Publish date: 2 September 2021
As you’ll be aware, the situation with availability of blood tubes is rapidly evolving and there is potential for this situation to become even more constrained over the coming weeks. However, We hope colleagues appreciate we have been working at speed on this complex issue to find the best possible solution for all involved.
NHS England issued an explicit instruction on 26 August to cease all routine blood tests, including those who may have booked in for tests, unless the test is clinically urgent. The latest version of the letter is available on the NHS England Website.
In response to this instruction, Mersey Care cancelled all blood tests from 1 September and up to 17 September 2021. For those patients that have been identified as urgent, they will be contacted and their test will be rebooked.
All patients have been informed and advised that their test will be reviewed by their GP to determine if they are urgent and need to be rescheduled or remain routine and will be placed on hold until the situation improves.
We have been working closely with all the respective CCGs (Liverpool, South Sefton, Southport and Formby and Knowsley) to ensure GP practices were made aware of the action taken and the process for re-booking urgent blood tests in line with NHSE/I guidance.
The Trust has therefore started the process of cancelling all patient appointments booked into Community Phlebotomy Clinics between now and 17 September. This will be reviewed on a daily basis and a decision will be made nearer the time as to whether the above date needs to be extended.
We will be advising all patients with routine and pre-booked domiciliary appointments to refer back to their GP or referring clinician for review.
Until further notice, all urgent Mersey Care initiated blood tests should be requested based on the clinical judgement of a qualified registered practitioner. For any clinical staff on wards and in inpatient areas, requests should be discussed between the MDT and/or involve approval by a doctor.
In order to meet the national requirements, all divisions are in the process of putting the necessary systems in place to ensure we can achieve the best solution for patients and wider stakeholders.
In light of the above, please do not over order or stockpile bottles. And where possible, use grey topped bottles for HbA1C tests.
If you require any further information, please refer your relevant divisional contact:
Mid Mersey – louise
Local – Noirin
Secure and SLD – Dale
Community – Anne
Southport and Formby – Wendy
Reducing blood tube usage and prioritising urgent tests
You will already be aware of the supply disruption to the Becton Dickenson blood specimen collection.
The supply position remains constrained and is forecasted to become even more so over the coming weeks.
The tubes impacted by this shortage are:
1. 5mls Yellow top – SST 2 – clotted sample (e.g. U&E, LFTs etc)
2. Purple top – EDTA (e.g. FBC, HbA1c)
The rationed use of blood collection bottles is required with responsibility upon clinicians to use their discretion on blood requests guided by the following principles:
Primary Care and community care trusts
All primary care and community testing has been halted until 17 September 2021, except for clinically urgent testing.
Examples of clinically urgent testing include:
• Bloods that are required to facilitate a two week wait referral
• Bloods that are extremely overdue and/or essential for safe prescribing of medication or monitoring of condition
• Bloods that if taken could avoid a hospital admission or prevent an onward referral
• Those with suspected sepsis or conditions with a risk of death or disability
Colleagues working within community settings may request clinically urgent bloods via telephone contact with the SPC as usual, or by email.
Acute and mental health trusts are required to reduce the use of the 2x blood collection bottles by 25%
Guidance is similar in principle to that outlined above:
• Bloods required for the safe prescribing of medication / monitoring of a condition should continue as normal
• Routine well-being / baseline screens are to be deferred until which time supply is replenished later in the year
• Where possible encourage add-on testing to avoid over-use of tubes
• Where possible utilise point of care testing haemoglobin devices
The list above is clearly not prescriptive, but clinicians are asked to consider whether bloods are clinically urgent in line with these principles.
Liverpool Clinical Laboratories have issued detailed additional guidance which is appended below for reference:
· STOP reprinting requests forms in their entirety when a patient only needs one test repeating
· STOP taking spare samples; in general only one serum gel tube is required for the majority of biochemistry requests. Use ICE for guidance on number of tubes required
· STOP routine testing at this time, only tests required for current patient management should be requested at this time
· STOP testing medically fit patients on the wards who are awaiting discharge, unless they become unwell.
· ADD ON requests are encouraged where appropriate rather than taking an additional sample.
· Group and Save - avoid routine group and screen testing unless patient likely to require transfusion, in line with Choosing Wisely guidance.
· On admission (acute trusts) please avoid repeating bloods if results of same day bloods are already available e.g. Primary Care leading to admission.
· Avoid daily coagulation screen following admission unless going for a procedure, pre-operative, rarer clinical indications like DIC or on anticoagulation (warfarin) and require monitoring.
· Please look at previous results before repeating bloods. Please try to avoid repeat requests when patients are moved between wards and services unless clinically indicated.
· Duplicate requests - please take note of duplicate alerts and do not proceed with the request unless clinically indicated.
· CRP and ESR should not be ordered simultaneously; CRP should be used as first line test and not repeated within 24 hours.
· LFTs should not be repeated within 72 hours unless acute poisoning, acute injury, TPN or ITU.
· U and E in stable inpatients not on IV fluids with sodium in the ref range do not require repeating within the average length of stay of 4 days.
· Bone Profile does not require repeating within 48 hours unless acute hypo/hypercalcaemia, TPN or ITU.
· Lipids should not be repeated within 3 months unless in patients on TPN or who have triglyceride induced pancreatitis.
· Any training that involves the use of additional tubes should be delayed.