Microbiology

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Medical Microbiology referrals on Trak are replacing the current clinical microbiology advice telephone service for non-urgent referrals at the sites listed below. Inpatients and patients in emergency areas should now be referred to Medical Microbiology via Trak (Mon to Fri between 0900 and 1600hrs).

The referrer can make a referral via the Clinical Menu >> Make Referral menu item.

Sites in scope & referrals available:

Referrals available

Sites available (new sites in bold)

Locations

Medical Microbiology Referral
  • Astley Ainslie Hospital
  • Belhaven Hospital
  • East Lothian Community Hospital
  • Ellen’s Glen Community Hospital
  • Ferryfield Community Hospital
  • Findlay Community Hospital
  • Midlothian Community Hospital
  • Princess Alexandra Eye Pavilion
  • Royal Edinburgh Hospital
  • Royal Hospital for Children and Young People
  • Royal Infirmary of Edinburgh
  • St John’s Hospital at Howden
  • Western General Hospital

All inpatient wards and emergency departments


NOT in scope:

  • All other sites not listed above
  • Emergency / Urgent referrals:
    • Mon-Fri 0900 to 1700, Weekends and Public Holidays 0900 to 1600 please phone 63373, option 4 for clinical microbiology advice
    • Mon-Fri 1700 to 0900, Weekends and Public Holidays 1600 to 0900 contact the on-call Medical Microbiologist via switchboard (see: How to be excellent at phoning Microbiology)
  • Outpatient referrals – please call as above
  • Referrals from outside NHS Lothian  - please call as above
  • GP referrals [ see: Microbiology – RefHelp]
  • Other infection specialties, e.g. Virology, Infectious Diseases, Infection Prevention and Control.

To place a referral: see attached PDF

Review the Edinburgh Laboratory internet site here. The microbiology lab can be contacted regarding sample updates. 

 

How to be excellent at phoning Microbiology

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.

IV to oral switch and duration decisions

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.