Clinical Advice at BCPS Microbiology

Before seeking Microbiology advice, please ensure you have first checked the Microguide app and the intranet clinical guidelines library to see if an answer is available there. All referrals should be discussed with an ST3+ or consultant doctor in the first instance.

The Microbiology clinical team accepts referrals via email for non-urgent enquiries during working hours (Monday to Friday, 9am-5pm, excluding bank holidays). Emails received before 3.30pm will be replied to the same day. Emails after 3.30pm will be answered by noon the following day. Emails are welcome from all grades but should be discussed with an ST3 or higher doctor before being sent.

Please copy and paste the fully completed Microbiology Clinical Query Request Form (Word Document  into an email and send to swb-tr.SWBH-GM-micromedics@nhs.net. In the subject line please put the patient’s RXK number and surname.  Please cc: in the patient’s consultant and any other members of the team who may need to know the advice. GP’s can also use the email referral system in place for microbiology queries during the routine hours.

For urgent or emergency advice in or out of hours please contact the on-call Microbiologist via switch. If the call is not urgent you may be directed to the email referral system. For calls between midnight and 8am, referrals to the on-call Microbiologist must come from another consultant. If any time due to mobile connectivity issues or increased number of phone calls where the duty Microbiologist is not contactable, we encourage users to leave a voicemail with their contact details on the mobile device of the duty Microbiologist so that we can call back to discuss the query.

We are a team of two consultants providing a patient-facing clinical infection consult service. We are available Mon-Fri, 09:00-17:00 daily (excluding bank holidays) via bleep 2306. Please bleep us for urgent telephone advice, or to request a bedside consult. Please be patient whilst awaiting our reply to your bleep given, we are often on ward rounds or in MDTs.

The Trust’s antibiotic guidelines (MicroGuide) are available. They are comprehensive and should be consulted prior to contacting us, particularly for:

• Empiric antibiotic advice, including in the context of allergies.
• Renal dose adjustments.
• Dosing and monitoring of drugs such as gentamicin, teicoplanin and vancomycin.
• Allergy assessment.
• Requesting and sending urgent samples.
• When and how to take blood cultures.
• Specific organism advice, including malaria, Lyme disease, candidaemia and MRSA prescribing advice.

Outside of our working hours, then urgent and emergency advice is available 24/7 via a shared on-call rota with the Royal Wolverhampton NHS Trust. Contact WHTs switchboard to be transferred. Please be prepared for this call, noting we the on-call Consultant may not be familiar with the site or patient, do not have immediate IT access out of hours and hence will require a thorough history including relevant microbiology to provide informed clinical infection advice.

Between 22:00 to 08:00, only calls should be made via the Consultant (or registrar if they are the most senior immediately available clinician) or senior decision maker e.g. general manager on-call.

We are a small team of consultants and will always do our best to answer clinical advice requests, in a timely manner. However, due to the increasing demands on our time from clinical teams we are not always able to answer calls immediately.

The options are, to leave a voicemail message for calls put through to mobile devices, to leave a message on exts 2056 or 2697, if you have been put through the microbiology office landline and the duty microbiologist is occupied on the wards or if the call is less urgent to email the microbiology inbox on dgft.microbiologyinbox@nhs.net we aim to reply the same day (weekdays only) for enquiries made by 3 pm.

All messages left must include clear information about the identity of the caller and contact details including a telephone number to enable a response to be made. Callers should also ensure that they have basic information about the patient available at the time of the call. This would include:

• information about the patient’s identity and current location

• a brief clinical history including current observations and recent antimicrobial treatments
• relevant diagnostic information eg, imaging results
• a working or differential diagnosis
• information regarding any drug allergies INCLUDING the nature of any allergic reactions

Please be aware that there are very thorough antimicrobial prescribing guidelines available via the Trust’s intranet and also via the app Microguide for DGFT where many answers to simple questions can be resolved. For queries relating to drug interaction and renal dosing the most appropriate person to contact is often the Antimicrobial Pharmacist.

Key information links:

http://thehub/antibiotic-guidelines

Microbiology Office hours (9 am – 5 pm Monday to Friday)

• Non urgent enquiries can be made via the email referral system via dgft.microbiologyinbox@nhs.net. We aim to reply to emails on the same working day if received before 3pm.
• Microbiology Office where messages can be left, exts: 2056 and 2697.
• Urgent clinical calls will be taken at any time in the day. Please ensure the most senior available doctor makes an urgent call as it requires a senior decision maker to resolve an urgent or complex clinical issue. Please contact switchboard to be connected.
• Please do not call the consultant Microbiologist to ask for laboratory results.

Microbiology Out of Hours (weekends and 5 pm – 9 am)

• The Consultant Microbiologist on call is available via switchboard for urgent clinical calls.
• In the first instance, clinical questions should be escalated through the onsite clinical or nursing teams before contacting a Microbiology Consultant out of hours.
• Call only if urgent discussion is required, calls are accepted from Consultants and senior decision-makers only. Routine calls should be made within working hours 9 am to 5 pm.

Antimicrobial Pharmacists

Dr Syed Anas Gilani, Consultant Antimicrobial Pharmacist (syed.gilani3@nhs.net) bleep 8018/ext 4520.

Mr Muhammad Abdulla, Principal Pharmacist (Muhammad.abdulla@nhs.net) bleep 8009/ext 4520.

We are a small team of consultants and always do our best to answer your clinical advice requests in a timely manner. Due to increasing demands on our time we are not always able to answer calls immediately or from all callers. Please note we will only be able to give antibiotic prescribing over the phone to registered prescribers. Non-prescribers can access the clinical service via email referral with an appropriate supervising doctor copied in. In some scenarios, your enquiry may be better answered by the pharmacy or infection control teams. Below are some links to useful resources.

Trust adult antimicrobial guidelines which includes:

• Empirical treatment guidelines (including for penicillin allergy)
• IV to PO switch guidance
• Vancomycin, gentamicin and teicoplanin dosing guidance.
• Email referral template
• BNF
• MRSA decolonisation adult regimen (I need to source)
• MRSA decolonisation children and neonates regimens (I need to source)
• How to interpret ‘I’ results in a culture report

Microbiology Office hours (9am-5pm Monday to Friday)

• Non urgent enquiries can be made via the email referral system. The email proforma can be found here and once complete emailed to rwh-tr.microbiologyreferrals@nhs.net. We aim to reply to emails on the same working day if received before 3pm.
• Urgent clinical calls will be taken at any time in the day. Please ensure the most senior available doctor makes an urgent call as it requires a senior decision maker to resolve an urgent or complex clinical issue. The duty Microbiologist can be contacted on ext 88249.
• Please do not call the consultant Microbiologist to ask for laboratory results.

Microbiology Out of Hours (weekends and 5pm-9am)

• The Consultant Microbiologist on call is available via switchboard for urgent clinical calls. Walsall and Wolverhampton have a shared out of hours on call rota so you may speak to a consultant from either site.
• In the first instance, clinical questions should be escalated through the onsite clinical or nursing teams before contacting a Microbiology Consultant out of hours.
• Call only if urgent discussion is required, calls are accepted from Consultants, and senior decision-makers only. Routine calls should be made within working hours 9am to 5pm.

Required Information
We aim to give safe and effective clinical advice. In order to do this, we need accurate information from the caller. Please ensure you have the following information available before phoning or emailing a Consultant Microbiologist:

• The patient details including their current location.
• A brief clinical history including their current observations.
• Relevant diagnostic information e.g. imaging results.
• A working or differential diagnosis.
• Information regarding any drug allergies including the nature of any allergic reactions.
• Information on current and previous antibiotic therapy.