Clinical Specialist Services Care Group Department of ...

Clinical Specialist Services Care Group

Department of Pathology

Index Number: QF/PA/MB/QI9 Version:1

Microbiology User Survey 2018

1. Aim

To seek Pathology User views of the service provided by the Microbiology Laboratory at

County Durham and Darlington NHS Trust (CDDFT) and to make suggestions for

development of services to meet changing clinical requirements, helping to improve

provision & plan service priorities.

2. Methodology

Users of CDDFT Pathology Services were encouraged to complete the online Pathology

User Survey. This was achieved via the Trust Bulletin which is issued from the

Communications team within the Trust and distributed via the GP intranet page and GP

practice managers to ensure all the primary care staff are aware of the survey.

3. Responses

Overview of respondents to evaluate Microbiology current service and assist with further

development and improvement in Quality, the Microbiology annual survey was sent out to

Acute Trust and GP users.

55 responses were received to the User Survey compared to 28 responses last year this is a

grest increase in user feedback. The survey was sent out 3rd July 201 and due to close 3rd

August 2018 but due to poor response the survey was extended for an additional month

closing end August 2018.

Would you describe yourself as Response Count

Response Percentage

Acute Trust Doctor 1 1.82

Acute Trust Nursing Team 5 9.09

Acute Trust Healthcare Assistant 1 1.82

Primary Care Doctor 18 32.73

Primary Care Nursing Team 13 23.64

Practice Manager 7 12.73

Primary Care Healthcare Assistant 8 14.55

Other- Phlebotomist, Receptionists 2 3.64




4. Survey Results

The responses for this survey have been changed to focus the feedback we receive: good –

no improvement necessary or improvement required. This way there is no ambiguity in the

responses.

The number of comments received from the users is increased from previous surveys, which

is positive that the users are suggesting improvements and also providing praise to the staff

within Microbiology at CDDFT.




Question 2

There were 8 comments with further information provided:

Comment Action/ Response

No particular opinion on the handbook. The mechanism for getting advice seems anachronistic; could we have email of messaging service? Would probably suit consultants and primary care.

Can’t email a response as yet, this has been previously discussed. Due to medical indemnity and clinical governance, no system currently exists that would be safe for patients.

what handbook? Sounds like a good thing. Where is it?

The pathology handbook can be located on the trust internet page, we are aware this is a new concept and we shall be making an effort to inform the users of the handbook, via newsletter and communications team on a regular basis.

As a PM I have not had any need to look at the handbook

No response required.

Not had any complaints sometimes have to try a few times before get to correct person and sometimes switchboard not sure who is on call.

Switchboards are issued with the on-call rota for the Biomedical Scientist technician and Consultant staff on-call in advance. Any changes are telephoned through to both switchboards.

Easy to access and handbook useful however if a query I have felt there are some staff willing to help more than others

Issue discussed at MQAG and daily huddles. All staff are encouraged to answer queries from service users or to find the correct person to answer the query if required.




not all tests are on the pathology handbook

we review the handbook on an annual basis, further information with regards missing or required information should be passed to the Pathology Quality Manager so these can be considered please contact [email protected]

staff are always very helpful when contacted and if cannot help do offer an alternative.

Thank you for the good feedback this shall be disseminated to staff

Lesley Richards in particular is very helpful regarding ICE forms (lots of extended access GP’s needing processing) thank you


The feedback from the previous survey was similar and so it is disappointing that we are still

receiving comments from users having difficulty with the handbook. It is good to see that

some users have expressed positive experiences when contacting the clinical teams.

Question 3

There were 10 comments received:


can be difficult especially if working from home (consultant that is not GP

See below response

mailto:[email protected]




can be tricky to get through See below response

unable to comment as most of the time it needs a clinician to speak to a consultant

See below response

Difficulty when needing microbiology consultant advice after 17.00 (bearing in mind that GP normal clinics until 18.00 and extended hours after this), especially 17.00-17.30 when consultants are travelling home. Lab will not bend from normal procedures regarding extended sensitivities or sensitivities needed for CSU even if the consultant is not available. No appreciation that GP’s have clinics/ patients waiting and finishing times too.

Issues have been and are continually reviewed at Speciality Group Meetings. In December 2018, the telephone policy was changed so that MLA staff (in Microbiology) could give out urine (MSU) sensitivity results for those antibiotics that were not supressed on the system. Further changes since have included these rules to be extended to CSU samples. Continual review shows that other changes are required and these are currently being discussed with a view to implement in the near future. There are plans to release all antibiotic sensitivity profiles for urine samples with appropriate comments about Antimicrobial Stewardship. Further discussions in line with the changing NICE guidance and links with EUCAST guidance/data may result in future changes as required.




Question 4

Users were also goven the option to leave further feedback:

Seems to be a big delay in reporting problem samples. E.g. sample taken 6 days to get to reported as unlabelled, surly this would have been noticed on booking in the sample and then repeat could have been organised on the same day?

Protocol is to report unlabelled samples at registration. Some tests are batch analysed, possibly accounting for a delay. Turnaround times for reports depend on sample type. Any issues which affect the service or patient should be reported through Safeguard incident reporting so that managers can investigate and respond. More information about specific incidences is required for investigation, please email Quality Lead for Microbiology [email protected] with further details if follow up required.

Interpretive comments could be more expansive

More information about specific incidences is required for investigation, please email Quality Lead for Microbiology [email protected] with further details if follow up required.

Sometimes no sensitivities given, results can often be sent more than once.

There are plans to release all antibiotic sensitivity profiles for urine samples with appropriate comments about Antimicrobial Stewardship. Further discussions in line with the changing NICE guidance and links with EUCAST guidance/data may result in future changes as required.

I can’t understand why the list of antibiotics tested for sensitivity in UTIs seems to vary, and sometimes doesn’t include commonly

There are plans to release all antibiotic sensitivity profiles for urine samples with appropriate comments about Antimicrobial






used ones. (also on ICE requests you are probably the last to still spell cefalexin as cephalexin!

Stewardship. Further discussions in line with the changing NICE guidance and links with EUCAST guidance/data may result in future changes as required.

Sure if still the case but sputum reports used to mention sensitivity to ocytetracycline and recommend this when doxycycline is the drug of choice

Continual discussions in line with the changing NICE guidance and links with EUCAST guidance/data may result in future changes as required.

The trust needs to consider the implementing of electronic ordering of blood tests. There are a number of occasions in paediatrics when samples are inadequate, as the staffs forget how many containers are needed or which the correct container I understand this may be part of the EPR in future, but that will be another few years, could their be an interim solution?

information regarding tests for the departments can be found in the pathology handbook, this information is reviewed regularly to update the user of sample requirements, if you feel there is missing information or a test has been missed or would like to recommend a particular information set be available please contact the Pathology Quality Manager [email protected]

Some msu mcs take a long time to come back

Any issues which affect the service or patient should be reported through Safeguard incident reporting so that managers can investigate and respond. More information about specific incidences is required for investigation, please email Quality Lead for Microbiology [email protected] with further details if follow up required.

Question 5

Are there any areas of the test repertoire of the Microbiology service you would like to

see change?

There were 23 responses to this question with the majority of responses stating No or good

additional comments included:


If waiting for MRSA screening results, it would be a good idea to let us know the swabs have been received by path lab

Unfortunately due to the nature of the current laboratory information IT system set up, this is not possible. This issue will be raised with IT and our providers.






Suggested treatment if GP feels clinical scenario warrants treatment rather than having to ring for this information


Problems only seem to be when requesting further supplies of forms and paper etc.

Any issues which affect the service or patient should be

reported through Safeguard incident reporting so that managers

can investigate and respond.


Improve turnaround times

Turnaround times are a monthly KPI that is reported and investigated by the departments to ensure any breaches are identified and the reason. This data collected for Turnaround times is reviewed monthly at speciality groups and by the senior management team. Any issues with ICM should also be logged, the laboratory always inform patient flow and bronze command of analyser downtime that impacts on the laboratory ability to delivery urgent turnaround times. Any concerns over turnaround times should be reported through safeguard. or contact the Cellular Science service manager [email protected]







Question 6


Drivers not always helpful.

The pathology department does not control the GP courier service this is handles through the CDDFT transport team. All enquires and complaints should be directed to the facilities manager [email protected]

More pods per ward.

The pneumatic air delivery system does not come under the directorate of pathology, any departments wishing to replace PODs or invest in further POD's should arrange so through own budget.

If telephoning an result requiring urgent action please make this clear to the receptionist - most staff know that a telephoned result needs urgent action but it doesn't happen that often and new staff may be unaware.

We are currently reviewing the telephone policy and shall put a statement in this document to indicate that this should be highlighted when phoning a result.

As previous - no problem with content of transport or drivers who are always flexible and accommodating - we just need x2 collections. We are unable to take samples in the afternoon due to this.


Our collection time is 3.30 which means we are unable to take samples after this time which is inconvenient for our patients. Also it is difficult to know who to speak to if we need to change a collection due to PLT.


2.16

4.91

3.06

3.87 4.13

3.3

Cost of Tests Turnaroundtimes

Transport ofsamples

Communicationwith laboratories

Results delivery(electronic

record)

AnalyticalProcesses

Which aspects of the service are important onsiderations when using our service?







all pretty good Thanks you for the positive feedback, we will ensure this is passed to the relevant staff.

Some transport drivers not helpful and manner not very nice.


Question 7

Users were given the option to leave a comment to further add to this question:

Comment Response

Thanks You do a very good job in supporting us generally


I am in a unique position (IV and OPAT team) and have been very well supported by the Microbiology team


Be honest when there are problems with the test sample. We get numerous reports of bottles incorrectly filled or forms not completed or test gone missing when the nurse has specifically ensured that everything was done correctly due to previous problems. Too many samples returned when the date on the ICE form hasn’t been changed yet everything else is ok. Surely there has got to be a better way around this as it is very distressing for the patient?

Any issues which affect the service or patient should be reported through Safeguard incident reporting so that managers can investigate and respond. More information about specific incidences is required for investigation, please email Quality Lead for Microbiology [email protected] with further details if follow up required.






The service is very good and we don’t have any complaints- many thanks to the team


Not all test are on the handbook We review the handbook on an annual basis, further information with regards missing or required information should be passed to the Pathology Quality Manager so these can be considered please contact [email protected]

Always helpful if I have a query Thank you for the good feedback this shall be disseminated to staff

Microbiology team are helpful Thank you for the good feedback this shall be disseminated to staff

Other feedback given

Specific Positive comments –

Microbiology team are helpful

Always helpful if I have a query

The service is very good and we don’t have any complaints- many thanks to the team

Thanks You do a very good job in supporting us generally

I am in a unique position (IV and OPAT team) and have been very well supported by the

Microbiology team

all pretty good

Lesley Richards in particular is very helpful regarding ICE forms (lots of extended

access GP’s needing processing) thank you

Staff are always very helpful when contacted and if cannot help do offer an

alternative.

Conclusions

The feedback from the 2018 survey is overall positive though there is work to be undertaken to

ensure the handbook is updated and that we can make this more user friendly and that we increase

our visibility to the users.

In 2017 the laboratory hosted numerous laboratory tours and the Clinical Scientists visited some

GP’s surgeries to start Educational Seminars. More of these are planned for 2018 and feedback will

be recorded as requested by ISO.

All action points will be added as non-conformities on Q-Pulse and the owners will be required to

feedback the outcome of discussions regarding the points raised.

We are more than happy for users to contact us at any time to discuss any issues they may have with

the service. Contact details are within the Pathology Handbook or contact us via the CDDFT

switchboard.




Action points

Action point Action Named Person Responsible

Target Date

Handbook:

Regular review

Make users aware

Handbook pages are uploaded to Qpulse for annual review. Trust communications notification of the handbook to be sent out at regular intervals to remind users of the handbook access. Hand book access / link in the pathology newsletter as a standing item.

Rebecca Sedman to load review document to Handbook Rebecca Sedman to send out communications notice Rebecca Sedman to complete quarterly newsletter including this information

All Staff to be as helpful as possible in response to queries from service users.

To discuss in MQAG meetings and daily huddles so that all staff are aware that if they can’t answer a query alone, they must find someone to help. NC1017

Laura Wilson MQAG 7.11.18 Huddle 23.11.18

Speciality group discussions around consultant communication and some reporting queries.

To take to next speciality group for further discussion and consensus between consultant team. NC1018

Laura Wilson to pass to Sharon Campbell. Sharon to take and discuss at Speciality Group.

Dec/Jan speciality groups.

Respond to further queries if required.

To investigate specific incidences if/when further information provided by service users.

Laura Wilson As information is gathered.

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