_for_you_and_your_baby.pdf

References

https://phescreening.blog.gov.uk/wp-content/uploads/sites/152/2016/03/Gateway-letter-cessation-date-for-antenatal-rubella-screening.pdf

http://legacy.screening.nhs.uk/rubellasusceptibility

PVSA Request Form *UPDATE*

April 24th, 2018

Please use updated PVSA request form for all future PVSA requests.

Important recommendations for implementation of Whole Genome Sequencing in the NHS published

April 23rd, 2018

The House of Commons Science and Technology Committee have published their report “Genomics and genome editing in the NHS” on the use of whole genome sequencing (WGS) within the NHS. It includes important recommendations for the UK government which will have significant implications for patients, clinicians, NHS genetic/genomic diagnostic services and the UK genomics industry.

The report has been authored following consultations with NHS genetics services (including Professor Sian Ellard, Head of the Department of Molecular Genetics in Exeter), experts in UK genomics research and industry, patient advocacy groups and independent think tanks at several science and technology select committee hearings and information gathered from other sources, such as the Chief Medical Officer’s “Generation Genome” report (published July 2017).

Full details of the report can be found using the above link or a short summary is available on the Genetics News Page.

Microbiology News Update – Minor changes to Urine Culture Methodology

March 13th, 2018

As part of our commitment to continually improve our diagnostic capacity, we are making some changes to urine culture to bring us into line with the National Standard Methods (NSM).

Please continue to use the PHE Urinary Tract Infection guideline when evaluating patients with potential UTIs (though this is being updated shortly)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/619772/Urinary_tract_infection_UTI_guidance.pdf

The changes are:

  1. Introduction of chromogenic agar to improve our identification of urinary coliforms.
  2. We are limiting our confirmatory testing for resistance markers. These 2 changes will enable us to issue more results at ~ 24 hours.
  3. Alteration to the cut-offs used to define significant bacteriuria in line with NSM. This will mean you will see different colony counts on the results; we will still only report significant bacteriuria. The advice on whether to treat remains unchanged (i.e. Treat SYMPTOMATIC cases only except in pregnancy)
  4. We have amended the electronic ordering – hopefully the questions are now more relevant and easier to complete (GP Ordercoms will be available in the next 12 months).
  5. You do not need to add the result of a dipstick to the request, but please include planned and previous antibiotic therapy in the clinical details, so we can tailor our result to your patient.

We are always pleased to receive feedback (good and bad) so please contact me if you want to discuss these changes.

Cressida Auckland,  Consultant Medical Microbiologist

cressida.auckland@nhs.net