Departments

Clinical Biochemistry

About EPA Biochemistry

The Clinical Biochemistry Department at the Norfolk and Norwich University Hospital is part of the Eastern Pathology Alliance (EPA), a network also involving the James Paget University Hospital, Gorleston and the Queen Elizabeth Hospital, King’s Lynn. The laboratory is accredited by the United Kingdom Accreditation Service (UKAS) to ISO 15189:2012.

The defined schedule of tests for which the laboratory is accredited can be found by clicking on the link below.

To view accreditation schedule no.10294 please visit https://www.ukas.com/

In order to maintain high standards of analysis this Department participates in national external quality assessment schemes (EQA) including General Biochemistry, Specialist Proteins and Toxicology, and maintains its own internal system of quality control checks (IQC), routine validation and daily calibrations on all assays. Full details of EQA scheme participation are available on request.

This page provides information about how users can access our services, who to contact for advice, which tests we perform, sample requirements, normal ranges and turnaround times. The information within this manual is accurate at time of issue and is reviewed and updated regularly.

For patients using these pages, please note that any information provided should not be used for self-diagnosis and should you have any concerns about your health please consult your GP.

If you find any errors within this information or would like to make any comments and/or suggestions for improvement, please contact Diane Murley, EPA Quality Manager on 01603 286900 or email diane.murley@nnuh.nhs.uk

 

Test Samples

General Sample Guidelines can be downloaded here.

Sample Acceptance/Rejection Criteria can be downloaded here
 

Packaging and Transport of Samples

Samples are a potential source of infection and should be treated accordingly. Please fill all sample bottles with the correct volume of blood to ensure correct anticoagulation, and all containers must be securely closed. Leaking samples with gross contamination of contents and containers are discarded. Pocket bags are available for sample transport. Samples should be placed in the appropriate container, which must be securely fastened. This must be placed in a clear plastic bag and sealed. Samples accompanied by forms without specimen bags must be put into marsupial bags with the request form being placed in the side pouch.

Add on Tests

Add-on investigations from within the Trust

There are occasions when extra tests are required to be added to existing samples for patient management.

NOTE – Only Add-On requests from the following locations will be accepted, unless the sample cannot be repeated:

Emergency Medicine A&E, AMUL/M, EAUS
Critical Care
NICU
CCC

  • At JPUH an Add-On request form must be filled in by the agreed locations.
  • Only those on the agreed list are added on. If other investigations are required they will have to be discussed with the Clinical Biochemistry Consultant who is contactable via switchboard.
  • If Add-On test is accepted then transfer information relating to patient and sample to Add-on Request Slip and send to the laboratory.
  • If samples are insufficient or inappropriate it is the responsibility of the laboratory to inform the requesting clinician of the problem.

Outside normal laboratory hours the following procedure will be followed:

  • The BMS will take the telephone call from the requesting clinician and use the add-on sheet available.
  • If there is any doubt regarding the request the BMS may refer the call to either the on-call Consultant or the Duty Manager, whichever is felt more appropriate.
  • Sample is then assayed as appropriate.
  • If insufficient or inappropriate sample then it is the responsibility of the relevant section to inform requesting clinician of problem.

Sending Samples

The transport of samples from GP surgeries or other primary care locations is carried out by the Logistics service staff who will collect all samples from dedicated collection points. Samples from within the hospital can be transported to Pathology either by the Pneumatic Tube System (PTS) if suitable or by a porter. For urgent samples ward staff are required to arrange delivery to the laboratory. Samples must first be placed in the plastic sample bags together with the completed request form.

The safe transport of specimens to the laboratory is the responsibility of the requesting doctor or carrier. Laboratory responsibility for the sample begins when it has arrived at the laboratory.

Sending samples via the pneumatic tube system

  • All items MUST be sent in the carriers provided.
  • Samples MUST not be placed directly into the carriers. ALL Pathology samples MUST be placed in specimen bags and the lids of all items with the potential to leak (fluids etc.) tightly secured BEFORE placing them in the carriers.
  • Do not cram samples/items into the carrier as this may lead to breakage/leakage and system failure.
  • Only one carrier at a time should be placed in a delivery station.
  • Ensure that carriers are closed securely at both ends to avoid them jamming in the tube network.
  • If any defect is noticed with the operation of the air-tube systems please notify the laboratory at the earliest opportunity.
  • The system must not be used for sending consumables and other “forbidden items” around the hospital.

The air tube systems are for the transport of Blood Sciences specimens to the laboratories only.

The air-tube system should NOT to be used for:

  • Danger of Infection samples
  • Blood gases
  • Blood cultures
  • Unrepeatable samples
  • CSFs (for culture, protein, glucose or xanthochromia)

JPUH

Forms can now be requested on Web ICE.

NNUH

Request Forms

Forms must be requested on Web ICE by 06:00 for that days round.

Extra forms will not be accepted by the phlebotomists during the ward round.

Requests marked ‘URGENT’ WILL NOT be taken by the Phlebotomist – these must be taken by the requesting clinician.

Request forms which have the incorrect location on the request form will be sent to the correct location (if identified) via the pneumatic air tube system. If the phlebotomist on the correct location has already completed their ward round the request form will become the responsibility of the ward staff to obtain blood sample collection for their patient.

If the phlebotomist is unable to obtain blood sample collection the request form will be returned to the clinician.

QEH

Paper Request Forms

All Blood Science requests are made on EPA three-part request forms with specimen bags attached. Please ensure addressograph labels are attached to all three copies.

Green – Haematology and Biochemistry
Red – Blood Transfusion
White – Microbiology
HMR101/5 – Cervical Screening Samples (NB: full details are required)

Electronic Requests:
Electronic test requesting is currently not available within the QEH.
Andrology requesting is booked through ICE via NNUH

“High Risk” samples

Medical officers responsible for the care of patients have a duty of care towards other members of staff – therefore all samples from patients who are known to have, or strongly suspected of having the conditions noted below must be identified.

  • Creutzfeldt – Jakob disease
  • Viral haemorrhagic fever (VHF) of any type
  • Microorganisms, (biological agents) in Hazard Group 3 or 4
  • Pyrexia of unknown origin (PUO) recently returned from Africa

Medical staff should ensure that appropriate information, including relevant travel history, is provided in order to alert laboratory staff of potential dangers. Clinical details supplied on sample request forms must contain clear information regarding the nature of the test being requested and sufficient detail to inform laboratory staff upon the safety precautions they need to take in order to process the sample without risk of infection.

If, during patient intervention, further information becomes available that has implications for the safety of laboratory staff this must be communicated immediately to the laboratory so that appropriate steps regarding containment can be taken.

Rejection of unacceptable specimens

Specimens and request forms are checked on receipt to confirm the patient identification (PID) information provided on the form and specimen agree. There are 4 PID data items; Surname, Forename, Date of Birth and ID Number (Hospital or NHS) which are required by the laboratory and these must match in order for the specimen to be accepted. It is good practice for us to have location and date & time of sample collection. If errors are found the laboratory may contact the requestor, explain the problem and request a repeat specimen.

For samples that are not easily repeated (such as CSF or paediatric samples) the problem will first be discussed with a BMS from the relevant section who will make a decision on whether testing may be allowed to proceed (usually after discussion with the clinician concerned). If the specimen is tested the report will clearly state the nature of the problem as a comment. Alternatively, the requesting clinician will be asked to send a repeat sample.

For further details regarding incompletely labelled samples or forms please contact the laboratory.

Procedure for requesting add-on investigation(s) from outside the Trust

  • At JPUH an Add-On request form must be filled in by the agreed locations.
  • Only those on the agreed list are added on. If other investigations are required they will have to be discussed with the Clinical Biochemistry Consultant who is contactable via switchboard.

Referred Tests

Some specialised or low volume assays are referred to external laboratories for analysis; these may take up to 4 weeks for a result to become available. Please contact the laboratory if there is any urgency for these investigations. Information regarding specimen type for referred tests can be obtained by contacting the laboratory.

In line with accreditation requirements we endeavour to use accredited laboratories whenever possible. Further information on the reference laboratories we use can be obtained from the Individual Head of Section or from the Quality Manager if required.

Results

Result enquiries / Telephoned results

Authorised results are available on the ICE system, which is updated in real time throughout the day. If a result is needed urgently and/or cannot be found via the ICE system the laboratory may be contacted on 01603 286929 (Ext 2929).

Critical test results will be telephoned in line to the Critical and Escalation Protocols for Telephoning Critical Results in Clinical Biochemistry and Immunology.

In the event that the laboratory is unable to deliver the required service due to equipment failure we will endeavour to contact all relevant users.

Guidance

For Clinical Biochemistry telephone limits please click here

For the Acute Kidney Injury Algorithm click here

For guidance on the reporting of estimated GFR (eGFR) click here

For guidance for the interpretation of elevated serum potassium in primary care click here

For information about key factors that are known to affect test performance and result interpretation click here

Clinical Liaison

Consultation about investigation and management of conditions is welcomed. For advice on diagnosis and the interpretation of Clinical Biochemistry results or advice on treatment during normal working hours (Monday – Friday, 09:00 – 17:30) contact the duty Biochemist on 01603 646685 or email nnu-tr.nnuhdutybiochemist@nhs.net Outside normal hours of service they can be contacted through the hospital switchboard. Tel: 01603 286286. Due to IG compliance requirements, results cannot be communicated directly to patients.

Leaflets

Opening Times

JPUH

Open 24 hours, 7 days a week. However, routinely staffed and most responsive during our core working hours.

Core Hours:

Monday08:00 - 18:00
Tuesday08:00 - 18:00
Wednesday08:00 - 18:00
Thursday08:00 - 18:00
Friday08:00 - 18:00
Saturday08:00 - 16:00
Sunday08:00 - 16:00
Bank Holiday08:00 - 16:00

The laboratory can be found at the rear of the building on the ground floor sign posted ‘Pathology – Blood Tests’

NNUH

Open 24hrs a day 365 days of the year

The laboratory can be found in East Block Level 1 sign posted ‘Pathology’

QEH

Open 24 hours, 7 days a week. However, routinely staffed and most responsive during our core working hours.

Core Hours:

Monday08:00 - 18:00
Tuesday08:00 - 18:00
Wednesday08:00 - 18:00
Thursday08:00 - 18:00
Friday08:00 - 18:00
Saturday08:00 - 13:00
Sunday08:00 - 16:00
Bank Holiday08:00 - 16:00

The laboratory can be found at the rear of the building on the ground floor, in area 4, the green section sign posted ‘Pathology & Blood Tests’