Microbiology

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Before you phone you should always check:

  1. With a senior - what is the question you want answered?
  2. TRAK - review previous discussion with microbiology or infection advice given.
  3. Review the available microbiology results - does the result help you choose an appropriate antibiotic?
  4. Pages within the Antimicrobial App related to your clinical question.
  5. With the ward pharmacist, they may be able to help if the question relates to antibiotic dosing.

If the patient is critically unwell and the Antimicrobial App tells you to phone or does not give sufficient advice follow the advice on phoning microbiology.

Antimicrobial advice

If the sections of the Antimicrobial App. or the microbiology report don't help then, in hours, or if urgent/an emergency, phone for advice.

You do not need to phone about alert/restricted/reserve antibiotics if the antibiotic is recommended in an approved guideline for the indication for which you are using it.

If you think you need to use a reserve antibiotic (see the NHS Lothian Antimicrobial Management Team intranet page for definitions and a list) and it is not recommended as part of a guideline then discuss with microbiology within 24 hours of starting the antibiotic.

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.

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.

Contact numbers

In hours: Mon-Fri 10:00-17:00 Sat-Sun 10:00-16:00

Ext: 63373 (if phoning externally 0131 536 3373)

Out of hours

For urgent calls contact RIE switchboard and ask to speak to the duty microbiologist