Antimicrobial prescribing: NHS Lothian
Clinical calls to medical microbiology are received from doctors > FY2 grade.
Weekdays, Monday-Friday, advice is available between 11am-4pm.
Calls out-with this time for urgent clinical calls only.
Microbiology
Before you phone you should always check:
- With a senior - what is the question you want answered?
- TRAK - review previous discussion with microbiology or infection advice given.
- Review the available microbiology results - does the result help you choose an appropriate antibiotic?
- Pages within the Antimicrobial App related to your clinical question.
- With the ward pharmacist, they may be able to help if the question relates to antibiotic dosing.
- Review the Edinburgh Laboratory internet site here. The microbiology lab can be contacted regarding sample updates.
Monday-Friday (11am-4pm) (excluding public holidays)
Advice is available via tel: 0131 536 3373 (internal 63373) with option 4 for medical microbiology. These calls will be triaged with the aim to respond usually within 2 hours.
>5pm weekdays (5pm -9am), weekends and public holidays
On-call medical microbiology.
Urgent clinical advice
Monday –Fridays (9am-11am, and 4-5pm)
Advice is available via tel: 0131 536 3373 (internal 63373) with option 4 for medical microbiology, urgent clinical calls only.
There are IV to oral switch recommendations along with recommended durations for most indications with the Antimicrobial App. Further guidance is available here.
These decision are never urgent. Only phone in hours.
Make sure you have all the information you need before phoning.
A phone call to microbiology
TOP TIP - have the patient's notes, drug chart, obs chart, (stool chart), open and in front of you when you phone.
SITUATION
- Hello my name is...I’m phoning from...about a patient (name, age, CHI).
- The working diagnosis is... and I would like to ask about....(IV to oral switch/duration etc.)
- Can I tell you more about the patient?
BACKGROUND
- Important co-morbidities, organ dysfunction (acute and chronic) and immunosuppression (transplant, chemotherapy, HIV etc).
- What has happened to the patient up to now?
- Have they had imaging? Has a collection been found? Has it been drained or is there a plan to drain it?
- Have they had an operation, when, what was found, is there a plan to go back to theatre?
- Do they have an indwelling vascular access devices (PVC, CVC, mid-line, PICC), do they have implanted prosthetic material (valve replacement, joints (hip, knee), do they have a pacemaker?
- Antibiotic history to date?
- What is the patient currently on (does, route and how long have they been these antibiotics so far)?
- Were they on different antibiotics before or in the community before admission?
- Can they take oral medication?
- Does the patient have any known allergies? Have you reviewed the penicillin allergy section in MicroGuide
ASSESSMENT:
- What is the patient's current NEWS? Is it getting better or worse? Do they have sepsis?
- What did you find when you examined the patient?
RECOMMENDATION:
- We are concerned about this problem? And would like to ask your advice.
Remember
- After you have phoned document in TRAK using \antibstart or \antibreview.
- Document who you spoke to.
- Document the antibiotic, dose, route and suggested duration.
- Document any IV to oral switch suggestions.
- Add the indication and duration information to the prescription chart.
- Ensure a review takes place at most 72 hours after changing antimicrobials (document the review using \antibreview).
More or different antibiotics alone are often not the answer.
Without draining the pus or removing the infected material antibiotics are likely to fail and antimicrobial resistant organisms will be selected.