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Aotea News - February 2015

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Editorial

Welcome to the first edition of Aotea News for 2015.
Happy new year, we hope you have had a good break over Christmas and enjoyed the summer weather. Articles in this newsletter:
  • Notification of Aotea Pathology’s withdrawal from the current DHB integrated laboratory RFP process
  • FOB testing clarification
  • Mislabelled/unlabelled cervical smears & herpes swabs
We hope you find this newsletter timely and relevant, as always your feedback is welcome.
Dr Karen Wood, CEO

Laboratory Contract Update

The Boards of Capital and Coast DHB, Hutt Valley DHB and Wairarapa DHB (the 3 DHBs) have been conducting a request for proposal (RFP) process for an integrated regional hospital and community laboratory service, commencing 1 November 2015.
                                   
Last week Aotea Pathology withdrew its tender from this RFP process. Our decision to withdraw was not taken lightly. We believe that the current process would result in an outcome that was clinically unsound and financially unsustainable, and with all risk being transferred to the provider.
 
Aotea Pathology is committed to providing high quality community laboratory services until its contract expires on 31 October 2015.

The full press release can be found at this link:
Withdrawal of Aotea Pathology RFP Bid - Abano Healthcare Group

Changes to handling of mislabelled/unlabelled specimens cervical smears and herpes swabs

Cervical smears and Herpes dry swabs have been treated as “precious specimens” with regard to Aotea‘s policy of handling mislabelled or unlabelled specimens.  However in line with how these samples are dealt with by other New Zealand laboratories and following several deleterious outcomes that have resulted from processing mislabelled/unlabelled smears at other laboratories, we will be initiating a change in our own procedures.  From 1st March we will be handling mislabelled / unlabelled cervical smears and herpes swabs as per other incorrectly labelled specimens.  This will mean that should the labelling errors reach a significant threshold of concern the specimen will be declined for testing and not processed, with a repeat sample requested.   Lower level mislabelling errors will usually not result in specimens being declined for testing, and for some other errors the cytology staff will endeavour to work with referrers to ensure that the specimen can be safely processed. However for major labelling errors there remains a significant risk of reporting errors for patients if such specimens are processed and these will now be rejected de novo in the interests of ensuring quality reporting.

The laboratory accreditation (IANZ) specimen labelling requirements are:
  • the first name and last name, plus
  • NHI or date of birth
Label printers can help ensure you meet these labelling requirements. Links to suggested label printers can be found here

Faecal Occult Blood Testing

Since November 2014 faecal occult blood (FOB) test requests on samples submitted for the investigation of infectious diarrhoea or anaemia have been declined for testing. This protocol change was based on bpac guidelines. Last year we published an Aotea Clinical Update that explained this change in protocol.
Recently several GPs expressed concern that their requests for FOB testing have been declined, so we revisit the topic below.

The selection and application of the FOB test has drifted over time to situations for which it was never originally intended. Several national guidelines for the correct use of the FOB test are agreed on the following statements:
 
  • FOB is a screening test for large bowel cancer and there is evidence that it may cause harm if used for purposes other than cancer screening.
  • The screening immunochemical test is unable to detect upper GI bleeding and is only applicable for lower GI bleeding.
  • FOB is not indicated in the investigation of iron deficiency anaemia
http://www.bpac.org.nz/BPJ/2012/may/colorectal.aspx
http://www.bpac.org.nz/BT/2012/June/06_faecal_occult.aspx
http://www.bpac.org.nz/BT/2013/September/investigating-anaemia.aspx

We wish to remind you the FOB test is not recommended for the investigation of gastro-intestinal infection. 
Whilst it is important to discover the cause of anaemia the specificity of the FOB test does not allow this interpretation.  The results of the FOB in this situation are un-interpretable and neither rule in or out all of the likely diagnoses.

The sole use of the FOB test is as a screening test for large bowel cancers/polyps, ideally performed in asymptomatic individuals over the age of 50 years as in other countries. Therefore any requests for FOB testing outside of this use will be declined to ensure accurate use of this diagnostic test.

You can read more here and if you have further questions, please contact Dr Mark Jones, Clinical Microbiologist:

mjones@apath.co.nz
027 471 5565
 
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