Ordering a test

Submitting specimens to Pathology

The Pathology service will accept requests from users that have agreements with the RCHT Pathology service. These requests will be analysed, if compliant with the Pathology Specimen Acceptance and Rejection Policy. This policy is strictly adhered to by all departments.

Use of the NHS Number (10 figures) on paper and electronic patient records is now a mandatory requirement included within the NHS Operating Framework 2008/9. Patient data should be used to identify the specimen up to the point where a NHS Number is allocated whereupon this becomes the primary identifier.

The laboratory computer (LIMS) uses the patient’s hospital number or the NHS number as the file accession number. The use of either of these numbers ensures correct patient identification and also speeds up sample processing. However, the NHS number is regarded as a safer means of positive identification as the computer system automatically performs an integrity check.

Verbal requests

If a verbal request is required please phone the relevant laboratory and request "add on" for the test required. Provide an addition request form to the lab.

Handwritten Labels

Poor or illegible handwriting may be misinterpreted and result in report delay. Please help to minimise this by completing all sections of the appropriate request form using a ballpoint pen. Printed patient addressograph labels are preferable to minimise error.

Specimens that do not meet the labelling requirements will NOT be processed unless the errors identified are rectified by the responsible clinician by confirming details via email or by attending the CMB department to correct the error within 24 hours.

Electronic Requesting – MAXIMS

The MAXIMS ordercomms system is the Trust’s preferred method of requesting Pathology tests. Emergency paper forms are available in clinical areas in case of system failure. All requests should normally be made electronically.

The MAXIMS system allows clinical requests to be made from all RCHT locations, offering tracking from the point of request through to the result issue and acknowledgment by a responsible clinician.

The electronic requesting software is accessed when a patient requires a Pathology test; the requesting clinician launches MAXIMS and selects the investigation that is required.

Once the order has been completed, an order message is sent to the laboratory computer system. At the same time a request form is printed within the ward/clinic or theatre. The sample is then collected and sent to Clinical Microbiology with the request form using the ATTS (pod).

When the sample arrives in Pathology, it is booked onto the laboratory computer system using a bar code reader. This then populates the laboratory computer system with the information provided in Maxims. The sample is then ready to be processed.

Once the result data has been entered onto the laboratory computer system and authorised, the data is ready to be transferred back to the responsible clinician.

• This system allows complete and accurate order entry by reducing the risk of transcription errors.
• Request tracking from point of request through to results reporting, as well as incoming request monitoring and a full audit trail.
• Reduction in the need to telephone the laboratory with enquiries either caused by data entry errors or to query the progress of a sample, as each order will contain status updates.

ICE

ICE is the Primary care order-comms Pathology requesting system. Users access the system via the patient record in the surgery computer system to place an electronic request for Pathology testing. The system will automatically record the request in the patient record and print a label for the sample. Individual users are set up with ICE accounts via CITS who manage all user account enquiries.

Urgent Requests

If results are required to assist with urgent clinical decisions, the laboratory must be notified by telephone, even during normal working hours, and the request form marked as ‘URGENT’. Without such notification, the specimen will not be prioritised and will be processed routinely even if the request form is marked as ‘URGENT’. Please note that writing “urgent” on the request form will not guarantee that the specimen will be handled as an emergency.

Specimen collection and storage

Date and time the specimen was taken must be clearly recorded on the specimen container and the request form/ordercomms. This information is essential to know the age of the sample due to the instability of some analytes and for the interpretation of results.

It is highly recommended that Primary Care locations centrifuge their blood Sciences samples, as delay can affect some results. Please deliver unspun samples to the laboratory asap. If storage of these samples is required overnight do not store in the fridge, instead store at room temperature (but cool). Any other samples for any other department please store in the fridge until they can be sent to Pathology with the exception of blood cultures, urines in boric acid containers and mycology which need to be stored at room temperature. However, please note the delay in centrifugation as well as analysis will lead to some tests being rejected by the laboratory.

To obtain advice and information on suitable centrifuges or on any aspect of centrifuging samples please contact the Pathology optimisation team on ext 4619. Angle head centrifuges are not ideal and may produce poor quality separation resulting in rejection of the sample.

	Essential	Desirable	Essential for all DMP specimens
Specimen	Essential NHS number or CR number* Patient’s FULL name or unique coded identifier (e.g. GU number) Date of Birth	Desirable Date and time of specimen Nature of specimen e.g. site of biopsy	Essential for all DMP specimens Surname, Forename or coded identifier NHS / Hospital number or Date of birth Signature of the requester Date of collection Time specimen taken Sample type Site and side Description of Biopsy Consultant or patient’s GP Patient location or address Report destination
Request Form	Essential NHS number or CR number* Patient’s FULL name or unique coded identifier (e.g. GU number) (Blood Transfusion – names on request forms must be correctly spelt and forms must be signed and dated by the person making the request and must also state date/time of any blood products required and all clinical details) Date of Birth Patients location and destination for report Patients consultant, GP or name of requesting practitioner Investigations required	Desirable Clinical information including relevant medication (this is sometimes essential) Date and time when specimen is collected (this is sometimes essential) Patients home address including postcode Practitioners contact number (bleep or extension) Gender	Essential for all DMP specimens Surname, Forename or coded identifier NHS / Hospital number or Date of birth Signature of the requester Date of collection Time specimen taken Sample type Site and side Description of Biopsy Consultant or patient’s GP Patient location or address Report destination Diagnostic Cytology – Label frosted slide end (Full Name and Hospital No or NHS number or DOB and Sample type and Site / side)

*For DMP Specimens that do not meet the labelling requirements as detailed in the table above, the specimen will not be processed until the errors identified are rectified by the responsible clinician. For Hospital requests the clinician is contacted directly and requested to rectify the error, this may be by confirming details via email or by attending the Histology department to correct the error, depending on the nature of the error. For GP requests the specimen is returned to the GP practice for correction.