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Press release: Hospital trust media specialist wins south of England health award
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A member of staff at Southampton's university hospitals is set to receive a prestigious regional health award for his work in
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/AboutTheTrust/Newsandpublications/Latestnews/2018/October-2018/Press-release-Hospital-trust-media-specialist-wins-south-of-England-health-award.aspx
STH816 v1 Department of infection user handbook
Description
Microbiology and Specialist Virology Services User Handbook STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 1 of 48 Contents About our Services Core Service hours On-call/out of hours service Location of laboratory Key contacts Availability of clinical advice Completion of the request form Specimen collection Why has my specimen been rejected? High risk specimens and safety Transportation of samples Results reporting Telephoning of Urgent and significant results Quality assurance Patient confidentiality Complaints handling procedure A to Z of diagnostic tests and investigations STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 2 of 48 About our services The department of infection provides a full clinical service for the diagnosis of infection, which includes bacteriology, virology, serology, parasitology, mycology, molecular epidemiological studies to UHS, other NHS Trusts, general practitioners and local authorities. Specialist sections include: • Antimicrobial chemotherapy, carrying out antibiotic assays and sensitivity tests on clinical isolates • Mycology, providing diagnostic mycology, medical parasitology and fungal serology services • The molecular diagnostics unit provides rapid identification of bacterial and viral pathogens directly from various patient specimens, by detection of pathogen DNA or RNA. • Microbiological and epidemiological information, advice and support to consultants in communicable disease control and their colleagues in Public Health Medicine; local surveillance and special studies in infectious disease • Laboratory expertise for the control of infections including investigations in the community and during national outbreaks of infection. • The Southampton specialist virology centre (SSVC) offers specialist virology diagnostic molecular and serological testing for hospital and community patients Core Service Hours Monday to Sunday including bank holidays, 09:00 to 17.30 During normal laboratory hours please telephone urgent requests to the main enquiry number and the call will be directed to the appropriate member of staff in the laboratory to ensure priority processing. Either bring the specimen to the laboratory reception yourself or arrange urgent transport. Details of the out of hours service may be found below. Out of hours service • There is a small team of staff on site to process some clinically urgent samples • Urgent specimens can be processed if requested and agreed criteria satisfied, depending on availability of competent staff • These requests need to be phoned and discussed directly with the laboratory on a case-by-case basis STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 3 of 48 Location of laboratory STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 4 of 48 Key contacts: All Enquiries: 023 8120 6408 UHS clinical services lead for the department of infection / consultant medical microbiologist & infectious diseases / microbiology/ID training programme director for Wessex. Dr Julian Sutton Laboratory manager Rebecca Allen Laboratory lead for bacteriology / consultant medical microbiologist / Dr Kordo Saeed deputy infection control doctor Consultant medical microbiologist Dr Sarah Glover Consultant medical microbiologist Infection control doctor / Dr TatShing Yam Consultant medical infectious diseases microbiologist & Dr Andrew Rosser Consultant medical microbiologist Dr Nitin Mahobia Consultant medical infectious diseases microbiologist & Dr Tom Cusack Consultant medical microbiologist Associate Professor UoS & Dr Adam Dale Consultant medical infectious diseases microbiologist & Dr Nicholas Norton Laboratory lead for Virology/Consultant medical virologist Dr Emanuela Pelosi Consultant medical virologist Dr Eleri Wilson-Davies Consultant medical virologist Dr Adhyana Mahanama Availability of Clinical Advice Consultation about investigation and management of infection is welcomed. • For advice on diagnosis and the interpretation of microbiology results and antimicrobial use contact the main enquiry number STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 5 of 48 • A senior member of medical staff is always available • Outside normal hours of service medical staff may be contacted through the hospital switchboard Completion of the request form Microbiology and virology tests can only be carried out when the appropriate request forms are used. N.B. Additional tests in other disciplines, e.g. for histological testing, require that a separate sample and the appropriate form are sent for that purpose. A request form must accompany all specimens sent to the laboratory and should clearly state the following information: • NHS number • Patient name and full address • Date of birth • Sex • GP/Consultant code (preferred) or name • Surgery/Ward code (preferred) or name • Type of specimen • Date and time specimen taken • Tests required • All relevant clinical details including any antimicrobial treatment (recent, current and intended) and foreign travel. Also, indicate if patient is pregnant and if so provide EDD • Risk status of patient should be clearly stated • Date of onset and duration of illness, particularly for serology • Signature of requester • For antimicrobial assays: provide date of last dose of antimicrobial and time given and dose • For wound specimens: detail anatomical site from which "wound" specimens were taken • Supply useful epidemiological information e.g. with children and ? shigella sonnei: give the name of the school with adults and ? salmonella -give the place of work and occupation • ? Campylobacter, Giardia, Cryptosporidium: state if contact with livestock or external water sources e.g. recreational or work related Specimen collection The best results are obtained when an appropriate, correctly taken specimen, in the proper container, is delivered to the laboratory promptly and relevant clinical information is provided on the request form. Guidelines on specific samples may be found in A to Z of diagnostic tests and investigations (Appendix), but in general: • Do not send specimens in non-sterile containers • Containers should be leak proof and CE marked STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 6 of 48 • Specimens should be obtained before antimicrobial agents have been administered • An adequate quantity of material should be obtained for complete examination • Always send pus rather than a swab of the pus • The specimen taken should be representative of the disease process. For example, material swabbed from the opening of a sinus tract is more likely to yield commensal micro-organisms on the skin than would material obtained by curettage or biopsy of the base of the tract • Care must be taken to avoid contamination of the specimen by micro-organisms normally found on the skin and mucus membranes. Sterile equipment and aseptic technique must be used for collecting specimens, particularly for those from normally sterile sites • Material must be transported promptly to the laboratory. Fastidious organisms may not survive prolonged storage or may be overgrown by less fastidious organisms before culturing • Please contact the laboratory if there is any doubt about the best specimen to take or concerning the availability of a test • Occasionally further tests are required on samples that have already been received by the laboratory. The laboratory uses 'The Retention and Storage of Pathological Records and Specimens (5th Edition 2012)' for guidance on retaining samples for testing. However, depending on the nature of the sample and its viability after storage some clinically important samples are kept for longer e.g. CSF. Serum samples are stored for a period of two years since collection, thus allowing retrospective testing whenever it is clinically required. Tests - key responsibilities 1. Ensure the appropriate test has been requested for the suspected infection 2. Ensure the correct amount of the correct specimen in the correct container is sent for any given test (see A-Z of Tests) 3. Ensure the patient details on request form and specimen correspond 4. Ensure prompt transportation of specimen to laboratory 5. Ensure high risk specimens are appropriately marked and transported 6. Ensure that the laboratory is notified in advance about urgent specimens 7. Ensure the specimen request form contains all appropriate information, full clinical details and correct contact details 8. Ensure tests are not requested in duplicate 9. It is the responsibility of the requestor to check results in a timely fashion High risk specimens and safety a. Specimens are regarded as HIGH RISK if taken from patients known to be affected by a serious infectious disease such as tuberculosis or typhoid, or from those at risk of being infected by one of these agents. These specimens must be labelled as HIGH RISK on the container and the request form. b. The appropriate yellow sticker 'DANGER OF INFECTION' must be used. The specimen must be placed in a biohazard bag. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 7 of 48 c. Great care must be taken in obtaining specimens. Equipment such as needles and blades must be immediately disposed of safely in approved sharps boxes. d. Should a spillage occur of blood, fluids, tissues, or other specimens, this should be made safe and disposed of no matter what the risk status of the patient is. e. Specimens should be transported to the laboratory as rapidly as possible after collection to allow for the most accurate generation and interpretation of results f. Ensure appropriate action is taken for abnormal results and, if unsure, seek advice in interpretation of test results and treatment from senior biomedical scientists and medics. g. Turnaround times will vary depending on the test h. For best results, please ensure the correct type of specimen is sent in the correct container i. Please note that availability for some tests is restricted and requires prior discussion/ authorisation by a microbiologist/ virologist j. If unsure as to how to interpret a result, contact us. Please be ready with a full clinical history, up to date clinical data and recent antimicrobial treatment details before you call Why has my specimen been rejected? Specimens are only rejected for valid reasons: • Inadequately labelled/unlabelled specimen • Labelling error/discrepancy (for example, between specimen and request form) • Unsuitable specimen or unsuitable specimen container • Leaked specimen • Contaminated specimen • Lack of/no relevant clinical information on request form Transportation of samples • Specimens should be placed in the appropriate container which must be securely fastened. This must be placed in a clear plastic bag and sealed and transported to specimen reception in an approved secondary container together with absorbant material • Hand-written request forms should be placed in the side compartment with the card folded inwards to help preserve request confidentiality • Request forms must not be placed in the same compartment as the sample • All high-risk specimens should be placed in a biohazard bag • If a specimen is to be posted the packaging must comply with postal regulations https://www.hse.gov.uk/biosafety/blood-borne-viruses/transportation-ofinfectious-substances.htm • Specimens are transported to level D pathology reception before being distributed to the microbiology/virology laboratory STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 8 of 48 • Specimens may not be suitable for testing if they are so inadequately labelled that the patient's identification is in doubt, or if they have leaked, been contaminated or if no relevant clinical information is given with the request • Rapid inpatient e.g. respiratory samples for viral pathogens may need to be brought directly to the laboratory or sent to Pathology Specimen Reception using the POD system Results reporting • Validated results are reported electronically to results server at UHS. • Electronic reports are produced for GP sources every hour for delivery via EDI PMIP services. • Hard copy reports for valid locations are printed and dispatched every working day, including Saturdays. Apart from negative urines which can be reported after one working day, most bacteriology culture results are reported after 2-5 days, depending on the investigation. Serology/immunology, virology reporting depends on the frequency of testing and the urgency of the request. • In order to provide the most clinically beneficial, operationally efficient and costeffective service, the laboratory employs a number of multiplex assays and it is normal practice to use these even when not all tests within the multiplex panel are requested. It is our policy to report all results along with those requested to provide as much information as possible to aid diagnosis. Telephoning of Urgent and Significant results Results of urgent requests and results which may aid the immediate patient management will be telephoned. This includes all likely true positive blood cultures and CSFs. Certain results may be rapidly available, and to aid the management of certain infections will be telephoned when they become available. Examples are: • Gram stain on CSF, pus from abscesses or empyema • Ziehl-Neelsen or phenol-auramine stain for acid and alcohol-fast bacilli • Positive PCR results in lower respiratory tract samples for Pneumocystis jirovecii. • Positive HSV PCR results in blood and surface swabs of neonates • CSF: Positive PCR results from patients with encephalitis clinical suspicion of meningitis/encephalitis CSF/fluid/tissue/pus etc referred for bacterial culture • At the time of request, the requester will be informed that the result will be on the computer system as soon as possible after receipt. No results will be telephoned. The result will be entered onto the computer and the following laboratory comment will be added: 'Sample processed on-call. Please refer to empiric guidelines if treatment required. If unsure what action to take please consult a senior member of your clinical team in the first instance. A senior member of the clinical team should contact an infection/microbiology doctor via switchboard if they require further advice.' STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 9 of 48 • For advice on diagnosis and the interpretation of microbiology results, antimicrobial use, infection control including the use of containment facilities, contact the duty NHS medical microbiologist via the Southampton General Hospital switchboard Quality assurance Samples from National Quality Assurance schemes are analysed routinely within the department. The laboratory is assessed by UKAS to ISO15189:2022 accreditation number: 8403, Full scope of accredited activities can be viewed on the UKAS website https://www.ukas.com/find-an-organisation/ There is a quality management system in place and the department participates fully in this process. The microbiology laboratory is accredited for the training of biomedical scientists by the Institute of Biomedical Science (IBMS). Patient confidentiality All staff working for Pathology have a legal duty to keep information about patients and staff members confidential and to protect the privacy of individuals. All staff adhere to the Trust’s data protection and confidentiality policy and are mandatorily required to perform annual Information governance training. Complaints handling procedure University Hospital Southampton complaints team, comprised of a complaints manager and complaints coordinators, can be contacted via email at complaints@uhs.nhs.uk or via email at pals@uhs.nhs.uk. Contact telephone number is 02381206325 or write to Patient advice and liaison service (PALS), Mailpoint 81, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 10 of 48 A to Z of diagnostic tests and investigations (Appendix) Diagnostic tests and investigations • This is an alphabetical listing of all the diagnostic tests offered by the laboratory • This consists of tests performed onsite and tests that are referred to a reference laboratory • Reference tests stated turnaround times referred to are working days Test Adenovirus PCR (Qualitative assay) AFB (acid-fast bacilli) Amikacin assay Amoebic serology Ano-genital ulcer PCR Antenatal Screening:(Full screen consists of: Syphilis total antibodies, Hepatitis B surface antigen (HBsAg), HIV antigen/antibody) Specimen Container Respiratory secretions (NPA, Throat Swabs, BAL), Eye swabs, Blood(serum) Sterile Universal See under Mycobacteria See under Antibiotic Assays Blood (serum) Clotted blood (redtop) Swab Swab in VTM Blood (serum) Clotted blood (redtop) Required volume Minimum 200 µl 5-10 ml 5-10 ml Laboratory Turnaround time Additional information SGH 3 days Reference 28 days SGH 2 days SGH 8 days eQuest ordering: Select [Partial Antenatal screen] for patients declining HIV test Select [Minimal Antenatal] for patients declining HIV and HBsAg STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 11 of 48 Test Anthrax (serology/ isolation/ PCR) Antibiotic Assays Amikacin pre-dose (trough) & post-dose (1 hour after drug has been given) Teicoplanin pre dose. Post-dose and random levels are NOT routinely needed. Loading dose regimen essential and wait for one week before testing level. Antibiotic Assay (OTHER)not listed above Anti streptolysin O titre] Antral washings Ascaris microcsopy Specimen Container Required volume Laboratory Turnaround time Additional information Blood (serum) Clotted blood (redtop) 5-10 ml (blood) Reference 5 days Consult microbiology to arrange & discuss request • Please HANDWRITE on the request form, the exact time that blood is drawn. • Vancomycin, gentamicin and tobramycin levels are processed in biochemistry 24 hours-a-day. • Other antibiotic assays are NOT performed on-call [2000-0900 hours]. Blood (serum) Clotted blood (redtop) 5-10 ml Reference 5 days Conventional 2-3 times daily dosing: aim for a pre-dose of 2 weeks. Reference SGH Reference Reference SGH SGH 11 days Consult microbiology to arrange & discuss request 3 days for standard MC&S 14 days Please specify if TB, fungal, viral or other test required (eg PCP . 14 days 2 days for negative, 3 days for presumptive positive 2 days for negative 3 days for positive . Specimens are rejected if > 48 hrs as sub optimal for the isolation or organism STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 15 of 48 Test Cerebrospinal fluid (CSF) MC&S For cell count, Gram staining and culture send 2 - 3ml of CSF in each of 3 sterile universal containers CSF for virological investigations CSF for Mycobacteria/ Fungal investigation [CSF for MC&S] and specify additional tests in clinical details Chagas' disease Chickenpox Chlamydia trachomatis/ NAATS Specimen CSF CSF Container Require d volume Sterile Universal 30ml 2-3 ml Sterile Universal 30ml 2-3 ml Laboratory SGH SGH Turnaround time 2-4 hrs (Microscopy) 2-3 days (Culture) 2 days Additional information If meningitis/ encephalitis is suspected contact the laboratory and send the specimens immediately. Send separate specimens for glucose and protein analysis to the appropriate departments Provide a date of onset, symptoms and travel history. Routine PCR testing includes: HSV, VZV, Enterovirus, parechovirus, Neisseria meningitidis If additional tests are required, contact virology CSF Sterile Universal 30ml 2-3 ml SGH Up to 8 weeks Send a separate sample for mycobacteria/ fungi Send blood films for diagnosis of acute infection, otherwise see Trypanosomiasis serology See under Varicella Urine/genital/HVS/ pharyngeal/rectal/ eye swab Alinity m collection tube As specified in collectio n kit SGH 2 days Contact laboratory if information regarding Alinity m collection kits are required. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 16 of 48 Test Chlamydia serology Clonorchis serology Test Clostridium difficile PCR ribotyping Clostridium difficile toxin testing CMV serology (IgM, IgG, IgG avidity) CMV PCR (Quantitative assay) Coccidiodes serology Cold agglutinins (Mycoplasma) Corneal scrape Specimen Container Blood (serum) Clotted blood (redtop) See under Fasciola serology Specimen Container Faeces Required volume 5-10 ml Required volume 1-2 gm Laboratory Reference Laboratory Reference Turnaround time 5 days Turnaround time 14 days Faeces Universal 30 ml faecal pot With the spatula provided transfer a plum-sized portion of faeces or equivalent volume of fluid SGH 1 day Blood Clotted blood (redtop) 5-10 ml SGH 1 day Blood EDTA blood 1-5 ml (minimum 200µl/ assay) SGH 2 working days Blood (serum) Clotted blood (redtop) 5-10 ml Reference 5 days Test performed by Haematology- consult Haematology for advice. Corneal scrape SGH 3-5 days Additional information Additional information Initial screening performed by PCR. . Discuss interpretation of results with virologist. Discuss with microbiologist if suspected. Please state clearly if fungal/ mycobacterial or viral investigations required STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 17 of 48 Test Coxiella burnetii serology Coxsackie virus serology Cryptococcal antigen Cryptosporidium spp. (see Enteric Pathogens PCR) CVP tips Cystic sputum Cysticercosis Dengue serology Dermatophytes Specimen Container Blood (serum) Clotted blood (redtop) See under Enterovirus IgM Blood (serum) CSF Clotted blood (redtop) Required volume 5-10 ml 5-10 ml (blood) 1 ml minimum (CSF) 1-2 gm Faeces Universal 30 ml faecal pot With the spatula provided transfer a plum-sized portion of faeces or equivalent volume of fluid See under Vascular Access Devices See under Sputum (cystic) See under Taenia/ Tapeworms Refer to Arboviral serology See under Mycology Laboratory Reference SGH SGH Turnaround time 14 days 2 days 1 day Additional information Discuss with microbiologist if suspected. . . STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 18 of 48 Test Specimen Container Diphtheria isolation Swab Swab in Amies transport medium with charcoal Diphtheria antibody for determination of immune status. Blood (serum) Clotted blood (redtop) Ear swab Swab in Amies N/A transport medium with charcoal. Ebola virus See Viral Haemorrhagic Fever EBV PCR Blood EDTA blood (purple top) EBV serology VCA IgG, VCA IgM, EBNA IgG, EBV VCA IgG avidity Blood (serum) Clotted blood (red top tube) Echinococcal (Hydatid) microscopy Cyst fluid Sterile Universal Echinococcal (Hydatid) serology Blood (serum) Clotted blood (red top tube) Required volume N/A 5-10ml N/A 1-5 ml 5-10 ml N/A 5-10 ml Laboratory Turnaround time SGH 3 days Reference 15 days SGH 4 days SGH 2 working days SGH 1 day SGH Reference Reference 1 day 14 days 14 days Ehrlichia (Anaplasma) serology Endotracheal aspirate (ETA) Entamoeba histolytica Enterobius vermicularis Blood (serum) Clotted blood (red top tube) 5-10 ml Reference Respiratory secretions Sterile Universal N/A SGH See under Amoebic serology & Send Faecal parasitology/ OCP See under Threadworms 14 days 3 days Additional information Discuss with microbiologist if suspected. Please discuss with laboratory STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 19 of 48 Test Specimen Enterovirus/Parechovirus (Qualitative RT-PCR Faeces, CSF, EDTA blood or clotted blood Mouth, Eye, Skin Swabs in viral transport medium) Enterovirus IgM Escherichia coli (E.coli) O157 serology Blood (serum) Blood (serum) Container Sterile Universal, EDTA or clotted blood tubes or Swab in viral transport medium Clotted blood (red top tube) Clotted blood (red top tube) Required volume 1-2 gm faeces 1 ml CSF 1-5 ml 5-10 ml ESBL Screening Swab Swab in Amies transport medium Eye swab for MC&S Swab Eye swab for virological investigations (HSV, VZV and adenovirus PCR) Eye fluids (intraocular fluids - vitreous and aqueous) for retinitis & uveitis panel (HSV, VZV, CMV, Syphilis and Toxoplasma gondii) Swab Intraocular fluids in syringe Swab in Amies transport medium with N/A charcoal. Swab in Viral Transport N/A Medium Intraocular fluids At least in syringe 0.25 mL Laboratory Turnaround time SGH 2 days Reference Reference SGH 14 days 15 days 2 days for negative 3 days for presumptive positive SGH 4 days SGH 4 days SGH 2-3 days Additional information Minimum required volume for assay: 200µl (includes Coxsackie viruses) See also Faeces MC&S Send a separate chlamydia swab if this is suspected. Advised to inform virology if expedite turnaround time is needed clinically STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 20 of 48 Test Specimen Faecal parasitology/ ova, cysts and parasites (OCP) Faeces Faeces for Viral Pathogens (Adenovirus/ Rotavirus/ Norovirus/Sapovirus/ Astrovirus) Faeces Norovirus Vomit samples Container Universal 30 ml faecal pot Universal 30ml faecal pot Universal Required volume Laboratory 1-2 gm With the spatula provided transfer a plum-sized portion of faeces, or equivalent volume of fluid With the spatula provided transfer a plum-sized portion of faeces, or equivalent volume of fluid SGH SGH Turnaround time 7 days 1 day SGH 1 day Additional information 3 specimens taken within a 5 day period-please give clinical details. This is an unverified sample type, testing is available on request. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 21 of 48 Test Faeces for Enteric Pathogens PCR (includes Giardia & Cryptosporidium) Salmonella spp (inc typhoid, paratyphoid), Shigella sp p, E.coli 0157 PCR positives confirmed by culture. N.B.Yersinia spp, Vibrio s pp (inc Cholera) confirmed by culture only Faeces Swab for Rapid G I panel PCR Fasciola & other intestinal fluke serology (Clonorchis/ Paragonimus) Filarial serology Fish & Shellfish Poisoning Flavivirus serology & PCR Fransicella tularensis Specimen Faeces Swab Container Required volume Laboratory Universal 30ml faecal pot 1-2 gm With the spatula provided transfer a plum-sized portion of faeces, or equivalent volume of fluid SGH Caryblair media N/A SGH Blood (serum) Clotted blood (red top tube) 5-10 ml Reference Blood (serum) Clotted blood (red top tube) 5-10 ml Reference Please call to discuss. [Scombroid/ Ciguatera/ PSP/ NSP/ ASP/ DSP] See under Arboviral serology See under Tularaemia Turnaround time 2 days 4-6 hours 28 days 28 days Additional information Please do not request for patients who have been in hospital for over 3 days STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 22 of 48 Test Fluids, tissues, biopsies for microscopy and culture (includes aspirates, biopsies, tissue samples/ curettage, heart valves) General comment Genital herpes Genital swab for MC&S Genital swab for MC&S Gentamicin levels Giardia Gonococcal NAATS Specimen Fluid/ tissue Container Required volume Laboratory Turnaround time Additional information [If biopsy is small add 0.5ml of Ringers or sterile saline to prevent it from drying out. Ensure there is NO preservative or formalin] Sterile Universal Dependant on specimen type SGH 3 days For Equest serology tests when unable to find specific tests- enter request under clinical details See under Herpes Simplex Virus HVS, LVS, Vulval, Vaginal, Penile Swab in Amies medium with N/A charcoal SGH 3 days Urethral, Cervical, Endocervical Swab in Amies medium with charcoal See under Antibiotic Assays See under Faeces Enteric Pathogens PCR Urine/Genital swab Specific collection tube dependent upon sample type N/A As specified in collection kit SGH SGH 3 days 2 days Please specify if culture for fungi, mycobacteria or other fastidious organisms is required. Send ECS/URE for PID or STD Specimens are rejected if > 48 hrs as sub optimal for the isolation of organisms. Specimens are rejected if > 48 hrs as sub optimal for the isolation of organisms. Contact laboratory if information regarding specific collection kits is required. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 23 of 48 Test HACEK organism isolation Haemophilus aphrophilus/ paraphropilus; Actinobacillus actinomycetecomitans; Cardiobacterium hominis; Eikenella corrodens; Kingella kingae Haemophilus ducreyi Hantaviruses- serology and PCR H F with renal syndrome (Hantaan v, Puumala v) Hantavirus pulmonary syndrome(Sin Nombre v) Heart valves/ tissue for MC&S Helicobacter faecal antigen Helicobacter serology Specimen Blood cultures Genital swab Blood (serum) Container BD Bactec culture vials Required volume Laboratory Turnaround time Additional information 8-10 ml SGH Fastidious organisms require up to 14 days incubation Please specify HACEK organisms on request form. N/A Reference 12 days Discuss with Microbiologist Clotted blood (red top tube) 5-10 ml Reference 10 days Discuss with a virologist See under Fluids Faeces Universal 30ml faecal pot > 1 gram should be sent in standard sealed specimen containers. SGH 7 days Faecal antigen testing is now the recommended test for the diagnosis of Helicobacter infection. Patients MUST NOT have taken any antibiotics or proton pump inhibitors for a minimum of 2 weeks prior to specimen collection for testing. Samples should be sent within 3 days of collection STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 24 of 48 Test Specimen Hepatitis A serology Blood (serum) Acute Hepatitis serology (Hepatitis B surface antigen, Hepatitis C IgG, Hepatitis A IgM, Hepatitis E IgM & IgG, CMV IgM, EBV) Hepatitis (past history) serology ( Hepatitis B core antibody, Hepatitis A IgG, Hepatitis C IgG) ] Hepatitis B: send a request for HBsAg and HBV core antibodies. In case of positive results, additional investigations to assess HBV status will be added as reflex tests. Blood (serum) Blood (serum) Blood (serum) Container Clotted blood (red top tube) Required volume 5-10 ml Laboratory Turnaround time SGH 1 day Additional information This is for testing for immunity. Please state on form if you suspect acute infection. Clotted blood (red top tube) 5-10 ml SGH 2 days Clotted blood (red top tube) 5-10 ml SGH 2 days Clotted blood (red top tube) 5-10 ml SGH 2 days Send a surface antibody for post-immunisation check. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 25 of 48 Test Hepatitis B DNA/ viral load (Only for use on hepatitis B surface antigen positive patients) Hepatitis C serology Hepatitis C RNA/ viral load Specimen Blood (serum) Blood (serum) Blood (serum) Hepatitis C genotype Hepatitis D serology (IgM/ IgG) & PCR To be requested ONLY for patients who are HBsAg positive Hepatitis E serology (IgM/ IgG) Hepatitis E PCR Blood (serum) Blood (serum) Blood (serum) Container Clotted blood (red top tube) Clotted blood (red top tube) Clotted blood (red top tube) Clotted blood (red top tube) Clotted blood (red top tube) Clotted blood (red top tube) Required volume Laboratory Turnaround time Additional information 5-10 ml (min. vol 200 µl) SGH 7-10 days HBV VL monitoring is requested by Hepatology 5-10 ml 5-10 ml (min. vol 200 µl) 5-10 ml SGH 2 days SGH 7-10 days Reference 5 days 5-10 ml Reference 28 days 5-10 ml SGH SGH 2 days 5 days Requested restricted to patients who are HBsAg positive STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 26 of 48 Test Herpes simplex virus PCR (HSV1 & HSV2) PCR] see Ano-Genital screen Herpes Simplex virus (HSV 1/2) resistance testing Herpes simplex virus (HSV 1/2) serology Specimen CSF Swabs Swabs Blood (serum) HHV6 & HHV7 Serology Blood (serum) HHV6 & HHV7 PCR Blood and CSF HHV8 PCR Blood Histoplasma serology HIV1/2 antigen/ antibody HIV-1 or HIV-2 resistance testing Blood (serum) Blood (serum) Blood (plasma) Container Sterile universal Swab in Viral Transport Medium Swab in Viral Transport Medium Clotted blood (red top tube) Clotted blood (red top tube) EDTA (purple top) CSF in universal Required volume 1 ml CSF N/A 5-10 ml 5-10 ml 1-5 ml Laboratory Turnaround time SGH 2 days Reference 7 days SGH 2 days Reference 7 days Reference 7 days Additional information EDTA (purple top) Clotted blood (red top tube) Clotted blood (red top tube) EDTA 1-5 ml 5-10 ml 5-10 ml 10 ml Reference 7 days Reference SGH 10 days 2 days Reference 14 days Please specify if patient is positive for HIV-1 or HIV-2 STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 27 of 48 Test HIV-1 Viral load HIV-2 viral load Hookworms HTLV 1&2 serology Human Papillomavirus (HPV) testing Hydatid reference test Influenza A/B PCR Interferon assays for TB Intestinal flukes Intrauterine infection serological tests Itraconazole levels Specimen Container Required volume Laboratory Turnaround time Blood EDTA blood (purple top) 5-10 ml (min 1 ml) SGH 7-10 days blood EDTA blood (purple top) Send Faecal Parasitology/ OCP Blood (serum) Clotted blood (red top tube) Tissue Sterile Universal See under Echinococcal serology See under Respiratory virus PCR/ NPA See under Mycobacteria See under Fasciola See under TORCH screen (mother) 5-10 ml (min 1 ml) 5-10 ml N/A Reference SGH Reference See under Antibiotic Assays 2 weeks 2 days 4 days Additional information Please note that the viral load assay is time critical. Freshly drawn specimens (whole blood) may be held at 2-30°C for up to 6 hours prior to centrifugation in the laboratory. After this time there may be degradation of nucleic acid with a resultant reduction of the viral load value. PCR: Contact virology STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 28 of 48 Test IVF screen Includes: HIV Ab/Ag Hepatitis B surface Ag Hepatitis B Core antibody Hepatitis C IgG Syphilis total antibodies Japanese B encephalitis JC virus PCR Kala-azar Lassa fever virus Legionella serology Legionella antigen Specimen Container Blood (serum) Clotted Blood (red top tube) See under Arboviral serology CSF Sterile Universal See under Leishmania See under Viral Haemorrhagic Fever Blood (serum) Clotted Blood (red top tube) Urine Sterile Universal Required volume 5-10 ml 1 ml min 5-10 ml 20 ml Leishmania reference test (serology) Leprosy Leptospira PCR Blood (serum) Tissue biopsy CSF/ /Urine/Blood Clotted Blood (red top tube) 5-10 ml Consult a microbiologist Sterile Universal/ 8-10 ml Laboratory Turnaround time SGH 2 days Reference 7 days Reference SGH 14 days 2 days Reference 28 days Reference 7 days Additional information Pre-treatment IVF screen. (Rubella and chlamydia need to be requested separately if required.) Discuss with a virologist Needs prior discussion with microbiologist Please state travel history and date of exposure. Discuss cases with microbiology Discuss cases with microbiology STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 29 of 48 Test Specimen Leptospirosis reference test] (serology) Blood (serum) Lyme disease serology] (Borreliosis) (screening test) Blood (serum) Lyme Immunoblot Blood (serum)/CSF Container Clotted Blood (red top tube) Clotted Blood (red top tube) Clotted Blood (red top tube) or Sterile Universal (CSF) Required volume 5-10 ml 5-10 ml 5-10 ml 1-2 ml Laboratory Turnaround time Reference 10 days SGH 2 days Reference 10 days Additional information Take sample 5-7 days after onset of symptoms. Please state date of onset or exposure and travel/ risk factors. Please provide clear history including risk factors and date of symptom onset. Lyme (Borreliosis) PCR CSF Lymphadenopathy/ sore throat] serology screen Blood Lymphocytic choriomeningitis virus (LCMV) serology Lymphogranuloma venereum (LGV) serovars of Chlamydia trachomatis Blood (serum) Rectal swab Sterile Universal 1 ml Reference 14 days Clotted Blood (red top tube) 5-10 ml Clotted Blood (red top tube) 5-10 ml Swab in Alinity m transport N/A medium SGH 3-4 days Reference 14 days Reference 14 days Discuss with microbiology Consider , EBV, CMV IgM, Toxoplasma gondii, Syphilis and HIV serological investigations Discuss with a virologist Discuss with a virologist or Sexual Health STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 30 of 48 Test Malaria detection Malaria reference test Marburg virus Acute measles serology (IgM) Measles IgG Measles PCR Meliodosis investigations Meningococcal PCR Meningococcal PCR If meningitis/ meningococcal sepsis is suspected contact the laboratory and send the specimens immediately. Meningococcal serology Microscopy Microsporidia serology Specimen Container Required volume Laboratory Turnaround time Blood EDTA (purple top tube) 5-10ml SGHHaematology Not useful for diagnosis of acute infection. Discuss with microbiologist if requested. See under Haemorrhagic Fevers Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 7 days Blood (serum) Clotted Blood (red top tube) Discuss with a virologist Discuss with a microbiologist Blood EDTA (purple top tube) 5-10 ml 5-10 ml SGH SGH 2 days 2 days Additional information Test performed by haematology CSF Sterile Universal 2-3 ml SGH 2 days Send separate specimens for glucose and protein analysis to appropriate departments Blood (serum) Dependant on specimen type Blood (serum) Clotted Blood (red top tube) Dependant on specimen type Clotted Blood (red top tube) 5-10 ml Dependa nt on specimen type 5-10 mls Reference SGH Reference 28 days same day 28 days Discuss with a microbiologist Discuss with a microbiologist STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 31 of 48 Test Specimen Container Milk bank serology screen Blood (serum) Clotted Blood (red top tube) Mouth swab Swab in Amies transport medium with N/A charcoal. MRSA screen Swab Swab Acute mumps serology IgM Mumps IgM reference test For clinical cases of mumps Mumps IgG [Mumps immunity] Mumps PCR Blood (serum) Clotted Blood (red top tube) Blood (serum) Discuss with a Virologist Clotted Blood (red top tube) Required volume Laboratory 5-10 mls SGH N/A SGH N/A SGH Turnaround time 3-4 days Additional information Consists of: HIV-1/-2 Ab/ Ag HTLV 1+2 Ab Hep B surface Ag Hep C IgG Syphilis IgG 3 days 2 days (> 3 days if culture positive). Specimens are rejected if > 48 hrs as sub optimal for the isolation or organisms 5-10 ml Reference 7 days Please state date of onset and contact history. 5-10 ml SGH 2 days STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 32 of 48 Test Mycobacteria/ AFB (Tuberculosis & Atypical/ non- tuberculous): Microscopy (Ziehl-Nielsen/ auramine), Isolation Please state clearly on request form that Mycobacterial/ TB/ AFB investigation required. Specimen Sputum BAL/ gastric aspirates CSF/ fluids/ tissue Urine Bone marrow Container Sterile Universal (send 3 sputa for suspected pulmonary TB) Sterile Universal Sterile universal (send early morning urine on 3 consecutive days Inoculated to BD Bactec Myco/F Lytic Culture Vials Required volume Min req vol (fluids) = 3 ml N/A Mycobacterium tuberculosis immunoassays (QuantiFERON Blood QuantiFERON kit N/A Mycobacterium tuberculosis PCR (fasttrack)/ Rifampicin probes (MDR suspected) BAL/Sputum/Tissue Sterile Universal 3 ml minimum Laboratory SGH/ Reference SGH SGH Turnaround time Additional information 6 -8 weeks Samples are monitored continuously. Any flagging positive are communicated to clinicians as an urgent result. Mycobacterial investigations are not performed on-call (from 2000hrs to 0900hrs) 3-5 days Same day testing once approved by microbiologist Discuss with a microbiologist See also Quantiferon-TB Gold Guidelines Please note this is a time critical assay. Samples must be received in the laboratory within 16 hours of collection. Failure to adhere to this may compromise the validity of the result. Discuss with a microbiologist. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 33 of 48 Test Specimen Mycology micro and culture (Systemic mycoses) Tissue, fluids, systemic Mycology micro and culture] (Dermatophytes) Skin, nail & hair Mycoplasma genitalium PCR Request restricted for the following syndromes: . Women with query PID . Men with urethritis . Their sexual partners Skin, nail and hair High vaginal swabs for women Urine for men: min volume 3 ml Mycoplasma pneumoniae serology IgM and IgG Nasal swab Blood (serum) Swab in Amies transport medium with charcoal. Container Sterile Universal Required volume N/A Laboratory SGH Turnaround time Additional information Microscopy 23 days culture up to 6 weeks Please state clinical history and if not E-quest order state clearly on request form that fungal culture is required. Sterile Universal or Dermapaks N/A SGH Microscopy 23 days days culture 2 weeks Abbot Alinitym collection tube SGH 3 days Follow kit instructions to collect the correct volume of urine for men: if tubes are underfilled or overfilled will be rejected. Clotted Blood (red top tube) 5- 10ml SGH 3 days N/A N/A SGH 3 days STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 34 of 48 Test Specimen Needlestick donor serology Consists of Hep B surface Ag, Hep C IgG, HIV-1/-2 ag/antibody, serum store Blood (serum) Needlestick recipient serology Blood (serum) Neonatal Viral Sepsis Screen EDTA blood, CSF, Eye/Rectal/Throat Swab. New leukaemic serology screen Blood (serum) Container Required volume Laboratory Turnaround time Additional information Clotted Blood (red top tube) 5-10 ml SGH 2 days It is your responsibility to consent the patient. Clotted Blood (red top tube) 5-10 ml SGH Minimum volume for EDTA or CSF 500 ul SGH Clotted Blood (red top tube) 5-10 ml SGH 2 days 2 days 7 days Hepatitis Bs Ab, serum store Consists of: CMV IgG EBV HIV-1/-2 ag/ab Hep B surface Ag Hep C IgG Syphilis total antibodies Toxoplasma IgG, IgM Varicella IgG HTLV-1/-2 STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 35 of 48 Test Norovirus PCR Occupational Health Screen Ova cysts and parasites Specimen Container See Faeces for Viral Pathogens Blood (serum) Clotted Blood (red top tube) See under Faecal parasitology. Pacemaker tips/ leads & other cardiac prostheses Device Sterile Universal Parainfluenza virus Parvovirus serology IgM & IgG See under respiratory viruses/ NPA Blood (serum) Blood (serum)/ amniotic fluid Clotted Blood (red top tube) Required volume Laboratory Turnaround time Additional information 5-10 ml SGH 7-10 days N/A SGH 3 days Will NOT be processed routinely. Only where line sepsis is suspected. SGH 5-10 ml 2 days Please state date of onset and if patient is pregnant. Parvovirus B19 PCR Pernasal Swab Pertussis investigations Pinworms Plague Pneumococcal antigen Pneumococcus PCR Liver samples in cases of miscarriage or IUD Use specific pernasal swab, see under Bordetella pertussis See under Bordetella pertussis See under Threadworms See under Yersinia pestis. Contact a Microbiologist urgently. Reference Urine/ CSF Sterile Universal 10-20 ml SGH Discuss with a Microbiologist 7 days 1 day Discuss with Consultant Virologist Needs prior authorization by a microbiologist STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 36 of 48 Test Pneumocystis jiroveci (PCP) PCR Specimen Lower respiratory secretions (sputum/ BAL/ETS) Polio serology Polio PCR Polyomaviruses (BK/ JC virus) PCR Postnasal swab for MC&S Pus Blood (serum) Faeces/ CSF Urine (BK) CSF (JC) EDTA blood (BK) Swab in Amies transport medium with charcoal. See under Fluids Container Sterile Universal Clotted Blood (red top tube) Sterile Universal Sterile Universal EDTA (purple top tube) N/A Required volume 1 ml minimum Laboratory Turnaround time SGH 2 days Additional information 5-10 ml N/A Reference Reference Reference 14 days 14 days 7 days Discuss with a virologist Discuss with a virologist Discuss with a virologist N/A SGH 3 days STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 37 of 48 Test [Q fever reference test] Rabies investigations Rash (viral serology screen) Rash non-vesicular Parvovirus IgM, IgG Rubella IgM, IgG Specimen Container See under Coxiella burneti Discuss with a virologist Required volume Laboratory Turnaround time Additional information Blood (serum) for parvovirus and rubella virus Clotted Blood (red top tube) 5-10 ml SGH 2-3 days Please state type and distribution of rash- this dictates which tests are performed. Please state if patient is pregnant. Rash vesicular Varicella zoster PCR HSV PCR Enterovirus PCR Respiratory syncytial virus (RSV) IF/ PCR Respiratory virus PCR Influenza A&B/ Parainfluenza viruses/ RSV/SARS-CoV2, Adenovirus/Metapneumovirus/Rhinovirus and Enterovirus] Respiratory virus Rapid PCR Influenza A&B/RSV/SARS-CoV-2 Lesion swab Lesion swab in Viral Transport Media See under Respiratory viruses PCR/ NPA Respiratory secretions NPA, BAL, Sputum, Nose and throat swab in viral transport medium. Nose and throat swab in viral transport medium Sterile Universal Swab in viral transport medium 2 ml (min vol 200µl) SGH 1ml SGH 2-3 days 4 hours Testing is seasonal only, October-March STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 38 of 48 Test Respiratory virus Rapid PCR (Qiastat) Extended Panel Specimen Nose and throat swab in viral transport medium Container Swab in viral transport medium Required volume Laboratory Turnaround time Additional information 1 ml SGH 4-6 hours Rickettsial serology- Typhus or Spotted Fever Ross River virus serology Rotavirus Rubella serology (acute) Rubella serology (immunity) Salmonella serology Blood (serum) Clotted Blood (red top tube) 5-10 ml See under Arboviral serology See under Faeces Virology investigations Blood (serum) Clotted Blood (red top tube) 5-10 ml Blood (serum) Clotted Blood (red top tube) 5-10 ml Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 10 days Discuss with microbiology. Provide a full travel history. SGH 1-2 days SGH 1-2 days Reference 17 days Please state if patient is pregnant. Requires prior discussion with a microbiologist STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 39 of 48 Test Schistosomiasis microscopy Specimen Faeces Urine (3 consecutive terminal urine samples collected at midday) Container Sterile Universal Sterile Universal Required volume 1-2 gm With the spatula provided transfer a plum-sized portion of faeces Laboratory SGH Turnaround time 7 days Additional information 3 specimens on 3 consecutive days – give clinical details 10 ml Schistosomal serology Sellotape slide Seminal fluid for MC&S Shigella serology Shingles Sleeping sickness Sputum/ ETA/ BAL/ NBL Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 14 days Send at least 6 weeks postexposure. See under Threadworms Seminal fluid Sterile Universal N/A SGH 1-2 days Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 14 days Requires prior discussion with a microbiologist See under Varicella Send blood films for diagnosis of acute infection, otherwise see Trypanosomiasis serology Respiratory Sterile Universal 5-10 ml SGH 2-3 days Please refer to Mycobacteria for TB investigation. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 40 of 48 Test Sputum (Cystic) Cystic Sputum/cough swab) Staphylococcal serology Staphylococcal reference test Staphylococcal (MSSA/ MRSA) PCR Stem cell transplant screen Streptococcal serology (ASOT, Anti DNAse B) Strongyloides microscopy Specimen Respiratory Container Required volume Laboratory Turnaround time Additional information Sterile Universal 5-10 ml SGH 6-8 days Please refer to Mycobacteria for TB investigation. Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 15 days Tissue/ Pus/ Swabs/ Fluids Requires prior discussion with a microbiologist Blood (serum) Clotted Blood (red top tube) 5-10 ml SGH 7 days See under ASO titre/ Anti Streptolysin O and Anti DNAse B titre See Faecal Parasitology/ OCP (may need up to 6 samples as is insensitive) Requires prior discussion with a microbiologist Consists of: CMV IgG EBV (EBNA IgG) HIV Ab/Ag HTLV 1+2 Ab Hepatitis B Core Ab Hepatitis BsAg Hepatitis C IgG Syphilis IgG Toxoplasma IgM, IgG Varicella IgG STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 41 of 48 Test Strongyloides serology Supra-pubic aspiration (SPA) Swabs for MC&S (skin/ wound etc) Syphilis serology (blood) or Syphilis antibody (CSF) Tapeworms / Taenia spp Taenia (cysticercal) serology TB investigations Teicoplanin levels Tetanus toxin serology Tissue/ Biopsy for MC&S Thread worms Specimen Container Blood (serum) Clotted Blood (red top tube) See under Urine MC&S Swab in Amies transport medium with charcoal. Blood (serum) N/A Clotted Blood (red top tube) CSF (VDRL, TPHA) Sterile Universal See Faecal Parasitology/ OCP Blood (serum) Clotted Blood (red top tube) See under Mycobacteria See under Antibiotic Assays Blood (serum) Clotted Blood (red top tube) See under Fluids Place sellotape over perianal region Transfer to clean microscope slide Required volume Laboratory Turnaround time Additional information 5-10 ml Reference 14 days N/A 5-10 ml 1-2 ml SGH 4 days SGH Reference 1-3 days 6 days Do not request MRSA swabs unless screening. 5-10 ml 5-10 ml N/A Reference 14 days For diagnosis of cysticercosis. Reference 21 days Collect before antitoxin given. Discuss with microbiology if suspected. SGH 1-2 days Best taken early morning STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 42 of 48 Test Throat swabs for MC&S Tobramycin levels Congenital infection screen (infant)] For serological investigation of suspected congenital infection. Toxoplasma gondii, CMV, Rubella Syphilis, parvovirus Congenital infection screen (mother)] For serological investigation of suspected intrauterine infection. Toxoplasma gondii, CMV, Rubella Parvovirus Syphilis. Specimen Container Swab in Amies transport medium with N/A charcoal. See under Antibiotic Assays Blood (serum) Clotted Blood (red top tube) Blood (serum) Clotted Blood (red top tube) Required volume Laboratory Turnaround time Additional information N/A SGH 4 days 5-10 ml SGH 1-2 days 5-10 ml SGH 1-2 days If not requesting via e-QUEST please state "suspected intrauterine infection" and give clinical details
Url
/Media/UHS-website-2019/Docs/Services/Pathology/STH816-v1-Department-of-infection-user-handbook.pdf
PLANETS texture modified recipe book
Description
A texture modified recipe book for patients with cancer of the oesophagus or stomach A texture modified recipe book for patients with cancer of the oesophagus or stomach Contents Introduction 3 Patient stories 4 From the dietitian 8 From the Chef 9 Purée food 10 Purée breakfast recipes 12 Purée soups 16 Purée main meals 20 Purée side dishes 30 Purée desserts & snacks 34 Drinks & supplement recipes 38 Soft & bite sized diet 40 Soft & bite size breakfast recipes 42 Soft & bite size main meals 46 Soft & bite size side dishes 54 Soft & bite size desserts & snacks 56 Introduction This recipe book aims to provide you with a selection of easy to prepare, high calorie and protein recipes of a suitable purée or soft texture that may be helpful during chemo or radiotherapy or following surgery for oesophageal or stomach cancer. The recipes in this book will make larger portions than you may be able to manage, so you will be able to divide them into several smaller portions. Each recipe will indicate if it can be stored in the fridge or frozen. Ensure you defrost food thoroughly and cook through. What is texture modification? A texture modified diet will contain carefully selected foods of an appropriate consistency which can be more easily managed if you are struggling with swallowing or pain on eating, or healing following surgery. Food fortification In order to help minimise weight loss, especially when you may only be able to manage small portion sizes it can be helpful to ‘fortify’ your food to maximise its nutritional content. • Avoid foods labelled as ‘diet’ or ‘light’ and choose full fat dairy products. • Add extra butter, cream, evaporated or condensed milk to increase calories. • Add fortified milk to drinks and foods. (see recipe below) Fortified milk recipe • 1 pint (approximately 600ml) full cream milk • 4 heaped tablespoons (60g) skimmed milk powder 1. Add milk powder to a small amount of milk and mix to a paste. 2. Gradually add the remaining milk. 3. Store in the fridge and use instead of normal milk. 2 3 Patient stories The following are advice and tips are from patients with oesophageal or stomach cancer who have followed a purée and soft & bite sized diet... Gordon Oesophagectomy August 2018 Early in 2018 I was diagnosed with cancer of the oesophagus. I had three cycles of chemotherapy after which in August 2018 I underwent an oesophagectomy at Southampton General Hospital. Initial foods by mouth consisted of purée foods including scrambled egg and soups. I was initially also receiving the bulk of my nutrition through a Jejunostomy feeding tube, which was weaned down and stopped in February 2019. I was provided both in hospital and at home with high calorie/protein supplements in the form of Fortisip. We (my carer was an active participant in finding an acceptable diet, a situation I would consider as being almost essential) then tried various commercial varieties such as ‘Complan’. For the first few weeks after leaving hospital I didn’t feel thirsty at all and again my carer became concerned that I would become dehydrated. Given the restricted room available for food intake in my re-arranged insides there was always a tussle for space between solids and liquids and we could not settle on a highly nutritious solution to meet both requirements. As soon as I was able to eat almost anything – I still have difficulty digesting pastry ten months after the op – I started to eat quantities of cheese, puddings and cream. We have now resorted to supermarket sourced ‘protein bars’ such as ‘Nature Valley’ and ‘Graze’ that I munch between the three traditional meals. I also ‘graze’ on nuts, biscuits and fruit. To start with I lost weight, going from 68.5kg down to 63.3kg at the end of April. Since then it has stabilised and we hope to perhaps gain another kilo or two. Not too much because, according to the NHS chart, for someone of my height it is an ‘ideal weight’. I think now, ten months down the track, we are getting things right. A typical daily intake for me is as follows: Breakfast: Coffee, cereal (not too much sugar), toast with a spread of some sort, fruit juice. Lunch: Possibly left-overs from last evening’s meal, eggs in a variety of ways, cheese on toast, soup, a sandwich followed by a piece of fruit. (continued over) 4 Evening meal: A whole variety of dishes; roasts, casseroles, stir fry, salads, curries usually followed after an hour or so by a dessert. All those meals are of very small portions – though getting bigger all the time, some days better than others – so in between meals I have snacks comprising a range of protein bars, biscuits, fruit and cashew nuts by the handful. It seems to be working.I’m feeling stronger all “ ” the time, exercising and enjoying life! Janice Oesophagectomy May 2019 I had an oesophagectomy in May 2019 so I am currently almost 5 months post-op. I won’t lie, up to a month ago I found the whole eating and dietary issues frustrating. A lot of that was down to my impatience in accepting that recovery was going to take a good year or more. However, in the last few weeks, I feel I’ve finally ‘cracked it’ and found a regime that works for me. The day before being discharged from hospital my daughter visited and, between us, we ‘brainstormed’ a list of foods that could be, or were already, puréed. Armed with an extensive list, my daughter shopped for all the items including some baby food containers. She filled the containers with some prepared meals and left them stacked in my fridge and freezer ready for my return. I can’t tell you just how much that helped in the early days at home. Not having to worry about what to prepare and eat to start with was a blessing. Luckily, my husband was happy to see to himself so I could concentrate on my own needs. Some of the foods I stocked up with were: • Tinned custard, semolina and variety of soups. • Potatoes, butternut squash, and carrots. • Whole milk, cream, strong cheese, eggs, creamy yoghurts, butter and ice cream. • Salmon, white fish, skinless sausages. • Jelly cubes (for milk jellies). • Cheese sauce granules, gravy granules and dried milk (for making the fortified milk). • Weetabix and instant porridge. (continued overleaf) 5 5 • Some baby foods that I used as a base e.g macaroni cheese that I just added more grated cheese to. • Smoothies I thought the easiest food to eat would be mashed potato enriched with an egg, milk, butter and cheese but I actually found it quite difficult to swallow so stuck to the butternut squash instead (still with everything added). Keeping hydrated was difficult as I’m not a great drinker anyway. You definitely need to drink a good 30 mins before or after food and not at the same time. I kept a jug of fortified milk on the go and used it for cereal, jelly and frozen milk lollies (using Nesquick). I did find that my taste buds changed and I struggled with dairy products in particular. Moving on to soft foods after 4 weeks was bliss. I was so bored with puréed food by that point. I was losing weight but was expecting that and hoped that the loss would slow down with a more varied diet. I still wasn’t keen on the sweet dairy products although I kept trying various yoghurts and desserts. I must say I did spend a lot of money on food but also wasted a large amount of food as well! I eat anything that could be mashed with a fork and found stronger flavours worked for me. • Cottage pie • Spaghetti Bolognese • Tagliatelle • Vegetable curry • Skinless sausage casserole • Cheese omelette with thin cut ham added My ‘go-to’ snacks included: cheese and crackers, buttery cheese straws, mini Babybels, tiramisu, spicy crisp puffs e.g Cheetos. Trying to keep a small portion of food warm enough for the 30 mins needed to eat it was a problem. I overcame it by buying a child’s wide-necked food thermos flask. It certainly kept the food at a reasonable temperature. After a couple of months, I was able to move on to a normal, varied diet. I now eat whatever I fancy and it’s just been trial and error finding the foods that work for me. My portions have increased considerably and I enjoy stir-fries, curries, roast dinners, fry-ups – you name it and I’ll try it. The only thing that I don’t cope with very well is red meat but everything else is fine. I make sure I chew everything thoroughly but it did take some time to realise when I’d eaten enough. Sometimes, that last spoonful was one too many and it would stick in my throat. It would go down eventually but it’s uncomfortable at the time. 6 My taste buds are getting back to normal and I now enjoy chocolate, cream cakes and some desserts again. I always keep a couple of ready meals in the fridge (Marks and Spencer do a range designed for a smaller appetite). I snack on things like crisps, peanuts, cashew nuts, fruit loaf, crumpets, waffles and fruit and nut chocolate bars. At my last weigh-in I had gained over 2kilos so I know the only way is up now and I’m feeling very positive about the future. I now eat whatever I fancy and it’s just been trial and error finding the foods that work for me. 7 7 From the dietitian… We have worked closely with our patients in producing this recipe book to help support you after surgery or during chemo/radiotherapy when you may find your appetite is very low. The recipes are designed to maximise the calorie and protein content, which will help you to better maintain your weight. Eating small portions regularly every few hours over the day can help, as well as serving small portions of food on a side plate or in ramekins so that it doesn’t look too overwhelming. Dietitian, Sarah Davies Don’t feel you have to make everything from scratch, you can often buy foods of an already appropriate texture from supermarkets, for example pots of custard or smooth soup to save you time. Several online ready-made meal companies can deliver good quality meals that have a range of suitable textures, including ‘mini’ or ‘petite’ ranges for smaller portions, which you may find helpful if you are feeling too tired to cook. Choose ‘purée’ or ‘soft and bite sized’ ranges according to which stage of diet you are on. If you require further advice or are worried about your weight or diet please ask to be referred to a dietitian. We hope you find this book helpful! 88 From the Chef… It’s really inspiring for me to read the positivity within the patient stories and learn about the different food plans that have worked for each individual. I can fully appreciate a lack of desire to get creative in the kitchen, especially post surgery, though along with some great existing recipes already in this book, I have put together some of my own that will hopefully encourage you to think positively about food and flavours. There will obviously be days where you may wish to simply blitz up a can of pre prepared soup though if feeling adventurous it would be a pleasure to learn that any of my recipes have been given a run through! Please do enjoy! Blender advice To get a really smooth consistency to your food it is really important that you use a powerful blender. I personally find the Ninja range superb & at an affordable price range. They have some great models from around £49.99 and are available from most supermarkets or it’s worth looking online for a good deal. If your blender fails to create the desired smooth texture, you can pass it through a fine sieve afterwards and discard any ‘lumps’. If the consistency of the food is a little dry, simply add a little extra water whilst blending. Chef, Gary 9 Purée foods 10 What is a purée diet? • A purée diet should be smooth throughout without any bits, lumps, skins or shells. • Food can be puréed using a blender or food processor. • Food can also be sieved to ensure there are no lumps. • Food should be puréed separately so there are individual portions of each food on the plate. This helps to retain the taste and colour of each item and makes it more appealing. • Add additional liquids to blend such as gravy, milk or stock. • Enhance flavours by adding sauces such as smooth mustard, curry powder, soy sauce or lemon juice. Suggested purée meal plan Breakfast 8.00am Drink Mid-morning snack 10.00 -10.30am Drink Lunch 12.00 -1.00pm Drink Mid-afternoon snack 2.30 - 3.00pm Drink Dinner 5.00 - 6.00pm Drink Dessert/ Evening Snack 7.00 - 8.00pm Purée cinnamon porridge Nourishing coffee Purée scrambled eggs Supplement drink Salmon Mousse Glass of milk Cream of chicken soup Supplement drink Purée shepherd’s pie Nourishing malt drink Purée rice pudding 1111 Purée breakfast recipes 12 Cinnamon Porridge • 25g porridge oats • 175g full fat milk • ¼ teaspoon of cinnamon • 1-2 tablespoons of full fat Greek yogurt to serve 1. Put the porridge oats in a saucepan, pour over the milk and sprinkle in a pinch of salt. Bring to the boil and simmer for 4-5 minutes, stirring from time to time and watching carefully that it doesn’t stick to the bottom of the pan. 2. Or you can try this in a microwave. Mix the porridge oats, milk and a pinch of salt in a large microwave-proof bowl, then microwave on High for 5 minutes, stirring halfway through. Leave to stand for 2 minutes before eating. 3. Stir through the cinnamon and drizzle with Greek yogurt to serve (you can thin this down with some more milk if needed). Storage: Refrigerate Weetabix, Peanut Butter & Banana Smoothie • ½ a banana • 2 tablespoons of smooth peanut butter • Approximately 250ml full fat milk • 1 Weetabix biscuit (or shredded wheat) 1. Slice the banana into the blender. 2. Add the peanut butter and 3 tablespoons of the milk. 3. Blend together until well combined. 4. Crush the Weetabix into the mixture. 5. Add the remaining milk and blend until smooth. Storage: Refrigerate 13 Purée Scrambled Eggs • 2 eggs • 6 tablespoons of single cream or approximately 60ml of full fat milk • Butter 1. Lightly whisk the eggs, 6 tbsp of single cream or full fat milk and a pinch of salt together until the mixture has just one consistency. 2. Heat a small non-stick frying pan for a minute or so, then add a knob of butter and let it melt. 3. Pour in the egg mixture and let it sit, without stirring, for 20 seconds. Then stir with a wooden spoon, lifting and folding it over from the bottom of the pan. 4. Once cooked through, place eggs in your blender and blend until smooth (you may need to add a little more milk to give the correct consistency). Storage: Refrigerate Fruity Greek Yogurt Smoothie • 250ml Full fat Greek yogurt (or pineapple flavoured Greek yogurt) • 50ml full fat milk • ½ a banana • 30g fresh or frozen mango • 30g fresh, tinned or frozen peach slices 1. Place the yogurt and fruit into the blender and mix until smooth (if using frozen fruit you may need to let this defrost for a few moments to make it easier to blend). 2. Add additional milk to thin down as required. Storage: Refrigerate 14 15 Purée soups All soups can be kept in the fridge for 1-2 days or frozen 16 Cream of Chicken Soup • 2 tablespoons of olive oil • 600ml chicken stock • 1 medium onion, chopped • 175ml double cream • 1 medium leek, thoroughly washed and chopped • A pinch of pepper • 2 large chicken breast fillets (chopped) 1. Heat the oil in a pan, add the onion and cook until softened. 2. Add the leek and cook for a further 5 minutes. 3. Add the chicken, stock and seasoning and bring to the boil for 2 minutes then reduce to a simmer. 4. Allow to simmer for 25 minutes until the chicken is cooked through. 5. Add the cream then blend until smooth. Lamb and Vegetable Soup • 2 tablespoons of olive oil • 800ml vegetable stock • 400g lamb mince • 150ml full fat milk • 1 medium onion, choppe d • 120g skimmed milk powder • 3 large carrots, peeled & cho ppe d • 100ml double cream • 1 medium potato, peeled & chopped 1. Heat the oil in a pan and add the lamb and onion and cook for 5 minutes, breaking up the lamb into small pieces. 2. Add the carrot and cook for 10 minutes until soft. 3. Add the potato and stock and bring to the boil, then reduce to a simmer for a further 30 minutes. 4. Combine the milk with the skimmed milk powder then add to the pan with the cream and season. 5. Blend the soup until smooth. 17 Pea and ham soup • 2 tablespoons of oil • 1 medium onion, chopped • 1 medium potato, peeled and finely chopped • 400ml vegetable stock • 600g frozen garden peas • 100g cooked ham, finely chopped • 300ml full fat milk • 100g skimmed milk powder • 30g parmesan 1. Heat the oil in a pan and add the onion. Cook for 5 minutes until soft 2. Add the potato and stock and season. Boil for 15 minutes until the potato is soft. 3. Stir in the peas and ham and cook for another 10 minutes 4. Mix the milk with the skimmed milk powder and then add to the soup along with the parmesan. 5. Blend the soup until smooth and then sieve to ensure all pea shells are removed. Seafood chowder • 1 tablespoon of olive oil • 1 medium onion, finely chopped • 1 tablespoon of plain flour • 2 small potatoes, peeled and finely chopped • 600ml fish or vegetable stock • 300ml full fat milk • ½ teaspoon of grated nutmeg • 170g salmon, chopped into small chunks • 150g cod, chopped into small chunks • 60ml single cream • 200g frozen prawns (thoroughly defrosted) 1. Heat the oil in a saucepan and add the onion. Cook for 5 minutes until soft, then add the flour and cook for a further 2 minutes. 2. Add the potatoes and stock and bring to the boil for a minute then turn down to a simmer and cook for around 15 minutes until the potatoes are soft. (continued over) 18 3. Add the milk and nutmeg with the salmon and cod and cook for 5 minutes. 4. Add the cream and prawns and simmer for 5 minutes until cooked through. 5. Blend the soup until smooth. Sweet potato and lentil soup • 3 tablespoon of olive oil • 1 large onion, finely chopped • 10g minced ginger (or ginger paste) • 10g minced garlic (or garlic paste) • 600g sweet potatoes, peeled and finely chopped • 200g dried red lentils • 400g tin of coconut milk • 800ml vegetable stock • 100ml double cream • 120g skimmed milk powder 1. Heat the oil in a saucepan then fry the onions, garlic and ginger for 5 minutes. 2. Rinse and drain the lentils. 3. Add the sweet potatoes, lentils, coconut milk and stock and simmer for 30 minutes until the potatoes are soft. 4. Mix together the cream and skimmed milk powder then add to the soup. 5. Blend until completely smooth (you may need to sieve the soup to ensure the lentils are completely blended). 19 Purée main meals 20 Salmon Mousse • 125g smoked salmon • 50g cream cheese • 25g crème fraiche • The juice of ½ a lemon 1. Place all of the ingredients in your blender and combine until smooth. 2. Season with salt and pepper to taste and serve. Storage: Refrigerate Fish Pie • 2 skinless and boneless white fish fillets (approximately 200g) • 2 skinless and boneless smoked haddock fillets (approximately 200g) • 400ml full fat milk • 50g butter • 3 heaped tablespoons of plain flour (50g) • A pinch of nutmeg 1. Put the fish in the frying pan and pour over the milk. 2. Bring the milk to the boil then reduce and simmer for 8 minutes. 3. Lift the fish onto a plate and strain the milk into a jug to cool. Flake the fish into large pieces in a baking dish. 4. Melt the butter in a pan, stir in the flour and cook for a minute over a moderate heat. Take off the heat then pour in a little of the milk from the jug and stir until blended. 5. Continue to add the milk gradually, mixing well until you have a smooth sauce. Season with nutmeg and pepper to taste. 6. Add to a blender with the fish and blend until smooth. 7. Layer in a small dish with creamy mashed potato on top (see recipe in side dishes section). 8. Heat the oven to 200°c and bake for 30 minutes. Storage: Refrigerate or freeze 21 Mediterranean inspired chicken & chorizo casserole chickpea - spinach - fresh basil This recipe is inspired by big Mediterranean flavours. The strong flavours from the chorizo flavour the whole dish and make it a pleasure to eat. The recipe will give a generous 4 - 6 portions though likely more for smaller appetites. • 100g diced chorizo • 200g diced chicken thigh • 1 onion, diced • 1 stick celery, diced • 1 carrot, diced • 1 tin of chick peas, drained • 2 tins chopped tomatoes • 200g baby spinach leaves, washed • Handful fresh basil • Juice of one lemon • Salt and pepper Gary’s 1. Start with a hot pan and colour the chorizo on all sides (no need for any oil) 2. Add the chicken and stir in - cook for a few minutes 3. Add the onion, carrot and celery - cook for about 5 more minutes over a gentle heat (lid on) 4. Add the tinned chickpeas and tomatoes - bring to the boil and simmer for 30 minutes, stirring occasionally 5. Add the baby spinach and fresh basil 6. Add salt and pepper and lemon 7. Blend until smooth 8. Enjoy 22 Mild red lentil & butternut squash curry coconut - lime - lemongrass This simple recipe is for a mild curry with Asian flavours. You can replace the squash with chicken if desired but I personally love a vegetarian curry and you get plenty of calories from the coconut milk and the red lentils. You can omit the chilli if wanting a milder version or add one or two extra in. Again, allows for 4 - 6 generous portions. • 1 butternut squash, diced • 1 onion, diced Gary’s • 4 cloves garlic, crushed • 1 inch fresh ginger, grated • 1 stick lemongrass, diced • 1 green chilli, de-seeded • Juice of two limes • Bunch fresh coriander • Teaspoon mild curry powder • Dash of fish sauce • Teaspoon turmeric • 200g red lentils • Two tablespoons soy sauce • Coconut oil for cooking 1. In a hot pan, heat the coconut oil and add the garlic, ginger, lemon grass and onions - sweat for a few minutes 2. Add the squash, chilli and curry powder - cooking for 5-10 minutes until starting to soften (keep lid on) 3. Add the coconut milk and bring to the boil - simmer for twenty mins 4. Meanwhile, boil the red lentils in 400ml water for five minutes with the turmeric (the water should evaporate whilst they cook) 6. Add the cooked lentils (drained) into the sauce 7. Add the lime juice, fish sauce and soy sauce 8. Blend until smooth 9. Enjoy 23 Vegetarian ‘Shepherd’s pie’ puy lentils - butter beans - root vegetables minted gravy Very fond of vegetarian food?..... I’ve included this recipe which works really well with the lentils replacing the meat. Plenty of flavour from the vegetables and served with buttery mash and additional gravy, it’s a real treat. • 200g puy lentils (cooked) • 1 onion, chopped • 1 stick celery, chopped • 1 carrot, chopped • 1/2 small swede, chopped • 4 cloves garlic, chopped • 1 tin butter beans, drained • Tablespoon tomato purée • Teaspoon dried mint • Teaspoon dried mixed herbs • Salt and pepper Gary’s 1. In a hot pan, sweat the onions with the dried herbs for a few minutes 2. Add the other vegetables and cook for a further ten minutes (lid on) 3. Add the tomato purée and red wine 4. Add the lentils and butter beans 5. Add the Worcester sauce and salt and pepper 6. Add the gravy 7. Simmer for 30 minutes 8. Blend until smooth adding a little extra water or gravy if necessary 9. Serve with the mash and extra gravy 24 Mash Ingredients • 40g potato, diced • 100g butter • Salt and pepper • Dash grated nutmeg (optional) • Teaspoon Dijon mustard 1. Bring the potatoes to the boil and simmer for 20 minutes until soft 2. Drain and beat with a whisk until smooth - avoid using the blender which will break down all the starch, causing loss of the natural texture we all love in a good mash. As long as it’s given a good beat with a sturdy whisk it will become smooth or you can use a ricer, putting through twice. 3. Add salt and pepper, butter and mustard Chef Gary’s Top Tips Invest in some reusable tubs. They are great for portioning and storing food when batch cooking. You can then prepare food ahead of time and freeze for when you need something that’s quick, healthy and nutritious. Purée down tinned rice pudding for a quick dessert that is packed full of calories. When the texture is one dimensional it’s so important to add flavour to keep you interested and looking forwards to mealtime. A little extra salt, sugar or lemon juice can go a long way. As long as you can purée them to a fine texture, add fresh herbs to any recipe to give dishes extra flavour. Basil is great with tomato based dishes and coriander pairs brilliantly with coconut or curried recipes. As you move forwards, by using the pulse on the blender, you can leave some texture in the dishes. All my recipes can of course be left ‘unblended’ if catering for other family members or friends. 25 Minced beef • ½ tbsp sunflower oil • 30g onion (finely chopped) • 30g carrots (finely chopped) • 100g minced beef (or substitute for Quorn mince) • 1 tablespoon of tomato purée • 200ml beef stock • 2 tablespoons of Worcestershire sauce 1. Heat the oil in a medium saucepan and soften the onions and carrots. 2. When soft, add the minced beef and cook until browned. Then add the tomato purée and Worcestershire sauce and fry for a few minutes. 3. Pour over the stock and then simmer for 30-40 minutes. 4. Place the mixture into a blender and blend until smooth. Serve into small portions. Ideal with mashed potato or purée vegetables (see sides section). Storage: Refrigerate or freeze Shepherds’ pie • 350g minced beef (or substitute for Quorn mince) • 2 tablespoons of olive oil • 1 small onion, chopped • 100g mushrooms (optional) • 2 medium carrots, peeled and chopped • 2 tablespoons of tomato purée • 350ml beef stock • 50g butter • 50g flour 1. Heat the olive oil in a pan and add the onions and soften. 2. Add the mince and brown through. (continued over) 26 3. Add the mushrooms and carrots. Cover with a lid and leave to cook on a medium heat, stirring regularly. 4. Make a roux sauce by melting the butter in a separate pan. Using a whisk add the flour and whisk well until combined. 5. Add the beef stock a little at a time to the roux, still mixing well to make a thick sauce. 6. Add this sauce with the tomato purée to the beef mixture and stir well. 7. Transfer to the blender and mix until smooth. 8. Place in a small dish and top with creamy mashed potato (see side dishes section). 9. Bake in the oven for 15-20 minutes until cooked through. Storage: Refrigerate or freeze Purée chicken • 100g of diced chicken breast • 1 small onion chopped • 100ml chicken stock • ½ a chopped leek • 1 tablespoon of chicken gravy granules • 1 teaspoon of oil 1. Heat the oil in a pan then add the onion, leek and chicken and cook through. 2. Add the chicken stock and simmer for 15 minutes. 3. When cooked, add the gravy granules then transfer to the blender and blend until smooth. Ideal to serve with creamy mashed potato. Storage: Refrigerate or freeze 27 Macaroni cheese • 3 tablespoons of butter • 350g of pasta (penne or spiral pasta) • 1 teaspoon garlic paste • 1 teaspoon mustard • 3 tablespoons plain flour • 500ml full fat milk • 250g cheddar cheese • 50g grated parmesan 1. Boil the pasta until cooked then drain and set aside. 2. Meanwhile melt 2 tablespoon of butter in a saucepan. 3. Add the garlic paste and English mustard and cook for 1 minute. 4. Stir in 3 tablespoons of plain flour and cook for 1 more minute. Gradually whisk in 500ml of the milk until you have a lump-free sauce. 5. Simmer for 5 minutes, whisking all the time until thickened. 6. Take off the heat and stir in the cheddar and parmesan. 7. Add the pasta then blend with the sauce until smooth. Add extra milk if you need to thin the mixture down. Storage: Refrigerate 28 Red lentil Dahl • 250g red lentils • 1 teaspoon turmeric • A pinch of salt • 2 tablespoons sunflower oil • 1 teaspoon cumin • 1 medium onion, finely chopped • 50ml cream 1. Put the lentils in a pan of 800ml of water and bring to the boil. 2. Add the turmeric and salt and simmer uncovered for 15 minutes. Stir occasionally until the lentils have broken down completely to a purée (the consistency of a smooth thick soup). 3. Heat the oil in a separate pan and add the onion. Cook for 5 -10 minutes until soft. 4. Add the onion, cumin and cream to the lentils then blend until smooth. Storage: Refrigerate or freeze 29 Purée side dishes 30 Creamy mashed potato • 6 medium potatoes, peeled and chopped into chunks • 60g butter • 100ml double cream 1. Place the potatoes in a pan and cover with cold water 2. Bring to the boil then cover with a lid and reduce to a simmer for 20 minutes until the potatoes are soft. 3. Drain the remaining water, add the cream and butter and gently heat. 4. Mash the potatoes or beat. Storage: Refrigerate or freeze Hint: Try adding cream cheese or mustard to give extra flavour Cauliflower cheese • 150g cauliflower florets • 1 level tablespoon of cornflour • 2 tablespoons of full fat butter or olive oil spread • 150ml full fat milk • 30g cheddar cheese, finely grated 1. Wash the cauliflower then steam for 8-10 minutes until soft. 2. To make the sauce combine the flour, butter and milk in your blender. 3. Transfer into a microwaveable container and microwave for 45 seconds then stir through. 4. Microwave for another 15-30 seconds until the sauce starts to thicken then stir in the grated cheese. 5. Combine the cauliflower and sauce in the blender until smooth. Add additional milk if required. Storage: Refrigerate or freeze 31 Sweet potato and carrot purée • 250g carrots, chopped • 250g sweet potato, chopped • 1 tablespoon of garlic purée • 25g butter 1. Put the sweet potato and carrots into a pan of boiling salted water and cook for around 15 minutes until soft. 2. Drain the vegetables then stir through the garlic purée and butter. 3. Blend until smooth. Storage: Refrigerate or freeze Hint: You could also try adding 100g parsnip Butternut squash purée with ginger • 1 butternut squash, halved lengthways and deseeded • Olive oil • 4cm piece of fresh root ginger, peeled and finely grated • 3 tablespoons of butter • 2 tablespoons of double cream or crème fraiche • Nutmeg (optional) 1. Preheat the oven to 200°c 2. Rub a little olive oil into the cut side of the butternut squash then roast in the oven on a baking sheet for around 45 minutes or until soft. 3. Scoop out the flesh with a spoon and set aside (discard the skin) 4. In a pan melt 2 tablespoons of butter and add the ginger and cook for 5 minutes. 5. Place the cooked squash and ginger in the blender and blend thoroughly until smooth. 6. Return to the pan and add the remaining butter and nutmeg if you are using this. Stir through the cream or crème fraiche. Storage: Refrigerate or freeze 32 Purée ratatouille • 50g aubergine • 50g courgette • 40g red or yellow pepper • 2 tablespoons of olive oil • 200g passata • 1 small onion, finely chopped • 30g mushrooms • ½ garlic clove peeled and crushed • 1 tablespoon of red wine vinegar • 50ml single cream (optional) 1. Heat the oil in a casserole dish or saucepan and cook the onions and garlic on a low heat for 10 minutes until soft with the lid on. 2. Add the peppers, aubergine and courgettes. Season with salt and pepper and cook for a further 20 minutes with the lid on. 3. Pour in the passata and red wine vinegar and cook for another 5 minutes without the lid 4. Transfer to your blender and blend until smooth. Stir through the single cream to add additional calories before serving Storage: Refrigerate or freeze 3333 Purée desserts & snacks 34 Banana dessert • 1 medium banana, peeled and sliced • 10g ground almonds • 1 teaspoon maple syrup • 2 tablespoons double cream • 20g skimmed milk powder • 1 teaspoon vanilla extract 1. Freeze the banana slice for at least 2 hours 2. Blend the frozen banana, almonds, maple syrup, cream, skimmed milk powder and vanilla extract into a creamy smooth texture. Add some extra milk if it is difficult to blend Storage: Refrigerate or freeze Rice pudding • 120g pudding rice • 700ml full fat milk • 50g sugar (or swap for sweetener) • 200ml cream • 1 teaspoon of vanilla extract • ½ teaspoon of ground cinnamon • 75g ground almonds • A pinch of salt • 100g skimmed milk powder 1. Blanch the rice in a pan of boiling water for 3 minutes 2. In another pot mix 600ml of milk with the sugar, cream, vanilla extract, cinnamon and salt and bring to the boil 3. Add the blanched rice and ground almonds and simmer for 30 minutes, stirring occasionally 4. Combine with the remaining 100ml of milk and skimmed milk powder 5. Blend until completely smooth and then serve into small portions Storage: Refrigerate 35 Vanilla custard • 1 pint of full fat milk • 55ml single cream • 1 vanilla pod or ¼ teaspoon of vanilla extract • 4 egg yolks • 30g caster sugar • 2 level teaspoons of cornflour 1. Bring the milk, cream and vanilla to simmering point gradually over a low heat. 2. Remove the vanilla pod if used. 3. Whish the egg yolks, sugar and cornflour together in a bowl until well blended. 4. Pour the hot milk and cream mixture into the egg mixture, whisking all the time with a balloon whisk. 5. Return to the pan and stir over a low heat until thickened. Storage: Refrigerate Spiced pear (ideal with the vanilla custard) • 2 pears, peeled, cored and cut into small chunks • A small pinch of cinnamon • A splash of full fat milk 1. Steam the pear for 8-10 minutes until tender. 2. Transfer to the blender and add a splash of milk and cinnamon and blend until smooth. 3. Can be frozen into ice cube trays. Storage: Refrigerate 36 Lemon mousse • 150g lemon curd • Zest of ½ a lemon • 150ml of double whipping cream 1. Put two-thirds of the lemon curd in a large bowl with the zest and cream. 2. Beat with an electric whisk until it holds its shape. 3. Dribble over the rest of the lemon curd, marbling the curd as you add it. 4. Transfer into small pots or glasses. Cover with clingfilm and freeze for 30-40 minutes until set. Storage: Refrigerate 37 Drinks and supplement recipes 38 Nourishing malt drink • 150ml full fat milk • 1 heaped tablespoon milk powder • 3 teaspoons of malted drink powder such as Ovaltine or Horlicks • 2 tablespoons cream Nourishing coffee • 150ml full fat milk • 1 heaped tablespoon milk powder • 1 teaspoon coffee powder • 2 tablespoons of cream Chocolate mocha pots • 1 teaspoon of coffee granules dissolved in a splash of boiling water • 25g butter • 100ml of chocolate Fortisip • 200g plain chocolate broken into chunks • 50g Muscovado sugar (or swap for sweetner) 1. Place all of the ingredients in a small pan and stir gently over a low heat until it has fully melted 2. Pour into small espresso size cups and allow to cool 3. Transfer to the fridge to set Cappuccino • 1 sachet of instant cappuccino mix • 110ml of hot water • 1 bottle of neutral of mocha flavoured Fortisip 1. Put the water, cappuccino mix and Fortisip in a saucepan. Mix well and heat gently until at serving temperature Fortisip milk jelly • 1 packet of blackcurrant or raspberry jelly • 400ml of Strawberry Fortisip • 100ml boiling water 1. Cut the jelly into cubes and place in a bowl 2. Add the boiling water and stir until the jelly is dissolved 3. When cooled slightly, add the Fortisip 4. Mix thoroughly and transfer to small containers and leave in the fridge to set What is Fortisip? You will initially be prescribed high calorie supplement drinks such as Fortisip Compact Protein. This will help you to maximise your nutritional intake. They are available in 8 flavours through your GP: vanilla, strawberry, banana, mocha, peach/mango, berries, neutral, and hot tropical ginger. They can also be frozen into ice cube trays or ice lolly moulds. 3399 soft & bite sized diet 40 What is a soft and bite sized diet? • A soft diet should be of fork-mashable consistency and require some chewing. • Avoid crunchy, sharp foods with skins and doughy foods such as bread. • Continue to aim for small regular meals and snacks over the day. Suggested soft and bite size meal plan Breakfast 8.00am Drink Mid-morning snack 10.00 -10.30am Drink Lunch 12.00 -1.00pm Drink Mid-afternoon snack 2.30 - 3.00pm Drink Dinner 5.00 - 6.00pm Drink Dessert/ Evening Snack 7.00 - 8.00pm Overnight oats Fortified cappuccino Pancakes and crème fraiche Supplement drink Salmon fish cakes Glass of fortified milk Flapjack Supplement drink Beef casserole with pepper mash Nourishing malt drink Tiramisu 41 Soft & bite sized breakfast recipes 42 No-bread eggs benedict • 1 ripe avocado, destoned • 2 slices of ham or smoked salmon • 2 eggs • 2 tablespoons mayonnaise • 1 teaspoon mustard • 2 teaspoons white wine vinegar 1. Bring a saucepan of water to the boil 2. Scoop the avocado flesh into a bowl and season with salt and pepper. Mash with the back of a fork and leave to one side 3. Once the water is boiling carefully crack in the eggs and poach at a gentle simmer for about 4 minutes until the yolk is still runny 4. While the eggs are poaching make the hollandaise sauce. Whisk together the mayonnaise, mustard and vinegar with 3 tablespoons of warm water 5. Once cooked layer the ham or salmon with the mashed avocado then top with poached eggs and spoon over the sauce Storage: Refrigerate Overnight Oats • 120g rolled oats • 120ml full fat Greek yogurt • 220ml full fat milk • ½ tablespoon honey or maple syrup (or sweetener) • 1 teaspoon vanilla extract To make ‘coconut latte’ overnight oats substitute full fat milk for 170ml coconut milk, do not use vanilla extract and instead add: • ½ teaspoon ground cinnamon • 60ml brewed coffee 1. Place all of the ingredients into a large glass container and mix well 2. Put the top on the container & refrigerate for at least 2 hrs or overnight Storage: Refrigerate 43 Potato waffles You will require a waffle iron • 300g peeled potatoes, chopped • 2 tablespoons butter • 1 onion, finely chopped or grated • 1 garlic clove finely chopped • 30g plain flour • 2 eggs 1. Boil the potatoes in a pan of water for around 15 minutes or until soft 2. Meanwhile melt the butter in a pan over a medium heat. Add the onion and garlic and cook until soft 3. Preheat the waffle iron according to the manufacturer’s instructions 4. Drain the potatoes when cook then combine with the onion mixture, flour, eggs and season with salt and pepper. Mix in a large bowl until well blended 5. Scoop the batter into the waffle iron and cook until golden brown Storage: Refrigerate Hint- Ideal to serve with scrambled egg, ham, mushrooms or a combination of toppings 44 Pancakes with banana and crème fraiche • 55g plain flour • 1 egg • 100ml full fat milk • 25g butter • 1 banana • Crème fraiche • Handful of raspberries or blackberries (optional) 1. Sift the flour with a pinch of salt into a large mixing bowl 2. Make a well in the centre of the flour and break in the egg 3. Whisk together and gradually add the milk until a smooth consistency 4. Melt 25g butter in a pan and add half of this to the batter mix and whisk in 5. Get the pan very hot with the remaining butter, then turn down to a medium heat 6. Add about 2 tablespoons of batter to the ban and tilt the pan to completely cover in the batter and thin 7. Cook the pancake on each side until golden but not too crispy 8. To make the fruit purée spoon the berries into a sieve and push through to remove any pips. Serve with crème fraiche Storage: Refrigerate 45 Soft & bite sized main meals 46 Salmon fish cakes • 4 medium potatoes, peeled and chopped into small pieces • 350g skinless and boneless salmon, flaked • Zest of 1 lemon • 1 tablespoon plain flour • 15g fresh chives, finely chopped • 1 medium egg • 30g grated parmesan • 2 tablespoon olive oil 1. Preheat the oven to 180°c 2. Put the potato pieces in a pot of boiling water and cook for 10-15 minutes until soft 3. Drain and mash the potato and allow to cool 4. Add the flaked salmon, lemon zest, flour, chives, egg and parmesan to a large bowl 5. Mix with the mashed potato until well combined 6. Divide the mixture into 8 cakes and shape 7. Place on a baking tray and brush with olive oil 8. Cover with tin foil and bake for 10-15 minutes until cooked through Storage: Refrigerate or freeze Smoked fish chowder • 450g smoked haddock fillet • 170g carrots, peeled and • 60g butter finely chopped • 1 onion, finely chopped • 150ml single cream • 2 tablespoons plain flour • 230g potatoes, peeled and finely chopped 1. Boil 1 litre of water in a saucepan then reduce to a simmer and cook the haddock for about 10 minutes until tender. (continued overleaf) 47 2. Drain the haddock and keep the water to use as stock later 3. Flake the haddock removing any skin and bones 4. Heat the butter in a pan and add the onion and cook until soft 5. Stir in the flour and cook for a minute then gradually add the water back as stock. Bring to the boil stirring constantly 6. Add the potatoes and carrots and simmer for 10 -15 minutes until tender 7. Stir in the flaked fish and cream. Season and serve Storage: Refrigerate Salmon curry • 1 tablespoon olive oil • 1 small onion, sliced • 2 garlic cloves, crushed • ¼ chilli, deseeded and sliced finely • 1 teaspoon milk curry powder (or medium if preferred) • 1 tin salmon or approximtely 200g fresh salmon fillet • 1 spring onion, chopped • 2 tablespoons tomato purée • Boiled brown rice 1. Heat the oil in a pan over a medium heat. Add the onion and garlic and cook until soft 2. Add the chilli and cook for another minute 3. Add 5 tablespoons of water and stir then turn down the heat to a simmer for 5 minutes until the water evaporates 4. Add the tin of salmon, spring onion, tomato purée and salt and pepper 5. Simmer until cooked and soft then serve with a small amount of cooked rice Storage: Refrigerate or freeze 48 Pesto chicken • 1 tablespoon olive oil • 2 small chicken breast fillets, sliced • 1 garlic clove, crushed • 1 tablespoon green or red pesto • 200ml crème fraiche • 10 cherry tomatoes • Boiled rice or pasta 1. Heat the olive oil over a medium heat. Add the chicken and cook for 405 minutes until brown on all sides 2. Immerse the cherry tomatoes in boiling water for a few seconds then carefully remove and peel off the skin 3. Add the onion, garlic, pesto and peeled tomatoes. Cook for 5 -10 minutes stirring continuously 4. Ensure the chicken is tender and fully cooked then stir in the crème fraiche 5. Serve with cooked rice or pasta Storage: Refrigerate 49 Beef and Swede Casserole • 2 tablespoons olive oil • 2 onions, finely chopped • ½ celery stick, sliced finely • 500g diced braising beef • 700ml beef stock • 500g swede, peeled and diced • 300g potatoes, diced • 3 thyme sprigs • 1 bay leaf • Mashed potato to serve 1. Heat the oil in a saucepan or casserole dish 2. Fry the onions and celery for a few minutes until turning brown 3. Add the beef and brown all over for 3-4 minutes 4. Add the stock, swede, potatoes, thyme and bay leaf. Bring to the boil then reduce the heat 5. Simmer for an hour or transfer to a slow cooker if preferred 6. Cook until the beef is tender then remove the thyme and bay leaf before serving Storage: Refrigerate or freeze Moussaka • 500g potatoes, peeled • 3 tablespoons olive oil • 1 red onion, sliced finely • 500g lamb mince • 2 garlic cloves, crushed • 1 teaspoon mixed spice • 500g carton of passata • 2 aubergines, sliced finely • 300ml crème fraiche • 150g grated cheddar 1. Boil the potatoes whole for 20 minutes until soft then drain and allow to cool 2. In another pan add 2 tablespoons of olive oil and fry the onion until softened 3. Add the lamb and fry for 5 minutes until cooked 4. Add the garlic, mixed spice and passata & bring to a simmer 5. Heat the oven to 200°c 6. Warm a new pan over a high heat and add a little oil. Cook the aubergines on each side 7. Once cool slice the potatoes into thick slices 8. In an ovenproof dish layer the potatoes, then aubergines, then a layer of lamb mince mixture and repeat until all of the ingredients are used, ensuring an aubergine layer is on top 9. Spread the crème fraiche over the top and sprinkle with cheddar 10. Bake in the oven for 10 minutes or until the top is golden Storage: Refrigerate or freeze 50 51 Vegetarian lasagne • 1 red pepper, deseeded and cut into chunks • 2 courgettes, sliced • 1 small aubergine • 2 garlic cloves • 1 red onion, finely chopped • Olive oil • 250g Quorn mince • 1 tablespoon Worcestershire sauce • 1 tin tomatoes • 1 teaspoon oregano • 450ml full fat milk • 25g butter • 40g plain flour • 70g cheddar • 30g parmesan • 120g lasagne sheets 1. Heat the oven to 220°c 2. Put the peppers, courgettes, aubergines, half the garlic and half the onion into a roasting tin. Season and drizzle with olive oil then roast for around 30 minutes until tender 3. Heat 2 tablespoons of olive oil in a pan and add the remaining onion and garlic and fry for a few minutes until soft. Add the Quorn mince, Worcestershire sauce, tomatoes and oregano and simmer for 5 minutes 4. In a separate pan put the milk, butter, flour and seasoning. Heat and whisk until thickened and smooth. Stir in the cheddar and parmesan 5. Layer the Quorn mince mix, roasted vegetables, lasagne sheets and cheese sauce alternately in an ovenproof dish 6. Cook for around 40 minutes at 200°c until golden Storage: Refrigerate or freeze 52 Swedish meatballs • 250g mince beef • 1 garlic clove, chopped • ½ onion, finely chopped • ½ egg • 2 tablespoons chopped fresh parsley • Olive oil • 1 tablespoon butter • 20g plain flour • 250ml beef stock • 120ml cream • 1 teaspoon Worcestershire sauce • Pasta (tagliatelle or penne) 1. To make the meatballs mix together the beef, garlic, onion, egg and parsley in a bowl. If the mixture is very thick add a little more egg 2. Using a tablespoon roll out meatballs from the mixture 3. Heat oil in a pan over a medium heat and add the meatballs and cook for about 10 minutes until browned, turning occasionally. 4. Remove the meatballs and leave to cool on a paper towel 5. To make the sauce melt the butter in a pan and whisk in the flour until golden brown. Slowly whisk in the beef stock and cook until thickened 6. Add the cream, Worcestershire sauce and season with salt and pepper. 7. Add the meatballs and coat in the sauce then sprinkle with parsley. 8. Boil the pasta in water until soft then serve with the meatballs Storage: Refrigerate or freeze 53 Soft & bite sized side dishes 54 Spinach mash • 500g potatoes, peeled and chopped • 100g spinach • 60ml single cream • 20g butter 1. Boil the potatoes in a pan of water until soft 2. In a separate pan steam the spinach leaves until wilted. When cool squeeze out excess liquid 3. Blend the spinach with the butter until almost smooth 4. Mash the potato in a large bowl then stir in the spinach purée and cream Storage: Refrigerate or freeze Pepper mash • 1 red pepper, quartered with seeds removed • 500g potatoes, peeled and chopped • 60ml single cream • 20g butter 1. Roast the pepper under a hot grill, skin side up until it blackens. 2. Leave to cool then peel the skin from the pepper then blend until smooth 3. Meanwhile boil the potatoes in a pan of water until soft 4. Mash the potato in a bowl then stir in the butter, cream and pepper purée Storage: Refrigerate or freeze Hint: You could use the purée side dish recipes within this book and mash with a fork rather than blend completely 55 Soft & bite sized desserts & snacks 56 Hummus and butter biscuits For the biscuits: For the hummus: • 160g plain flour (whole wheat or white) • 1 tablespoon sugar • Pinch of salt • 80ml water • 4 tablespoons unsalted butter • 1 400g tin of chickpeas • 1 small clove of garlic • 1 tablespoon tahini • 1 lemon • Olive oil 1. Preheat the oven to 200°c 2. Line a baking sheet with parchment paper 3. Put the flour, sugar and salt in a food processor 4. Add the butter and blend until the butter is fully incorporated 5. With the mixer still running, add the water and blend until it forms a smooth dough 6. Once smooth remove the dough from the blender and divide into 4 equal pieces 7. Lightly flour the work surface then roll each dough piece into a large triangle, turning frequently to stop it sticking to the surface 8. Use a pizza cutter or knife to cut into approximately 3cm squares. 9. Place onto the baking sheet and cook until lightly browned for about 10 minutes 10. To make the hummus; drain the chickpeas and add to the blender. Peel and add the garlic and tahini with a good squeeze of lemon juice and 1 tablespoon of olive oil 11. Season with a pinch of salt and blend until smooth. Add extra lemon juice or a splash of water if needed Storage: Refrigerate hummus, store biscuits in an airtight container 57 Tiramisu • 600ml double cream • 175g pack sponge fingers • 250g mascarpone (full-fat) • 25g dark chocolate • 5 tablespoons golden caster sugar • 2 teaspoons cocoa powder • 300ml strong coffee (2 tablespoons coffee granules in 300ml boiling water) 1. Put the double cream, mascarpone and caster sugar in a large bowl and whisk until completely combined 2. Pour the coffee into a shallow bowl and dip in the sponge fingers a few at a time for a few seconds until nicely soaked but not too soggy 3. Grate the dark chocolate coarsely 4. In a large dish form alternating layers of sponge fingers, then a layer of cream mixture and topped with chocolate and cocoa powder. Repeat until all the ingredients have been used up Storage: Refrigerate for up to 2 days Flapjacks • 115g rolled oats • 55g butter • 200g no added sugar, seedless Jam (try fig, apple or pomegranate) • Dark chocolate for drizzling 1. Heat the oven to 180°c 2. Melt the butter and jam in a large pan over a gentle heat 3. Add the oats and stir until well combined 4. Press into a greased square tin or cake tin 5. Bake in the oven for 25-30 minutes until brown 6. Melt some dark chocolate and drizzle over the flapjack to serve 7. Once cool cut into small pieces 58 Apple sponge pudding • 2 large cooking apples, peeled and cored • 85g caster sugar (or swap for sweetener) • 3 tablespoons cold water • ½ egg • Finely grated zest and juice • 1 teaspoon baking powder of 1 lemon • 65g plain flour 1. Quarter the apples and place in a saucepan with
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STHW841-V1-Biomerieux-Blood-culture-guidance
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BLOOD CULTURE A key investigation for diagnosis of bloodstream infections OUR SPECIAL THANKS GO TO Dr Susan M. Novak-Weekley Ph.D. D(ABMM), S(M)ASCP Vice-President, Medical Affairs, Qvella, Carlsbad, CA, USA Wm. Michael Dunne, Jr. Ph.D. D(ABMM), F(AAM, CCM, IDSA, PIDJ) Senior Fellow, Clinical Microbiology, Data Analytics Group, bioMérieux, Inc., Durham, NC, USA Adjunct Professor of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA Adjunct Professor of Pediatrics, Duke University School of Medicine, Durham, NC, USA for their helpful advice and comprehensive review of this booklet. INTRODUCTION “…the laboratory detection of bacteremia and fungemia remains one of the most important functions of clinical microbiology laboratories... A positive blood culture establishes or confirms that there is an infectious etiology of the patient’s illness. Moreover, it provides the etiologic agent and allows antibiotic susceptibility testing for optimization of therapy.”1 The laboratory detection of bacteremia and fungemia using blood cultures is one of the most simple and commonly used investigations to establish the etiology of bloodstream infections. Rapid, accurate identification of the bacteria or fungi causing bloodstream infections provides vital clinical information required to diagnose and treat sepsis. Sepsis is a complex inflammatory process that is largely underrecognized as a major cause of morbidity and mortality worldwide. There are an estimated 19 million cases worldwide each year,2 meaning that sepsis causes 1 death every 3-4 seconds.3 Early diagnosis and appropriate treatment make a critical difference when it comes to improving sepsis patient outcomes. Chances of survival go down drastically the longer initiation of treatment is delayed. If a patient receives antimicrobial therapy within the first hour of diagnosis, chances of survival are close to 80%; this is reduced by 7.6% for every hour after. Yet, if a patient initially receives inappropriate antimicrobial treatment, they are five times less likely to survive.4 This booklet aims to: a nswer key questions commonly asked in relation to blood culture p rovide practical recommendations for routine blood culture procedures o ffer an illustrated step-by-step guide to best blood culture collection practices. This booklet is intended to be a useful reference tool for physicians, nurses, phlebotomists, laboratory personnel and all other healthcare professionals involved in the blood culture process. DEFINITIONS Bacteremia: the presence of bacteria in the blood. It may be transient, intermittent or continuous. Blood culture: blood specimen submitted for culture of microorganisms. It enables the recovery of potential pathogens from patients suspected of having bacteremia or fungemia. Blood culture series: a group of temporally related blood cultures that are collected to determine whether a patient has bacteremia or fungemia. Blood culture set: the combination of blood culture bottles (one aerobic and one anaerobic) into which a single blood collection is inoculated. Bloodstream Infection (BSI): an infection associated with bacteremia or fungemia. Contaminant: a microorganism isolated from a blood culture that was introduced during specimen collection or processing and is not considered responsible for BSI (i.e., the isolates were not present in the patient’s blood when the blood was sampled for culture). Contamination: presence of microorganisms in the bottle that entered during sampling but were not actually circulating in the patient’s bloodstream. Fungemia: the presence of fungi in the blood. Sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection.5 Septicemia: clinical syndrome characterized by fever, chills, malaise, tachycardia, etc. when circulating bacteria multiply at a rate that exceeds removal by phagocytosis.6 Septic episode: an episode of sepsis or septic shock for which a blood culture or blood culture series is drawn. Septic shock: a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality.5 Source: Wayne, P.A. Principles and procedures for Blood Cultures; Approved Guideline, CLSI document M47-A. Clinical and Laboratory Standards Institute (CLSI); 2007 unless otherwise specified. 2 TABLE OF CONTENTS 1 BLOOD CULTURE ESSENTIALS p. 2 1 What is a blood culture? p. 4 2 Why are blood cultures important? p. 4 3 When should a blood culture be performed? p. 5 4 What volume of blood should be collected? p. 6 5 How many blood culture sets should be collected? p. 8 6 Which media to use? p. 10 7 Timing of blood cultures p. 11 8 How to collect blood cultures p. 12 9 How many days of incubation are recommended? p. 14 10 Is it a contaminant or a true pathogen? p. 15 2 SPECIAL TOPIC : INFECTIVE ENDOCARDITIS p. 18 3 PROCESSING POSITIVE BLOOD CULTURES p. 20 4 INTERPRETATION OF RESULTS p. 22 5 BLOOD CULTURE/ SEPSIS GUIDELINES p. 24 REFERENCES p. 26 RECOMMENDATIONS FOR BLOOD CULTURE COLLECTION p. 30 3 1 BLOOD CULTURE ESSENTIALS 1 What is a blood culture? A blood culture is a laboratory test in which blood, taken from the patient, is inoculated into bottles containing culture media to determine whether infection-causing microorganisms (bacteria or fungi) are present in the patient’s bloodstream. v B lood cultures are intended to: Confirm the presence of microorganisms in the bloodstream Identify the microbial etiology of the bloodstream infection 3 MAIN AIMS OF BLOOD CULTURE*: Help determine the source of • Confirm infectious etiology infection (e.g., endocarditis) • Identify the etiological agent P rovide an organism for • Guide antimicrobial susceptibility testing and optimization therapy of antimicrobial therapy * Adapted from ESCMID (European Society of Clinical Microbiology and Infectious Diseases) guidelines, 2012.7 2 Why are blood cultures important? Blood culture is the most widely used diagnostic tool for the detection of bacteremia and fungemia. It is the most important way to diagnose the etiology of bloodstream infections and sepsis and has major implications for the treatment of those patients. A positive blood culture either establishes or confirms that there is an infectious etiology for the patient’s illness.3 A positive blood culture also provides the etiologic agent for antimicrobial susceptibility testing, enabling optimization of antibiotic therapy.3 Sepsis is one of the most significant challenges in critical care, and early diagnosis is one of the most decisive factors in determining patient outcome. Early identification of pathogens in the blood can be a crucial step in assuring appropriate therapy, and beginning 4 BLOOD CULTURE ESSENTIALS effective antibiotic therapy as early as possible can have a significant impact on the outcome of the disease.8, 9 v P roviding adequate antibiotic therapy within the first 24-48 hours leads to:10-14 Decreased infection-related mortality (20-30%) Earlier recovery and shorter length of hospital stay Less risk of adverse effects Reduced risk of antimicrobial resistance Cost reduction (length of stay, therapy, diagnostic testing) Figure 1: Fast effective antimicrobial therapy increases survival chances Adapted from Kumar A, et al. Crit Care Med. 2006;34(6):1589-96.15 Total patients (%) Patient survival rate (%) 100 Patients with e ective antibiotic therapy 80 60 40 20 0 0 hours 1 2 3 4 5 6 9 12 24 36 Time to antibiotics 3 When should a blood culture be performed? Blood cultures should always be requested when a bloodstream infection or sepsis is suspected. v C linical symptoms in a patient which may lead to a suspicion of a bloodstream infection are: undetermined fever (≥38°C) or hypothermia (≤36°C) shock, chills, rigors s evere local infections (meningitis, endocarditis, pneumonia, pyelonephritis, intra-abdominal suppuration…). abnormally raised heart rate low or raised blood pressure raised respiratory rate 5 BLOOD CULTURE ESSENTIALS v B lood cultures should be collected: as soon as possible after the onset of clinical symptoms; ideally, prior to the administration of antimicrobial therapy.16 If the patient is already on antimicrobial therapy, recovery of microorganisms may be increased by collecting the blood sample immediately before administering the next dose and by inoculating the blood into bottles containing specialized antimicrobial neutralization media. 4 W hat volume of blood should be collected? The optimal recovery of bacteria and fungi from blood depends on culturing an adequate volume of blood. The collection of a sufficient quantity of blood improves the detection of pathogenic bacteria or fungi present in low quantities. This is essential when an endovascular infection (such as endocarditis) is suspected. The volume of blood that is obtained for each blood culture set is the most significant variable in recovering microorganisms from patients with bloodstream infections.17, 18 Blood culture bottles are designed to accommodate the recommended bloodto-broth ratio (1:5 to 1:10) with optimal blood volume. Commercial continuously monitoring blood culture systems may use a smaller blood-to-broth ratio ( 200 4 2 6 12.8-36.3 28-80 > 800 10 10 20 > 36.3 > 80 > 2,200 20-30 20-30 40-60 % of patient’s total blood volume 4 4 3 2.5 1.8-2.7 7 BLOOD CULTURE ESSENTIALS 5 H ow many blood culture sets should be collected? Since bacteria and fungi may not be constantly present in the bloodstream, the sensitivity of a single blood culture set is limited. Using continuous-monitoring blood culture systems, a study investigated the cumulative sensitivity of blood cultures obtained sequentially over a 24-hour time period. It was observed that the cumulative yield of pathogens from three blood culture sets (2 bottles per set), with a blood volume of 20 ml in each set (10 ml per bottle), was 73.1% with the first set, 89.7% with the first two sets and 98.3% with the first three sets. However, to achieve a detection rate of > 99% of bloodstream infections, as many as four blood culture sets may be needed.22 Figure 2: Cumulative sensitivity of blood culture sets22 Adapted from Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of Bloodstream Infections in Adults: How Many Blood Cultures Are Needed? J Clin Microbiol 2007;45:3546-3548. Detection sensitivity 100% 90% 89.7% 98.3% 80% 73.1% 70% 20 ml 40 ml 60 ml A single blood culture bottle or set should never be drawn from adult patients, since this practice will result in an inadequate volume of blood cultured and a substantial number of bacteremias may be missed.3, 22 8 BLOOD CULTURE ESSENTIALS A contaminant will usually be present in only one bottle of a set of blood culture bottles, in contrast to a true bloodstream infection, in which multiple blood culture bottles/sets will be positive. Therefore, guidelines recommend to collect 2, or preferably 3, blood culture sets for each septic episode.3, 7, 16 If 2 to 3 sets are taken and cultures are still negative after 24-48 hours incubation, and the patient is still potentially septic, 2 to 3 additional cultures may be collected, as indicated in the following diagram.16 Figure 3: Recommended number of blood culture sets Adapted from Baron EJ, Cumitech 1C, Blood Cultures IV. Coordinating ed., E.J. Baron. ASM Press, Washington, D.C. 2005 Collect 2 to 3 sets of bottles (aerobic + anaerobic) for each septic episode If culture is negative after 24-48 h incubation and patient is still potentially septic without an identified source Collect 2 to 3 additional sets of bottles (aerobic + anaerobic) If culture is negative after 24 h incubation Repeat protocol Prolong if necessary incubation Investigate non-microbial etiology 9 BLOOD CULTURE ESSENTIALS 6 W hich media to use? Microorganisms causing bloodstream infections are highly varied (aerobes, anaerobes, fungi, fastidious microorganisms…) and, in addition to nutrient elements, may require specific growth factors and/or a special atmosphere. In cases where the patient is receiving antimicrobial therapy, specialized media with antibiotic neutralization capabilities should be used. Antibiotic neutralization media have been shown to increase recovery and provide faster time to detection versus standard media.23-26 It is recommended that each adult routine blood culture set include paired aerobic and anaerobic blood culture bottles. The blood drawn should be divided equally between the aerobic and anaerobic bottles. If an anaerobic bottle is not used, it should always be replaced by an additional aerobic bottle to ensure that a sufficient volume of blood is cultured.27 v A blood culture medium must be: sensitive enough to recover: - a broad range of clinically relevant microorganisms, even the most fastidious (Neisseria, Haemophilus…) - microorganisms releasing small amounts of CO2 (Brucella, Acinetobacter…) versatile: able to provide a result for all types of sample collection (adults, infants, patients receiving antibiotic therapy, sterile body fluids…) v Which bottle should be inoculated first? If using a winged blood collection set, then the aerobic bottle should be filled first to prevent transfer of air in the device into the anaerobic bottle. If using a needle and syringe, inoculate the anaerobic bottle first to avoid entry of air. If the amount of blood drawn is less than the recommended volume*, then approximately 10 ml of blood should be inoculated into the aerobic bottle first, since most cases of bacteremia are caused by aerobic and facultative bacteria. In addition, pathogenic yeasts and strict aerobes (e.g., Pseudomonas) are recovered almost exclusively from aerobic bottles. Any remaining blood should then be inoculated into the anaerobic bottle.8 * For recommended volumes, see page 6 “What volume of blood should be collected? 10 BLOOD CULTURE ESSENTIALS 7 T iming of blood cultures Studies have shown that the time interval between collecting two blood culture samples is not considered to be a critical factor as the diagnostic yield remains the same.7 Guidelines recommend that the first two/three sets (2 bottles/set) of blood culture be obtained either at one time or over a brief time period (e.g., within 1 hour) from multiple venipuncture sites.1,16 Drawing blood at spaced intervals, such as 1 to 2 hours apart, is only recommended to monitor continuous bacteremia/fungemia in patients with suspected infective endocarditis or other endovascular (i.e., catheterrelated) infections.16 Two to three additional blood culture sets can be performed if the first 2-3 blood cultures are negative after 24-48 hours incubation in cases of severe infection or in order to increase detection sensitivity (in cases of pyelonephritis for example). This also depends on the microorganisms involved: while sensitivity is relatively good for organisms like Escherichia coli or Staphylococcus aureus, it is lower for Pseudomonas aeruginosa, streptococci or fungi.28 8 H ow to collect blood cultures Sample collection is a crucial step in the blood culture process. Standard precautions must be taken, and strict aseptic conditions observed throughout the procedure. Compliance with blood culture collection recommendations can significantly improve the quality and clinical value of blood culture investigations and reduce the incidence of sample contamination and “false-positive” readings. A properly collected sample, that is free of contaminants, is key to providing accurate and reliable blood culture results. It is recommended that blood cultures should be collected only by members of staff (medical, nursing, phlebotomist or technician) who have been fully trained and whose competence in blood culture collection has been assessed.29 11 BLOOD CULTURE ESSENTIALS 10 Key Steps to Good Sample Collection: For an illustrated step-by-step, see page 30. 1 Prior to use, examine the bottles for evidence of damage, deterioration or contamination. Do not use a bottle containing media which exhibits turbidity or excess gas pressure, as these are signs of possible contamination. 2 Check the expiry date printed on each bottle. Discard bottles that have expired. 3 S trictly follow the collection protocol in use in the healthcare setting, including standard precautions for handling blood at the bedside. 4 Blood culture bottles should be clearly and correctly labelled, including patient identification, date and collection time, puncture site (venipuncture or intravascular device). 5 E ach blood culture set should include an aerobic and an anaerobic bottle. 6 Blood for culture should be drawn from veins, not arteries.30 7 It is recommended to avoid drawing blood from a venous or arterial catheter, since these devices are often associated with higher contamination rates.31 12 BLOOD CULTURE ESSENTIALS 8 Carefully disinfect the skin prior to collection of the sample using an appropriate disinfectant, such as chlorhexidine in 70% isopropyl alcohol or tincture of iodine in swab or applicator form.1 9 Transport the inoculated bottles and the completed blood culture request to the clinical microbiology laboratory as quickly as possible, preferably within 2 hours per CLSI.1 Any delay in testing the inoculated bottles may potentially lead to an increased risk of false negative results. If delays are expected, it is important to refer to the manufacturer’s Instructions for Use (IFU) for guidance. As an example for guidance regarding delays, the ESCMID guidelines recommend that blood culture bottles for testing in continuous monitoring systems should be stored temporarily at room temperature, whereas bottles for manual testing should be incubated as soon as possible.32Again, refer to the manufacturer’s IFU for guidance. The use of vacuum tube transport systems can facilitate the rapid transmission of bottles to the microbiology laboratory. However these systems should be used with caution if using glass bottles.33 10 All blood cultures should be documented in the patient’s notes, including date, time, collection site and indications. 13 BLOOD CULTURE ESSENTIALS 9 H ow many days of incubation are recommended? The current recommendation, and standard incubation period, for routine blood cultures performed by continuous-monitoring blood systems is five days.34 However, published data suggest that three days may be adequate to recover over 97% of clinically significant microorganisms. A study by Bourbeau, et al. (JCM, 2005) showed the number of significant microorganisms isolated per day for 35,500 consecutive blood cultures collected over 30 months, of which 2,609 were clinically significant isolates and 1,097 were contaminants.35 Figure 4: Clinically significant isolates per day35 Adapted from Bourbeau PP, Foltzer M. Routine incubation of BACT/ALERT* FA and FN blood culture bottles for mo10re0t%han 3 days may not be necessary. J Clin Microbiol. 2005;43:2506-2509. 80% 74.1% 60% 40% 19.7% 20% 3.6% 1.7% 0.9% 0% Day 1 Day 2 Day 3 Day 4 Day 5 These results demonstrate that 97.4% of clinically significant isolates were recovered within the first 3 days of incubation and 93.8% within 2 days of incubation. v Incubation of Fastidious Microorganisms Another study by Cockerill, et al. (CID, 2004) demonstrated that, when using a continuous-monitoring blood culture system, 99.5% of non-endocarditis bloodstream infections and 100% of endocarditis episodes were detected within 5 days of incubation.19 This data suggests that extended incubation periods previously recommended for detection of the fastidious microorganisms* that sometimes cause endocarditis, are no longer necessary when using continuous-monitoring blood culture systems.16 * including Brucella, Capnocytophaga and Campylobacter spp., and the HACEK group (Haemophilus (except H. influenzae) species, Aggregatibacter (previously Actinobacillus) species, Cardiobacterium hominis, Eikenella corrodens and Kingella species)36 14 BLOOD CULTURE ESSENTIALS 10 I s it a contaminant or a true pathogen? Contamination of blood cultures during the collection process can produce a significant level of false-positive results, which can have a negative impact on patient outcome. A false positive is defined as growth of bacteria in the blood culture bottle that were not present in the patient’s bloodstream, and were most likely introduced during sample collection. Contamination can come from a number of sources: the patient’s skin, the equipment used to take the sample, the hands of the person taking the blood sample, or the environment. Collecting a contaminant-free blood sample is critical to providing a blood culture result that has clinical value. Certain microorganisms such as coagulase-negative staphylococci, viridansgroup streptococci, Bacillus spp, Propionibacterium spp., diphtheroids, Micrococcus spp. rarely cause severe bacterial infections or bloodstream infections. These are common skin contaminants, and a though they are capable of causing serious infection in the appropriate setting, their detection in a single blood culture set can reasonably be identified as a possible contaminant without clinical significance. However, it is important to consider that coagulase-negative staphylococci are the primary cause of both catheterand prosthetic device-associated infections and may be clinically significant in up to 20% of cases.37 The most difficult interpretation problem for the physician is whether the organism recovered from a blood culture is a true pathogen causing bloodstream infection, or a contaminant. If it is a contaminant, the patient may be treated unnecessarily with antibiotics, leading to additional patient risks. Interpretation of true pathogen versus contaminant should be based on whether the blood has been collected with a venipuncture or an intra-vascular device, and multiplicity of isolation of the same species. This illustrates the crucial nature of having collection site information included with the blood culture request sent to the laboratory. 15 BLOOD CULTURE ESSENTIALS In contrast to patients with infective endocarditis or other true positive bloodstream infections, patients whose blood cultures grow contaminants usually have only a single blood culture that is positive. This information is of great practical value for physicians, and underlines the importance of taking two to three blood culture sets from different anatomical sites.16 Contamination rates can be most effectively reduced by strict compliance with hand hygiene rules and best practices for blood collection, particularly during the stages of skin antisepsis, venipuncture and sample transfer to blood culture bottles. However, even when the best blood collection protocols are used, it may not be possible to reduce the contamination rate below 2%.38 The American Society for Microbiology and CLSI recommend targeting contamination rates not exceeding 3% of the total of collected sets.1, 16 v Impact of contamination rates A contaminated blood culture can result in unnecessary antibiotic therapy, increased length of hospitalization and higher costs. It has been found that each false positive result can lead to: Increased length of stay - on average 1 day.39 39% increase in intravenous antibiotic charges.39 $5,000 to $8,720 additional charges.40, 41 20% increase in laboratory charges.39 3 days longer on antibiotics.39 16 BLOOD CULTURE ESSENTIALS Figure 5: E xample of a laboratory-based algorithm to determine blood culture contamination42 Adapted from Richter SS, Beekman SE, Croco JL, Diekema DJ, et al. Minimizing the workup of blood culture contaminants: implementation and evaluation of a laboratory-based algorithm. J Clin Microbiol. 2002;40:2437-2444. Potential contaminant* isolated from blood culture Additional draws +/48 hours? NO YES Positive with same organism? NO YES Evaluation by qualified personnel Probable contaminant; AST** not performed unless requested Viridans group streptococci? NO YES Evaluation by qualified personnel Pathogen; set up AST† * Microorganisms such as coagulase-negative staphylococci, Streptococcus viridans, Bacillus spp, Propionibacterium spp., diphtheroids, Micrococcus spp. † AST: Antimicrobial Susceptibility Testing 17 2 SPECIAL TOPIC: INFECTIVE ENDOCARDITIS Blood culture is essential in the diagnosis of infective endocarditis (infection of the heart valves). In this elusive disease, blood cultures may need to be taken repeatedly during febrile episodes, when bacteria are shed from the heart valves into the bloodstream. For patients with infective endocarditis, positive blood cultures will be obtained in greater than 90% of cases, if optimal culture conditions are respected.43 v Acute Infective Endocarditis This is a fulminant illness progressing rapidly over days to weeks, which may be caused by highly virulent pathogens, such as Staphylococcus aureus. When suspected, the severity of this disease requires blood cultures to be drawn immediately to avoid unnecessary delays in treatment. Multiple blood culture sets should be drawn during a 30-minute period prior to administration of empiric antimicrobial therapy.44 v Subacute Infective Endocarditis If sub-acute infection is suspected, there is usually not an urgent need to initiate empiric therapy. It is more important to attempt to establish the microbiological diagnosis. Multiple blood culture sets should be obtained prior to initiation of antimicrobial therapy, with sets spaced 30 minutes to one hour apart. This may help document a continuous bacteremia, and could be of additional clinical value.3 v Fungal Infective Endocarditis Once a rare occurrence, the incidence of fungal endocarditis is increasing considerably.45 Candida species are the most common fungal pathogens involved in infective endocarditis.46 If optimum collection conditions are observed, the yield for positive blood cultures in fungal endocarditis for Candida spp. is 83 to 95%.47 18 SPECIAL TOPIC: INFECTIVE ENDOCARDITIS v How many cultures? In order to distinguish between contamination and true bacteremia, a total of three to five blood culture sets should be sufficient. Initially, two to three blood culture sets should be obtained from patients with suspected infective endocarditis. If the first 2-3 sets are negative after 24-48 hours, collect two to three more sets of cultures.3 Often patients with suspected infective endocarditis have been put on antibiotics prior to blood collection. This is the most common reason for “culture-negative” infective endocarditis. It is therefore important to use a blood culture medium that has antimicrobial neutralization capacity in order to sustain microbial growth in the presence of antibiotics (see page 10 “Which media to use?”).48,49 However, “culture-negative” endocarditis may also be due to fastidious microorganisms, such as Aspergillus spp., Brucella spp., Coxiella burnetii, Chlamydia spp. and HACEK* microorganisms. S ince current continuous-monitoring blood culture systems can recover all HACEK and other fastidious organisms within a 5-day period, extending incubation beyond this period is no longer considered to be necessary. However, if all blood culture bottles are negative after 5 days, and infectious endocarditis is still suspected, all bottles should be subcultured to chocolate agar.50 19 3 PROCESSING POSITIVE BLOOD CULTURES Today, continuously-monitored blood culture systems provide the optimum solution for blood sample processing. Generally accepted incubation periods can vary from 5-7 days, with 5 days being most popular.27 The study discussed in Figure 4 shows that 98% of all positive specimens were detected within the first 3 days (see page 14).35 Patients who progress to septic shock have a 7.6% increase in mortality every hour while not on appropriate therapy.15 Following an instrument-flagged positive event, the bottle is removed from the system and a Gram stain and subculture is performed. If the sample is Gram stain positive, the morphology of the organism should be reported immediately to the physician. Subcultures or rapid techniques (e.g., molecular diagnostics) should be initiated immediately in order to provide further organism identification and antibiotic susceptibility testing should be performed as soon as possible. If a sample is Gram stain negative, no report is made to the clinician unless there is growth on subculture. A positive blood culture is a critical result and must be reported as soon as available, due to the immediate impact on patient care decisions. When reports are delivered rapidly, studies have shown broadly improved outcomes and efficiencies in patient management.51, 52 A study by Barenfanger, et al. (Am J Clin Pathol. 2008) validated that Gram stains of positive blood cultures are a very important factor influencing appropriate therapy and patient outcomes. The study documented a statistically significant increase in the mortality rate for patients who had blood cultures processed after a delay (i.e., Gram stain performed ≥1 hour after being detected as positive; P= 0.0389). The timely removal and reporting of Gram stain results have a positive impact on patient care and this study supports the need for 24/7 coverage of blood culture instruments.53 20 PROCESSING POSITIVE BLOOD CULTURES Recent technological advances such as MALDI-TOF (Matrix-Assisted Laser Desorption Ionization Time of Flight) provide the ability to rapidly deliver definitive organism identification. Molecular diagnostics can identify the most common pathogens in positive blood cultures as well as specific antibiotic resistance genes associated with bloodstream infections. Rapid identification allows physicians to prescribe more targeted and effective antimicrobial therapy earlier to positively influence outcomes.54-56 Additionally, antibiotic susceptibility testing techniques should be performed on positive blood cultures to provide the clinician with a complete result. Appropriate use of antibiotics is crucial in cases of bloodstream infections and sepsis. Accurately determining the antimicrobial resistance profile of the causative pathogen in order to select the most effective antibiotic therapy can have a significant impact on patient outcomes. When processed correctly, blood cultures provide clinically relevant information that can help improve patient outcomes, decrease length of hospital stay and reduce use of antibiotics. 21 4 INTERPRETATION OF RESULTS The microbiology laboratory can provide useful information to clinicians to help them determine whether a blood culture sample is a true positive or a false positive (contaminant). For example, the identity of the micro- organism isolated can help determine if the culture is contaminated, and the number of Figure 6: Example of interpretation algorithm for blood culture results 1 More than one positive bottle monomicrobial culture + clinical symptoms (e.g., endocarditis, meningitis, pneumonia…) polymicrobial culture (from the appropriate clinical setting (e.g., transplants, intraabdominal infection, immunocompromized patient…) bloodstream infection probable bloodstream infection 3 Negative blood cultures but clinical symptoms 22 INTERPRETATION OF RESULTS cultures positive with the same organism can help predict true infections.57 Time to positivity is also a factor used to determine potential contamination as contaminants usually have a delayed (longer) time-to-detection due to a lower overall bio-load. Laboratories should consult with their medical director to create an algorithm which helps determine whether or not an isolated organism is a contaminant vs. an infective agent. Models, such as the algorithm below, can give guidance only on the interpretation of blood culture results.42, 57, 58 These guidelines should be used in conjunction with clinical guidelines e.g., patient’s full blood count, presence of catheters, radiological findings, etc. 2 Only one positive bottle if pathogenic organism: Listeria, S. aureus, Brucella, Haemophilus, Enterobacteriaceae, … if normal skin flora: Propionibacterium, corynebacterium, Bacillus, coagulase-negative staphylococci if viridans streptococci or coagulase-negative staphylococci and consistent with clinical setting (e.g., indwelling catheter, prosthetic heart valve, immunocompromized patient) probable bloodstream infection probable contamination probable bloodstream infection Repeat blood samples Consider non-infectious etiology Investigate viral etiology or non-culturable microorganism 23 5 BLOOD CULTURE/SEPSIS GUIDELINES v International Guidelines WHO guidelines on drawing blood: best practices in Phlebotomy. World Health Organization 2010. http://whqlibdoc.who.int/publications/2010/9789241599221_eng.pdf Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Dellinger RP., et al. Crit Care Med. 2013;41:580-637. http://www.survivingsepsis.org/guidelines/Pages/default.aspx The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Singer M., et al. JAMA. 2016;315(8):801-810. http://jama.jamanetwork.com/article.aspx?articleid=2492881 v National Guidelines COUNTRY/ REGION GUIDELINES Australia Clinical Excellence Commission. SEPSIS KILLS Adult Blood Culture Guideline Updated September 2016. SHPN (CEC) 160406. http://www.cec.health.nsw.gov.au/__data/assets/pdf_ file/0005/259412/adult-blood-culture-guideline-updated-sept2016.pdf Brazil Elmor de Araujo MR, Hemocultura: recomendações de coleta, processamento e interpretação dos resultados, J Infect Control 2012; 1: 08-19 http://www.iqg.com.br/pbsp/img_up/01355393320.pdf Europe European Society for Clinical Microbiology and Infectious Diseases, European Manual for Clinical Microbiology, 1st Edition, 2012. https://www.escmid.org/escmid_publications/manual_of_microbiology/ 24 BLOOD CULTURE/SEPSIS GUIDELINES COUNTRY/ REGION France GUIDELINES REMIC 2015. Automatisation des cultures microbiennes : quel cahier des charges ? Chapitre 11 http://www.sfm-microbiologie.org/ Germany Reinhart K, Brunkhorst FM, Bone HG, Bardutzky J, et al., Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI). German Medical Science, 2010, Vol. 8: 1-86 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899863/pdf/ GMS-08-14.pdf South Africa Guideline for the optimal use of blood cultures. SAMJ 2010; Vol. 100, No. 12: 839-843 SAMJ https://www.fidssa.co.za/Content/Documents/Guideline_for_the_optimal_use_of_blood_cultures.pdf UK UK Standards for Microbiology Investigations. Investigation of Blood Cultures (for Organisms other than Mycobacte- rium species). Bacteriology | B 37 | Issue no: 8 | Issue date: 04.11.14 | Page: 1 of 51. Issued by the Standards Unit, Health Protection Agency, PHE. https://assets.publishing.service.gov.uk/government/uploads/sys- tem/uploads/attachment_data/file/372070/B_37i8.pdf Taking blood cultures - a summary of best practice: Saving lives reducing infection, delivering clean and safe care. London: Department of Health; 2007. http://webarchive.nationalarchives.gov.uk/20120118171812/http://hcai. dh.gov.uk/files/2011/03/Document_Blood_culture_FINAL_100826.pdf USA American Society for Microbiology: Cumitech 1C, 2005 (EJ Baron et al.) ASM Press Clinical and Laboratory Standards Institute (CLSI®), document M47-A, Vol 27, 2007 (ML Wilson et al.) E mergency Nurses Association (ENA). Clinical Practice Guideline: Prevention of Blood Culture Contamination https://www.ena.org/docs/default-source/resource-library/practice-resources/cpg/bcccpg2c37f1815b664d2fa8d7e9fd0f475a41.pdf E .Septimus.CDCClinicianGuideforCollectingCultures.2015 https://www.cdc.gov/antibiotic-use/healthcare/implementation/clinicianguide.html 25 REFERENCES 1. P rinciples and procedures for Blood Cultures; Approved Guideline, CLSI document M47-A. Clinical and Laboratory Standards Institute (CLSI); Wayne, P.A. 2007 2. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet 2010;376(9749):1339–1346. 3. WSD fact sheet 2013. www.world-sepsis-day.org 4. Kumar A, Ellis P, Arabi Y, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136(5):1237-1248. 5. Singer M, Deutschmann CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. 6. Koneman EW. Color Atlas and Textbook of Diagnostic Microbiology. Third Edition. 7. European Society for Clinical Microbiology and Infectious Diseases, European Manual for Clinical Microbiology, 1st Edition, 2012 8. Garey KW, Rege M, Pai MP, Mingo DE, et al. Time to Initiation of Fluconazole Therapy Impacts Mortality in Patients with Candidemia: A Multi-Institutional Study. Clin Infect Dis. 2006;43(1):25-31. 9. Khatib R, Saeed S, Sharma M, Riederer K, Fakih MG, Johnson LB. Impact of initial antibiotic choice and delayed appropriate treatment on the outcome of Staphylococcus aureus bacteremia. Eur J Clin Microbial Infect Dis. 2006; 25(3):181185. 10. K ollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999;115(2):462-474. 11. H arbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pittet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med. 2003;115(7):529-535. 12. Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. Outcomes analysis of Delayed Antibiotic Treatment for Hospital-Acquired Staphylococcus aureus Bacteremia. CID 2003;36:1419-1423. 13. Kang CL, Kim SH, Kim HB, et al. Pseudomonas aeruginosa bacteremia: risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis. 2003; 37(6): 745-51 14. Forrest GN, Mankes K, Jabra-Rizk MA, et al. Peptide Nucleic Acid Fluorescence In Situ Hybridization Based Identification of Candida albicans and Its Impact on Mortality and Antifungal Therapy Costs. J Clin Microbiol. 2006;44(9):3381-3383. 26 15. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589-1596. 16. B aron EJ, Weinstein MP, Dunne Jr. WM, Yagupsky P, Welch DF, Wilson DM. Cumitech 1C, Blood Cultures IV. Coordinating ed., E.J. Baron. ASM Press, Washington D.C. 2005. 17. M ermel LA, Maki DG. Detection of bacteremia in adults: consequences of culturing an inadequate volume of blood. Ann Intern Med. 1993;119:270-272. 18. Bouza E, Sousa D, Rodriguez-Creixems M, Lechuz JG, Munoz P. Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections? J Clin Microbiol. 2007 45:2765-2769. 19. Cockerill FR 3rd, Wilson JW, Vetter EA, et al. Optimal testing parameters for blood cultures. Clin Infect Dis. 2004;38:1724-1730. 20. K ellog JA, Manzella JP, Bankert DA. Frequency of low-level bacteremia in children from birth to fifteen years of age. J Clin Microbiol. 2000;38:2181-2185. 21. Freedman SB, Roosevelt GE. Utility of anaerobic blood cultures in a pediatric emergency department. Pediatr Emerg Care. 2004;20(7):433-436. 22. Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of Bloodstream Infections in Adults: How Many Blood Cultures Are Needed? J Clin Microbiol. 2007;45:3546-3548. 23. Lee DH, Kim SC, Bae IG, Koh EH, Kim S. Clinical Evaluation of BACT/ALERT FA Plus and FN Plus Bottles Compared with Standard Bottles. J Clin Microbiol. 2013;51(12):4150-4155. 24. Amarsy-Guerle R, Mougari F, Jacquier H, et al. High medical impact of implementing the new polymeric bead-based BACT/ALERT FA Plus and FN Plus blood culture bottles in standard care. Eur J Clin Microbiol Dis. 2015:34(5):1031-1037. 25. Kirn TJ, Mirrett S, Reller LB, Weinstein MP. Controlled Clinical Comparison of BACT/ ALERT FA Plus and FN Plus Blood Culture Media with BACT/ALERT FA and FN Blood Culture Media. J Clin Microbiol. 2014;52(3):839-843. 26. Doern CD, Mirrett S, Halstead D, Abid J, Okada P, Reller LB. Controlled Clinical Comparison of New Pediatric Medium with Adsorbent Polymeric Beads (PF Plus) versus Charcoal-Containing PF Medium in the BACT/ALERT Blood Culture System. J Clin Microbiol. 2014;52(6):1898-1900. 27. R iley JA, Heiter BJ, Bourbeau PP. Comparison of recovery of blood culture isolates from two BACT/ALERT FAN aerobic blood culture bottles with recovery from one FAN aerobic bottle and one FAN anaerobic bottle. J Clin Microbiol. 2003;41:213-217. 27 REFERENCES 28. W einstein MP,Towns ML, Quartey SM, et al. The clinical significance of positive blood cultures in the 1990s; a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;24:584-602. 29. U K Department of Health: Taking Blood Cultures – A summary of best practice. 2007 30. W einstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis. 1996;23:40-46. 31. E verts RJ, Vinson EN, Aholla PO, Reller LB. Contamination of catheter-drawn blood cultures. J Clin Microbiol. 2001;39:3393-3394. 32. Cornaglia G, Courcol R, Hermann JL, Kahlmeter G. European Manual of Microbiology. ESCMID-SFM 2012. 33. K irm TJ, Weinstein MP. Update on blood cultures: how to obtain, process, report, and interpret. Clin Microbiol Infect. 2013;19(6):513-520. 34. W ilson ML, Mirrett S, Reller LB, Weinstein MP, Reimer LG. Recovery of clinically important microorganisms from the BACT/ALERT blood culture system does not require testing for 7 days. Diagn Microbiol Infect Dis. 1993;16:31-34. 35. Bourbeau PP, Foltzer M. Routine Incubation of BACT/ALERT FA and FN blood culture for more than 3 days may not be necessary. J Clin Microbiol. 2005;43:2506-2509. 36. S chlossberg D, ed. Clinical Infectious Disease. Cambridge University Press, 2015. 37. Hall KK, Lyman JA. Updated Review of Blood Culture Contamination. Clin Microbiol Rev. 2006,19(4):788. 38. D unne Jr. WM, Nolte FS, Wilson ML. Cumitech 1B, Blood Cultures III. coordinating ed. Hindler JA. ASM Press. Washington, D.C. 1997. 39. Hall KK, Lyman JA. Updated review of blood culture contamination. Clinical Microbiology Reviews. 2006;19:788-802. 40. Bamber AI, Cunniffe JG, Nayar D, Ganguly R, Falconer E. The effectiveness of introducing blood culture collection packs to reduce contamination. Br J Biomed Sci. 2009;66(1):1-9. 41. Gander RM, Byrd L, DeCrescenzo, Hirany S, Bowen M, Baughman J. Impact of Blood Cultures Drawn by Phlebotomy on Contamination Rates and Health Care Costs in a Hospital Emergency Department. J Clin Microbiol. 2009;47:1021-1024. 42. Richter SS, Beekman SE, Croco DJ, et al. Minimizing the workup of blood culture contaminants: implementation and evaluation of a laboratory-based algorithm. J Clin Microbiol. 2002;40:2437-2444. 43.T owns ML, Reller LB. Diagnostic methods: current best practices and guidelines for isolation of bacteria and fungi in infective endocarditis. Infect Dis Clin N Am. 2002;16:363-376. 44. Osborn TM, Nguyen HB, Rivers EP. Emergency medicine and the surviving sepsis campaign: an international approach to managing severe sepsis and septic shock. Ann Emerg Med. 2005;46:228-231. 45. R ubenstein E, Lang R. Fungal endocarditis. Eur Heart J. 1995:16(Suppl B):84-89. 46. E llis ME,Al-Abdely H, Sandridge A, Greer W,Ventura W. Fungal endocarditis: evidence in the world literature, 1965-1995. Clin Infect Dis. 2001; 32:50-62. 28 REFERENCES 47. M cLeod R., Remington JS. Fungal endocarditis. In: Rahimtoola SH et al., eds. Infective Endocarditis. New York, NY: Gune & Stratton.1978:211-290 48. Z iegler R, Johnscher I, Martus P, Lenhardt D, Just HM. Controlled Clinical Laboratory Comparison of Two Supplemented Aerobic and Anaerobic Media Used in Automated Blood Culture Systems to Detect Bloodstream Infections. J Clin Microbiol. 1998;36:657-661. 49. Pohlman JK, Kirkley BA, Easley KA, Basille BA, Washington JA. Controlled Clinical Evaluation of BACTEC Plus Aerobic/F and BACT/ALERT Aerobic FAN Bottles for Detection of Bloodstream Infections. J Clin Microbiol. 1995;33:2856-2858. 50. B aron EJ, Scott JD,Tompkins LS. Prolonged incubation and extensive subculturing do not increase recovery of clinically significant microorganisms from standard automated blood cultures. Clin Infect Dis. 2005;41:1677-1680. 51. Beekmann SE, Diekema DJ, Chapin KC, Doern GV. Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges. J Clin Microbiol. 2003;41:3119-3125. 52. Munson EL, Diekema DJ, Beekmann SE, Chapin KC, Doern GV. Detection and treatment of bloodstream infection: laboratory reporting and antimicrobial management. J Clin Microbiol. 2003;41:495-497. 53. B arenfanger J, Graham DR, Kolluri L, et al. Decreased Mortality Associated With Prompt Gram Staining of Blood Cultures. Am J Clin Pathol. 2008;130:870-876. 54. Timbrook T, Boger MS, Steed LL, Hurst JM. Unanticipated Multiplex PCR Identification of Polymicrobial Blood Culture Resulting in Earlier Isolation, Susceptibilities, and Optimization of Clinical Care. J Clin Microbiol. 2015;53(7):2371-2373. 55. Bauer KA, West JE, Balada-Llasat JM, Pancholi P, Stevenson KB, Goff DA. An Antimicrobial Stewardship Program’s Impact with Rapid Polymerase Chain Reaction Methicillin-Resistant Staphylococcus aureus/S. aureus Blood Culture Test in Patients with S. aureus Bacteremia. Clin Infect Dis. 2010;51(9):1074-1080. 56. Dierkes C, Ehrenstein B, Siebig S, Linde HJ, Reischl U, Salzberger B. Clinical impact of a commercially available multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis. BMC Infect Dis. 2009; 9(1):126 57. Weinstein MP. Blood Culture Contamination: Persisting Problems and Partial Progress. J Clin Microbiol. 2003;41:2275-2278. 58. Weinstein MP, Towns ML Quartey SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;24:584-602. 59. Ernst DJ. Applied Phlebotomy. Dennis J. Ernst (MT(ASCP)). Lippincott Williams & Wilkins, 2005. 60. Lieseke CL, Zeibig EA. Essentials of Medical Laboratory Practice. F.A. Davis, 2012. 61. Q amruddin A, Khanna N, Orr D. Peripheral blood culture contamination in adults and venipuncture technique: prospective cohort study. J Clin Pathol. 2008;61:509513. 29 RECOMMENDATIONS FOR BLOOD CULTURE COLLECTION A) USING WINGED BLOOD COLLECTION SET (preferred method of collection)59-61 1 PREPARE BLOOD COLLECTION KIT Confirm the patient’s identity and gather all required materials before beginning the collection process. Do not use blood culture bottles beyond their expiration date, or bottles which show signs of damage, deterioration or contamination. It is recommended to identify the Fill-to Mark or mark the target fill level on the blood culture bottle label about 10 ml above the media level. 2 PREPARE BOTTLES FOR INOCULATION Wash hands with soap and water then dry, or apply an alcohol hand rub or another recognized effective hand rub solution. Remove the plastic “flip-cap” from the blood culture bottles and disinfect the septum using an appropriate and recognized effective disinfectant, such as chlorhexidine in 70% isopropyl alcohol, 70% isopropyl alcohol, or tincture of iodine in swab or applicator form. Use a fresh swab/applicator for each bottle. Allow bottle tops to dry in order to fully disinfect. 30 3 PREPARE VENIPUNCTURE SITE If skin is visibly soiled, clean with soap and water. Apply a disposable tourniquet and palpate for a vein. Apply clean examination gloves (sterile gloves are not necessary). Cleanse the skin using an appropriate disinfectant, such as chlorhexidine in 70% isopropyl alcohol or tincture of iodine in swab or applicator form. The venipuncture site is not fully clean until the disinfectant has fully evaporated. 6 OTHER BLOOD TESTS If blood is being collected for other tests, an insert placed into the adapter cap may be required. The insert is used to guide blood collection tubes onto the needle. If other blood tests are requested, always collect the blood culture first. 4 VENIPUNCTURE Attach a winged blood collection set to a collection adapter cap.* To prevent contaminating the puncture site, do not re-palpate the prepared vein before inserting the needle. Insert the needle into the prepared vein. 5 CULTURE BOTTLE INOCULATION Place the adapter cap over the aerobic bottle and press straight down to pierce the septum. Hold the bottle upright, below the level of the draw site, and add up to 10 ml of blood per adult bottle and up to 4 ml per pediatric bottle.† Ensure the bottle is correctly filled to the Fill-to Mark or target fill level. Once the aerobic bottle has been inoculated, repeat the procedure for the anaerobic bottle. 7 FINISH THE PROCEDURE Discard the winged collection set into a sharps container and cover the puncture site with an appropriate dressing. Remove gloves and wash hands before recording the procedure, including indication for culture, date, time, site of venipuncture, and any complications. Ensure additional labels are placed in the space provided on the bottle label and do not cover the bottle barcodes, and that the tear-off barcode labels are not removed. If additional labels contain a barcode, they should be positioned in the same manner as the bottle barcode. Inoculated bottl
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Having a sialogram - patient information
Description
This factsheet explains what a sialogram is, what to expect at your appointment and what the possible risks are.
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Magnetic resonance imaging (MRI) arthrogram - patient information
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This factsheet explains what a magnetic resonance imaging (MRI) arthrogram is and what to expect at your appointment.
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Handling concerns and complaints policy
Description
Handling Complaints Policy, Version 13.0 Trust reference PET003 Version number 13.0 Description Policy to explain how University Hospital Southampton implements the framework for the NHS Complaints (England) Regulations 2009. It clarifies what people should expect when then complain, in accordance with Parliamentary and Health Service Ombudsman’s complaint standards. Level and type of document Target audience Trust-wide corporate policy – controlled document. Staff, patients, relatives, and carers. Author(s) (names and job titles) Policy sponsor Shona Small, Complaints Manager Jenny Milner, Associate Director of Patient Experience This is a controlled document. Whilst this document may be printed, the electronic version posted on Staffnet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from Staffnet. All documents must remain watermarked as ‘draft’ until they have been approved by the Expert Group. 1 Date Version control Author(s) Version Approval created committee 6.9.2024 Shona Small 6.9.2024 Experience of care committee Date of approval 10/7/24 Date next review due 10/7/27 Key changes made to document To bring in line with Ombudsman’s new complaint standard terminology. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 1 2 Index 1 Version control ............................................................................................................... 1 2 Index.............................................................................................................................. 2 3 Introduction .................................................................................................................... 2 4 Quick References .......................................................................................................... 3 5 Scope and purpose ........................................................................................................ 3 6 Definitions ...................................................................................................................... 4 7 Details of policy.............................................................................................................. 5 8 Roles and responsibilities ............................................................................................ 15 9 Communication and training plans ............................................................................... 15 11 Document review...................................................................................................... 16 12 Process for monitoring compliance ........................................................................... 16 13 Appendices .............................................................................................................. 17 • Appendix A ................................................................................................................. 17 • Appendix B................................................................................................................. 18 • Appendix C................................................................................................................. 18 • Appendix D................................................................................................................. 21 • Appendix E ................................................................................................................. 22 • Appendix F ................................................................................................................. 23 • Appendix G................................................................................................................. 24 • Appendix H................................................................................................................. 31 • Appendix I .................................................................................................................. 33 • Appendix J ................................................................................................................. 34 • Appendix K - Audit tool to monitor policy compliance ............................................. 35 • Appendix L ................................................................................................................. 36 14 References ............................................................................................................... 36 3 Introduction The purpose of this policy is to explain how University Hospital Southampton NHS Foundation Trust (UHS) implements the statutory legal framework for the local authority, social services and National Health Service Complaints (England) Regulations 2009, and how the Trust meets the requirements of the NHS Constitution. The policy makes clear what people should expect when they complain (NHS Constitution) and supports a culture of openness, honesty and transparency (duty of candour). Trust practice is informed by the Parliamentary and Health Services Ombudsman (PHSO) Complaint Standards and Principles of Remedy, including the Scale of Injustice. The policy deals with the handling of concerns and complaints (regarding Trust services, buildings or the environment) received from patients, patient’s relatives, carers, visitors and other service users. In most circumstances the quickest and most effective way of resolving a concern or complaint is to deal with the issues when they arise or as soon as possible after this (early resolution). PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 2 In circumstances where early resolution is not possible, this policy describes the processes in place to ensure that complaints are handled efficiently and investigated thoroughly. Patient and Family Relations (P&FR) are responsible for the overall management of complaints. P&FR combines the patient advice and liaison service (PALS) and the complaint handling functions, to provide a flexible approach to resolving complaints. The policy promotes the use of people’s experience of care to improve quality. By listening to people about their experience of healthcare, the Trust can resolve mistakes faster, learn new ways to improve the quality and safety of services, and prevent the same problem from happening again in the future. The reporting and monitoring of trends, themes and lessons learnt is undertaken through divisional governance structures, quality committee and the quality governance steering group and is used to ensure compliance with commissioner, regulatory and good practice requirements. The Trust is committed to providing safe, effective and high-quality services. However, it is recognised that things can occasionally go wrong. When complaints are raised, the Trust has a responsibility to acknowledge the complaint, put things right as quickly as possible, prevent reoccurrence and identify service improvements. Written information regarding how the Trust deals with complaints will be made available in all departments, the main reception, patient support services, the Trust website and through the local Integrated Care Bureau (ICB), The Advocacy People and other patient forums. 4 Quick References None 5 Scope and purpose The purpose of the policy is to: • Outline the Trust policy on handling complaints • Describe the procedure followed to respond to complaints • Confirm the roles and responsibility associated with this process • Provide staff with guidance on how to respond to a complaint • Describe how this policy links to the National Complaint Handling Framework o Promotes a learning and improvement culture o Positively seeks feedback o Is thorough and fair o Gives a fair and accountable decision The aim is to explain how UHS implements the statutory legal framework for the local authority social services and NHS Complaints (England) Regulations 2009, meets the requirements of the NHS Constitution and duty of candour, and ensures compliance with commissioners, regulatory and good practice requirements. The aims and outcomes of this policy promote early, local and prompt resolution involving the complainant in deciding how their complaints are handled. Likewise, good complaint handling and continuous learning is endorsed throughout the policy, promoting improvements in the quality and safety of services at UHS and facilitating positive patient experiences. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 3 Aims • To listen, to acknowledge mistakes, explain what went wrong and to consider prompt, appropriate and proportionate remedy to put things right. • To provide a consistent approach to the timely and efficient handling of complaints and establish an agreed plan with the complainant with an emphasis on early resolution, sharing learning and improving our services. • To ensure organisational openness and an approach that is conciliatory and fair to people both using and delivering services. • To respect the individual’s right to confidentiality and treat all users of this policy with respect and courtesy. Outcomes • The policy and procedure will, as far as is reasonably practical, be easy to understand, accessible, publicised in ways that will reach all service users and include information about support and advocacy services, if relevant. • All staff will receive an appropriate level of training to enable them to respond positively to complaints, and endeavour to resolve issues quickly. • The Trust will ensure that service users and carers can raise a complaint without their care, treatment or relationship with staff being compromised. • Investigations will be thorough, fair, responsive and appropriate to the seriousness of the complaint. They will also be conducted within the timescales agreed with the complainant. • The format of the response to the complaint will be agreed with the complainant. This may be verbal, by phone or at a meeting, or written, by email or letter. • The Trust will strive to resolve all complaints locally, while reminding people of their right to take the matter to the Parliamentary and Health Service Ombudsman if they are not satisfied. • Within divisions and care groups, local leadership and accountability will facilitate early resolution and ensure complaints are responded to promptly and used to initiate actions and opportunities for service and staff improvement. • Divisional governance structures will be used to ensure organisational learning from complaints and the sharing of best practice. 6 Definitions Please see Appendix A for flow chart. For the purpose of this policy, the following definition will apply: Term Everyday Conversations Early Resolution Definition Defined as every-day issues that with help can be resolved there and then (within 24 hours), without the person becoming dissatisfied and wanting to make a complaint. Defined as a more straightforward complaint that can be resolved fairly quickly (within 10 days), e.g., appointment issues, staff attitude, services not provided to expected standards. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 4 Closer Look Defined as an expression of dissatisfaction, or a perceived grievance or injustice, that needs a closer look. Timescale for resolution is agreed with the complainant. 7 Details of policy 7.0 Details of complaints process – refer to Appendix B for process overview. 7.1 Making a complaint Service users and the public who contact P&FR to make a complaint will receive appropriate assistance from the Trust to enable them to understand the procedure and, if required, will be signposted to complaint advocacy. 7.1.1 How to make a complaint – Stage 1 Information on how to raise a concern or make a complaint can be found on both our internal and external webpages. Complaints may be made about any matter reasonably connected with the exercise of the functions of the Trust, both clinical and non-clinical. They can be made verbally, in person or via telephone, or in writing either in a letter or electronically. A complaint may be raised with any member of Trust staff, P&FR (PALS or complaints team) or the chief executive. Alternatively, the complainant may choose to address their complaint to their local commissioner, NHS England, a member of parliament or another third party, such a health advocate. 7.1.2 Who may make a complaint – Stage 1 Complaints may be made by a patient, their representative, or any persons who are affected by or likely to be affected by the action, omission or decision of the Trust. This includes family, carers, advocates, care home/nursing homes, MPs, Integrated Care Bureau (ICB) and NHS England. When complaints are made by persons other than the complainant, the need for consent will be assessed. In the above circumstances where the Trust does not intend to consider a complaint, the complainant will be notified of the reasons for this decision in writing. Complainants will be made aware of independent complaints advocacy for help and support to make a complaint. Other specialist advocacy agencies covering areas such as mental health, learning disabilities, elderly or disadvantaged groups, and independent mental capacity advocacy (IMCA) are also available for general support. Details are available from PALS and the complaints team. 7.1.3 Consent if the complainant is not the patient – Stage 1 In cases where a patient’s representative makes a complaint, consent will be obtained from the patient, or person legally responsible for the patient, for permission to access their health records for the purpose of the investigation, where required, and to release the details of the investigation to the representative. If the patient is unable to act for themselves, the nominated first contact, or an individual who holds Power of Attorney (POA) for Health and Welfare can make a complaint on the patient’s behalf and will be able to provide consent for this to be investigated and the details released PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 5 to them. If the complainant is not the patient’s nominated first contact or does not hold POA, we will inform the complainant that the nominated first contact, or POA holder needs to confirm they are happy for the outcome of the investigation to be shared with another party. If the patient has died, the Trust will respect any known wishes that had been expressed by the patient. This includes sharing the outcome of an investigation with parties who are not the nominated first contact or POA holder, but in these circumstances, we will contact the nominated first contact, or POA holder to ensure they are happy for the details to be shared. In circumstances where a complaint is made by a third party when the patient has not authorised the complainant to act on their behalf, this does not preclude the Trust from undertaking a full and thorough investigation into the concerns raised. Specifically, if the complaint raises concerns about patient safety or the conduct of staff, the relevant Trust policies will be evoked. Without consent, a response to the third party will be limited and the reasons for this explained to the complainant. 7.1.4 Complaints relating to Private Patient Services For complaints relating to private patient services at UHS, the patient should refer to the private patient policy, which includes the private patient complaint’s procedure for patients wishing to raise a concern regarding their private treatment at the Trust. 7.1.5 Complaints excluded from the scope of this policy The Trust is not required to consider the complaint in the following circumstances. However, the Trust will consider each case individually and, as soon as reasonably practicable, notify the complainant in writing of its decision and the reason for the decision. a) A complaint made by a responsible body (local authority, NHS body, primary care provider or independent provider who provides care under arrangements made with an NHS body). b) A complaint by an employee of a local authority or NHS body about any matter relating to that employment. c) A complaint which has been investigated previously or either has been or is currently being investigated by the Parliamentary and Health Service Ombudsman. d) A complaint arising out of the alleged failure to comply with a request for information under the Data Protection Act 2018, or a request for information under the Freedom of Information Act 2000. Please refer to the UHS information governance policy. e) Complaints about private treatment provided in the Trust. However, any complaint made about the Trust’s staff or facilities relating to care in their private bed will be investigated under this policy. f) Lost property claims, which are investigated and handled directly by the care group manager. However, any claim for lost property made as part of a complaint will be dealt with under this policy. g) Complaints concerning incidents or events which occurred over 12 months from the date the complaint is submitted. These are seen as out of time in the NHS complaints process – see 3.2.8. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 6 7.2 Specific considerations when dealing with complaints 7.2.1 Complaints involving a vulnerable adult or child protection Where it is known that the complaint involves a vulnerable adult or child, the executive lead for child protection or vulnerable adults will be informed. The name nurse for safeguarding children or adults (as appropriate) will be consulted and contribute to the decision as to the most appropriate route of investigation agreed. This may not be the complaints procedure. The named nurse will support with advice on additional notifications and communication with the complainant. 7.2.2 Complaints that include a Patient Safety Incident Investigation (PSII) If the content of the complaint is only about the ‘event’, the patient safety team (PST) will lead and co-ordinate the PSIRF investigation, explain duty of candour and respond to the complainant. If there are matters that need to be investigated outside of PSIRF, agreement will be made between the PST and the complaints team about which elements of the investigation will not be covered by PSIRF and will need to be investigated through the complaints process. In these circumstances, the PST will notify P&FR of appropriate timescales for completion and release of their investigation. P&FR will then agree the timescale for the final complaint response with the complainant and will usually continue to be the main point of contact for the complainant. This is dependent on the nature of the incident and sometimes different arrangements are agreed at the patient safety case review meeting. If there is a need for a dual approach to the investigation, this will be explained to the complainant. Usually, a written response to the whole complaint (i.e., including both investigations) will be offered, explaining the extended period of time required for the Trust to respond. Where a written response is required, this will be produced by the P&FR with support from the PST. Where the investigation has uncovered significant failings in care and treatment, oversight of this process will be provided by the head of P&FR working in partnership with legal services, head of patient safety and Trust medical lead for complaints as appropriate. The complainant will also be offered the opportunity to meet with Trust staff to discuss the findings of the PSII and provide opportunity for Trust staff to respond to any outstanding queries. Alternatively, the complainant may choose to receive the outcome of the two investigations in separate written responses. 7.2.3 Complaints that are relating to Overseas Visitors If a patient considers that they have been charged incorrectly, they should raise this with the Overseas Visitor Manager (OVM) in the first instance to discuss on what basis they have been found to be chargeable and whether the provision of further documentary evidence is required. Where there continues to be a disagreement about how the Charging Regulations have been applied to a particular patient, the patient may want to seek the services of PALS. Where a patient is unhappy with the healthcare they have received, they or someone on their behalf and with their consent, can use the NHS complaints procedure as set out in this policy. The OVMs will ensure that the chargeable patients are aware of the complaint’s procedure. Complaints regarding charging will be fairly heard by an impartial person who is independent of the overseas visitors charging operation within the Trust. 7.2.4 Clinical negligence, personal injury or another claim. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 7 If the complainant indicates a clear intention to bring legal proceedings for clinical negligence, personal injury or other claim, the use of the complaint’s procedure is not necessarily precluded. The complaints team will discuss the nature of the complaint with the litigation and insurance services department or Trust solicitor, if required), to determine whether the progression of the complaint might prejudice subsequent legal or judicial action. If there is no legal reason why the complaint should not be investigated, the complaints team will continue to investigate the complaint in accordance with Trust policy. In cases where there are legal reasons why a complaint should not be dealt with under this policy, the complaint investigation will cease. The complainant will be advised of this fact and requested to ask their legal representative to contact the claims department. The complaints team can continue to investigate any issues raised within the complaint that are not part of the claim. 7.2.5 Disciplinary or professional investigation or investigation of a criminal offence Cases regarding professional conduct where a complaint is found to be justified may require an internal disciplinary investigation to be undertaken. Such an investigation may result in the involvement of one of the professional regulatory bodies and/or police/counter fraud team depending on the nature of the allegations. Appropriate action will be taken in accordance with the Trust disciplinary procedure. In such circumstances, the complainant will be informed that a disciplinary investigation will be undertaken but that they have no right to be informed of the outcome of the investigation. Any other issues raised in the complaint which do not form part of the disciplinary or criminal investigation may continue to be dealt with under the complaints policy. 7.2.6 Coroner’s inquest In complaints involving a death that is referred to the coroner, the PST will lead and co-ordinate the investigation. This ensures clear lines of communication and investigation for clinicians and families. The complaints team will advise the family that their concerns will be investigated by the PST in preparation for the inquest hearing and that HM coroner’s office (HMCO) will endeavour to include all concerns raised. Any separate issues can be investigated by the complaints team under the NHS complaint regulations. 7.2.7 Allegations of fraud or corruption Any complaint concerning possible allegations of fraud and corruption is passed immediately to the NHS counter fraud service for action. 7.2.8 Media interest In cases where a complainant has contacted, or expresses their intention to contact, the media, the head of communications will be informed and will take appropriate action regarding Trust communication and media management. 7.2.9 Time limit for making a complaint Normally a complaint should be made within 12 months of the date on which the matter occurred, or 12 months of the date on which the matter came to the notice of the complainant. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 8 Where a complaint is made after this time, the complaint may be investigated if the complainant had good reasons for not making the complaint within the above time limits and where, given the time lapse, it is still possible to investigate the complaint effectively and efficiently. In circumstances when a complaint is not being investigated on this basis, the complainant will be informed of the reason for that decision and advised that they may still ask the Parliamentary and Health Service Ombudsman to consider their complaint. 7.2.10 Handling of joint complaints between organisations In cases where a complaint involves more than one NHS provider, commissioner, local authority or third-party independent provider, and the complainant so wishes, the Trust will work with the other relevant organisations in seeking resolution. There is a jointly agreed protocol for the ‘Handling of NHS Inter-organisational Complaints in Hampshire and the Isle of Wight’, (Appendix C). This provides a framework for the handling of joint complaints between organisations, clarifies roles and responsibilities of organisations, enhances inter-organisation co-operation and reduces confusion for service users. The lead organisation will provide a single response on behalf of all organisations involved, ensuring that the complainant receives a seamless, effective service. The procedure for dealing with multi-agency complaints involving third party independent providers can be found at Appendix D. 7.3.11 Complaints received from nursing and care homes on behalf of their residents See Appendix E 7.3.12 Harassment and vexatious/intractable complainants Harassment Violence, racial, sexual or verbal harassment towards staff will not be tolerated; neither will language that is of a personal, abusive or threatening nature, either written or verbal. If staff should encounter this behaviour, they should seek support from their line manager and complete an adverse event form (AER). Where appropriate, the complainant will be informed in writing that their behaviour is unacceptable. Please see the UHS eliminating bullying and harassment policy. Abuse will be reported to the police. In the event that the complainant has harassed or threatened staff dealing with their complaint, all personal contact with the complainant will be discontinued. The complaint thereafter can only be pursued through written communication. Vexatious or intractable complainants In a minority of cases, people pursue their complaints in a way that can either impede the investigation of their complaint or can have a significant resource issue for the Trust and cause undue stress for staff. Unfortunately, despite patience and sympathy there are times when there is nothing further that can reasonably be done to assist them to rectify a real or perceived problem. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 9 Judgement and discretion must be used when considering potential persistent, habitual or vexatious complainants. The criteria and procedure can be found at Appendix F and authorisation of vexatious status will be made by the head of P&FR. 7.3 Responding to complaints of patients, their relatives or carers 7.3.1 Local resolution Early resolution is the first line of investigation and response to a complaint and is undertaken within the Trust. Local resolution enables the Trust to provide the quickest opportunity for a full and thorough investigation and respond with the emphasis on a positive outcome rather than the process. The local resolution response will: • Acknowledge failures. • Apologise. • Quickly put things right when they have gone wrong. • Use the opportunity to improve services. Complaints are often raised directly to the staff involved. This is often frontline staff in wards, clinics or reception. All Trust staff, as a means of improving service provision, will welcome the complainant’s concerns or complaint positively. In most circumstances, the quickest and most effective way of resolving a complaint is to deal with the issues when they arise or as soon as possible after this (early local resolution). Upon raising a complaint, the complainant will be listened to, treated courteously and have their confidentiality assured. Discussions should include seeking an understanding of how they would like their complaint managed and what outcomes they are seeking. Every opportunity should be taken to resolve complaints at the outset and deescalate the complaint. If the staff member approached is unable to deal with the issue, they will refer the matter to a more senior member of staff on duty at the time, such as ward sister, matron, head of department or site manager. A complainant may simply require an apology, explanation, clarification of a misunderstanding or remedial action to be taken and therefore should not be automatically referred to P&FR, unless this is the complainant’s wish. 7.3.2 Early resolution All complaints are first assessed by our PALS team. If possible, they will agree with the complainant to investigate to achieve early resolution, in a sooner timescale. The PALS team will investigate via the NHS complaints process and provide a written response. 7.3.3 Taking a closer look If it is not possible to achieve early resolution, the complaint is passed to the complaints team to take a closer look. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 10 • 7.3.3 Complaint assessment and acknowledgement On receipt of a complaint in the PALS or complaints team the first responsibility is to ensure that the patient’s immediate health needs are being met; ideally this will occur within 24 hours. In cases where a complaint that is being investigated under the NHS Complaint Regulations is received verbally, a transcript of the concerns should be made and sent to the complainant for agreement before the start of the investigation. The nature, complexity and seriousness of the complaint are assessed and graded using the complaint assessment tool (Appendix G). Any immediate actions are undertaken which may include, but are not restricted to, contact with Trust directors or divisional leads, PST, claims, communications, child protection, vulnerable adults, infection prevention and human resources. An assessment will also be made as to the requirement for consent to be sought before any investigation can proceed. Complaints are acknowledged within three working days, and this includes details of advocacy services and ‘Raising a concern or complaint’ (previously ‘Have your say’) leaflet detailing the Trust’s complaint process. Complaints received via email out of hours will receive an automated acknowledgement of receipt of email. The complaint handler will establish a relationship, offer an apology or empathy, clarify issues for investigation and seek to understand what resolution looks like for the complainant. They will also discuss and agree the management of the complaint, including any opportunity for early resolution, the timescales and the method of response. 7.3.4 Complaint investigation planning The nature and grade of the complaint will influence the level of investigation and the level of notification or cascade throughout the organisation. This is based on the complexity and severity score of the complaint (minimum, minor, moderate, major or severe) and the primary focus or professional group who are the subject of the complaint (medical, nursing, allied professionals, managerial or administrative). Higher graded complaints require prompt action, more robust investigations and may require the involvement of investigation contributors: • external to the division but internal to the organisation • external to the organisation The complaint handler will assess the complaint and plan the scope and approach to the investigation. This includes identifying the key staff required to contribute to the investigation (complaint investigation contributors). Where the contributors are adversely commented upon in the complaint, care is taken to ensure they are informed of the complaint by the complaint lead or line manager to ensure they receive support throughout the process. The complaint lead (CL) can add an additional level of scrutiny and modify or validate the complaint investigation plan prior to the start of the investigation, usually within three days. Staff directly involved in the complaint will not be allocated the role of complaint lead. 7.3.5 Complaint investigation Complaints will be thoroughly investigated in a manner appropriate to resolving the issues speedily and efficiently within the agreed timeframe. The complaint handler remains responsible for keeping the complainant up to date with the progress of the investigation and negotiates any necessary extensions to the agreed timeframe. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 11 For all complaints assessed as ‘severe’, if appropriate, and where possible a scoping meeting will be held by the PST to identify any immediate actions and to support investigation planning. This meeting may be virtual or face-to-face, involving the complaint lead, complaint handler and care group clinical lead or matron. The complaint lead will oversee the quality and timeliness of the investigation and validate the conclusions, outcome and actions agreed for inclusion in the complaint response. On completion of the investigation the complaint handler will review the complaint investigation to ensure that it has been thorough and addresses all the issues raised by the complainant. The complaint lead will support the complaint handler to scrutinise the findings, draw conclusions, agree the complaint outcome and consider whether there is evidence of service failure or maladministration. The compliant lead will also ensure that a robust action plan is formulated to cover all upheld elements of the complaint. 7.3.6 Complaint Response When responding to a complaint staff will give a clear, balanced account of what happened based on the established facts. Staff will be open and honest when things have gone wrong and where improvements can be made. All complaints will receive a fair and honest response. The complainant may prefer to receive this via letter, email, at a meeting or as a telephone call. The latter will usually be followed up in writing or via email. The response will address all issues raised, provide a full explanation, an apology as appropriate, any decisions regarding remedy and any actions that have or are planned to be undertaken to put the matter right. Details will also be given of what actions should be taken should the complainant believe the response has not adequately answered the issues raised. Where possible, the response will be in a format suitable for the complainant, such as large font or translation into another language. The complaint handler is responsible for producing a draft response for validation by the complaint lead once all contributors have had the opportunity to comment. The written response may take the form of a complaint response letter or a letter of apology, together with a separate investigation report or recorded audio disc. A final internal quality assurance check is undertaken before sending the response letter to the CEO or delegated deputy for signing and sending out by registered mail or secure email. A main complaint category is identified with the complainant, and this is used to determine the status of the complaint on closure by the complaint handler. Where the main category is found to be upheld, the complaint is recorded as upheld. If the main category is not upheld but some or all of the remaining categories are upheld, the complaint is closed as partially upheld. 7.3.7 Remedy If a complaint is upheld or partially upheld, the Trust will decide whether the maladministration or service failure has caused an injustice (Health Service Ombudsman’s Principles of Remedy). The Trust should, as far as is possible, put the individual back into the position they would have been in if the maladministration or service failure had not occurred. If that is not possible, the Trust should compensate appropriately. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 12 The Trust will consider suitable and proportionate financial and non-financial remedies for the complainant and, where appropriate, for others who have suffered the same injustice. An appropriate remedy may be an apology, an explanation or remedial action. Financial compensation will not be appropriate in every case but should be considered. Appropriate and proportionate financial remedy will be considered by the CGM (budget holder for the service complained about) and complaint handler in the first instance. If an agreement cannot be reached, the head of P&FR will review, make comparisons to similar cases and reach agreement for any financial remedy with the director of nursing and, where appropriate, the key internal stakeholders involved. This provides consistency in evaluating the amount of financial remedy that is fair, reasonable and proportionate to the injustice suffered. On agreement with the CGM, any financial remedy is then offered to the complainant explaining the amount, why this has been offered and who to contact to accept the offer. The governance framework includes monitoring of the decision-making processes and recording payments of financial remedy offered to complainants. This will be reported quarterly to the patient experience and engagement steering group. This policy does not relate to medico-legal claims for compensation which will be dealt with through the legal services department in conjunction with the NHSLA. 7.3.8 Re-investigation of a complaint – Stage 2 In cases where the complainant is not satisfied with the Trust response, the complaint will be re-opened, also called Stage 2. This may be because the complainant considers the initial investigation to be inadequate, incomplete or unsatisfactory, or the complainant believes that their issues have not been addressed, fully understood or new questions have been raised. The complaint will be reassessed and the issues that remain unresolved for the complainant will need to be clarified and a new complaint investigation plan agreed. The same investigative procedure will be followed. However, the Trust can decline a Stage 2 investigation if the team feel that there is nothing more to investigate, add or clarify, and believe that the Stage 1 investigation is complete. Independent advice or a second opinion may be considered on the element of the complaint that has been re-opened for investigation. Meeting with the complainant is encouraged to aid resolution of the complaint. In some circumstances, and in agreement with all parties, conciliation or mediation could also be considered. If early resolution has been completely exhausted and the complainant still remains dissatisfied, the complainant is informed of their right to go to the PHSO. 7.3.9 Stage 3: Parliamentary and Health Service Ombudsman (PHSO) & The Independent Sector Adjudication Service (ISCAS) PHSO: In cases where the Trust has been unable to resolve a complaint to the complainant’s satisfaction, the complainant has the right to refer their complaint to the PHSO for independent review. The PHSO is independent of the NHS and is appointed by the government and will undertake an independent investigation into complaints where it is considered that the Trust has not acted properly, fairly or has provided a poor service. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 13 The Trust will fully comply with all PHSO requests for information. As appropriate, divisional management teams and directors will be notified by P&FR of any complaint that is being investigated by the PHSO, or any recommendations made by them. The PHSO can be contacted at: www.ombudsman.org.uk Parliamentary and Health Service Ombudsman Millbank Tower 30 Millbank Westminster London SE1P 4QP Telephone: 0345 015 4033 ISCAS: Is a scheme that provides independent adjudication on complaints about independent healthcare providers. ISCAS CEDR, 3rd Floor 100 St Paul’s Churchyard London EC4M 8BU www.iscas.cedr.com Telephone: 0207 7536 6091 7.4 Confidentiality and record keeping 7.4.1 Confidentiality and ensuring patients, their relatives and carers are not treated differently as a result of raising a concern or complaint Information about complaints and all the people involved is strictly confidential, in accordance with Caldicott principles. Information is only disclosed to those with a demonstrable need to know or a legal right to access those records under the Data Protection Act 2018. All data will be processed in accordance with Trust policy. Complaints will not be filed on health records but maintained in a separate case file subject to the need to record any information that is strictly relevant to their health record. Complaints must not affect the patient’s/complainant’s treatment and the complainant must not be discriminated against. Any identified discrimination will be reported to HR and managed as per Trust policies. 7.4.2 Record keeping A complete documentary record will be maintained for each complaint on the Ulysses database. This will include all written or verbal contacts with the complainant, staff involved in the investigative process and all actions taken in investigating the complaint. The complaint file is a confidential record. It will be stored securely and should be easily retrieved and understood in the event of further enquiry. In accordance with the UHS records management policy 2010, complaint files are kept and disposed of confidentially. Complaint files are retained for eight years. 7.5 Support for complainant and staff See Appendix H describing roles and responsibility of staff who can provide support. 7.3.6 Process by which the organisation aims to improve as a result of concerns and complaints being raised PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 14 Every complaint received should be regarded as an opportunity to learn and improve services. 7.6.1 Development of action plans P&FR will request a completed action report (Appendix I) from the complaint investigation contributors involved in all complaints that are upheld or partially upheld. In some cases, the actions required may already be completed and documented within the complaint response. In this situation the complaint lead should inform P&FR that a separate plan is not required, and this should be recorded on the complaints database. The complaint lead or divisional governance team is responsible for validating the action plan identified within the report. The divisional director of operations (DDO), or delegated person, is responsible for ensuring the action plans arising from concerns and complaints are completed within the agreed timescales and processes are in place for the action plan to be reviewed and monitored by the local governance groups. The DDO, or delegated, is supported by the divisional governance manager (DGM). 7.6.2 P&FR - support of learning The P&FR team will support divisional complaint information hubs, allowing real time information to be accessed by divisions and care groups as to number of complaints for each clinical area and identified key themes. Each division will have an identified lead within P&FR to support development of their individual approaches to learning and they will attend divisional and care group governance with the division. See Action Plan (Appendix I). 7.6.3 Complainant feedback The P&FR will ensure every complaint response is sent out with a patient satisfaction survey and the results are monitored, reported annually to QGSG and used to consider quality improvements. 8 Roles and responsibilities Roles and responsibilities See Appendix H describing roles and responsibilities of staff involved in resolving complaints. 9 Communication and training plans Communication plan This policy will be displayed on the Trust website and Staffnet and sent to divisional management teams to ensure dissemination throughout each division to all staff groups. An introduction to complaints is provided within the staff induction programme and further training is available via the Trust VLE portal in electronic format. Bespoke face-to-face training will be provided by the P&FR team on request to all staff groups. Monitoring of this policy by P&FR team will be used to identify areas where further training may be required. 10 Equality impact assessment (for all policies only) See Appendix L and J Equality and diversity are at the heart of our Trust values. Throughout the development of the policy, we give regard to the need to eliminate discrimination, harassment and victimisation, PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 15 to advance equality or opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited in under the Equality Act 2010) and those who do not share it. As part of its development this Complaints policy and its impact on equality has been analysed and approved as being appropriate. The Policy & Guidance Team hold all equality impact assessments centrally. These are available upon request from Policy&Guidance@uhs.nhs.uk 11 Document review All Trust policies will be subject to a specific minimum review period of one year; we do not expect policies to be reviewed more frequently than annually unless changes in legislation occur or new evidence becomes available. The maximum review period for policies is every three years. The author of the policy will decide an appropriate frequency of review between these boundaries. Where a policy becomes subject to a partial review due to legislative or national guidance, but the majority of the content remains unchanged, the whole document will still need to be taken through the agreed process as described in this policy with highlighted changes. This Complaints policy will be reviewed in three years’ time in 2027. This policy will be reviewed every three years or earlier if any amendments to the NHS complaints regulations are made, or if any aspect of the policy is found to be inadequate. 12 Process for monitoring compliance The purpose of monitoring is to provide assurance that the agreed approach is being followed. This ensures that we get things right for patients, use resources well and protect our reputation. Our monitoring will therefore be proportionate, achievable and deal with specifics that can be assessed or measured. Key aspects of this policy will be monitored: Element to be monitored Lead (name/job title) Tool Frequency Reporting arrangements Compliance to NHS Complaints (England) Regulation 2009 and Parliamentary and Health Service Ombudsman’s Complaints Standards. Shona Small Measure against policies Every three years Reporting to Jenny Milner Where monitoring identifies deficiencies actions plans will be developed to address them. PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 16 13 Appendices • Appendix A Managing complaints Processing complaints in the PALS and complaints team. Complaint received into PALS & complaints team. The role of patient support officers (PSOs) and the complaint coordinator is to listen, understand concerns and risk assess situation. PSOs and/or administrator to register issue on Ulysses, consider whether consent is required, categorise concern and discuss with complainant how they would like the matter resolved. Low level to medium level of seriousness and can be resolved in 24 hours or up to 10 days Categorise as a COMPLAINT (Early Resolution) Managed by PALS manager and Patient Support Officers (PSO). • Identify actions needed. Provide feedback to care group if issues are for feedback only • Escalate any concerns to B6/B7/Matron/Consultant • Signpost to other teams/bodies where relevant, such as The Advocacy People • Investigate • Find resolution • Respond to complainant at the earliest opportunity and within 10 working days • Identify learning and share with care group Resolved – Yes • Record outcome and close case Resolved – No • Review whether complaint needs to be passed to the complaints team to take a closer look. Medium to high level of seriousness and requires investigation via the NHS complaints process. Categorise as a COMPLAINT (Taking a Closer Look) Managed by complaints team • Further risk assessment such as PST or safeguarding • Investigate in accordance with the complaints policy • Respond within agreed timescale with a Trust letter or hold complaint resolution meeting to share outcome of investigation • Identify learning and share with care group and divisional governance Resolved – Yes • Record outcome and close case on Ulysses. Resolved – No • Re-open case on Ulysses • Discuss and agree further actions or investigation plan with complainant • Respond within agreed timescale with a Trust letter or share outcome with complainant at resolution meeting Resolved – Yes • Record outcome and close case on Ulysses Resolved – No • Direct complainant to the Parliamentary and Health Service Ombudsman (PHSO) or litigation PET003 Handling Complaints Policy version 13. Issued 10.7.24 Page 17 • Appendix B Making a Complaint process There are different ways to make a complaint. It is usually easier to resolve concerns close to the time they occur by talking to the staff who are looking after you. This may be the ward manager, or matron for the department. They can discuss the things you are not happy with and will try to resolve them for you. If your concerns have not been resolved by talking to the department, you can contact the Patient Advice and Liaison Service (PALS). Their contact details are: Telephone: 023
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Engaging for increased research participation - full report
Description
Engaging for increased research participation Public and healthcare professionals' perceptions For further information contact: Chris Stock Head of R&D communications and strategy University Hospital Southampton NHS Foundation Trust T: 07795506319 / E: christopher.stock@uhs.nhs.uk Ben Hickman Research director Alterline Research T: 01616050862 / E: ben.hickman@alterline.co.uk This report presents independent research funded in part by the National Institute for Health Research (NIHR) Clinical Research Network: Wessex. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Contents 1. Executive summary 1.1. Headline findings and recommendations 1.1.1.People are positive about research and participation 1.1.2. The critical conversations are not happening 1.1.3 Healthcare professionals perceive major barriers to involvement 1.1.4 The public need information, of immediate relevance to their health 1.1.5 Time and fitting participation into life is a concern 2. Introduction and Methodology 2.1. Introduction 2.2. Key objectives 2.3. This report 2.4. Method 3. Review of the literature 3.1. General background 3.2. Why do people take part in clinical research? 3.3. What stops people from taking part in clinical research? 3.4. Why do people take part, or not take part, in related activities? 3.5. Summary 4. Likelihood to participate in clinical research 4.1. The public view clinical research as important 4.1.1. Demographic Differences 4.2. Few people have been asked to take part in clinical research 4.3. Likelihood to participate 4.3.1. Demographic differences 4.4. Likelihood to participate in various types of research 5. Motivations for taking part 5.1. Why do other people take part in clinical research? 5.2. What would motivate you to take part? 5.2.1. Demographic differences 5.3. Exploring motivations in more depth 6. Barriers to taking part 6.1. Why don't other people take part? 6.2. What stops you from taking part? 6.2.1. Demographic differences 6.3. Exploring barriers in more depth 6.4. What do people mean by the `risks' involved? 6.5. How are people forming opinions about risk? 6.6. What might reassure people? 7. The experience of taking part in clinical research 7.1.What motivated people to take part? 7.2. Would people recommend the experience? 7.3. Why would people recommend the experience? 7.4. Why would people not recommend the experience? 7.5. Knowing someone who has taken part 7.6. Why would people be more likely to take part, knowing someone who has? 7.7. Why would people be less likely to take part, having known someone who has? 4 4 4 4 4 4 5 6 6 6 7 7 8 8 9 9 10 11 12 12 12 14 15 15 16 18 18 18 19 19 22 22 22 24 24 26 27 28 29 29 29 29 31 31 31 32 Engaging for increased research participation ? key findings and recommendations 2 8. Knowledge and information 8.1. Level of understanding of clinical research 8.1.1. Demographic differences 8.2. Seeking information 8.3. What information would you need? 8.4. Media coverage 9. Healthcare professionals' perceptions of clinical research 9.1. What do healthcare professionals think of clinical research? 9.2. Who do they think are getting involved in research? 10. Motivations for getting involved in clinical research 10.1. What motivates healthcare professionals to get involved? 11. Barriers to getting involved in clinical research 11.1. What stops healthcare professionals from getting involved? 12. Research opportunities 12.1. Approaching healthcare professionals 12.2. Why are healthcare professionals approaching patients? 12.3. Why are healthcare professionals not approaching patients? 13. Availability of information 13.1. Awareness of clinical research 13.2. Finding information about clinical research 14. The future 14.1.What would make you more likely to get involved in research in the future? 14.2.What would make you more likely to get speak to patients the future? 15. Conclusions and recommendations 15.1. People are positive about research and participation 15.2. The critical conversations are not happening 15.2.1. Recommendation 1 15.3. Healthcare professionals perceive major barriers to involvement 15.3.1. Recommendation 2 15.4. The public need information, of immediate relevance to their health 15.4.1. Recommendation 3 15.5.Time and fitting participation into life is a concern 15.5.1. Recommendation 4 Appendix 1 ? Public survey demographics 33 33 33 34 34 35 37 37 38 39 39 41 41 43 43 44 44 45 45 46 47 47 48 49 49 49 49 49 49 50 50 50 51 52 Engaging for increased research participation ? key findings and recommendations 3 1. Executive summary See section 15 for summary findings and specific recommendations for increasing clinical research participation. 1.1.1 People are positive about research and participation The Wessex population views research in the NHS positively and a large proportion are open to participating: 90% of respondents think that it is important for the NHS to support research into new treatments, whilst 47% think it likely they would be willing to participate in clinical trials in the future. Those that have participated have positive perceptions, and they will likely have a significant influence on others' future participation: 80% of people who have taken part in clinical research would recommend taking part to a friend or family member, whilst around half (44%) of people who know someone who has taken part in clinical research said that they are more likely to participate now because of their experience. 1.1.2 The critical conversations are not happening Only 15% have had clinical research discussed with them by a healthcare professional in their lifetime, whilst only 5% of those who have seen healthcare professional in the last 12 months had clinical research discussed with them. Recommendation 1: Communications supporting participation in interventional trials should be focussed on enabling effective clinical conversations, with a reduced emphasis on broad public awareness approaches. 1.1.3 Healthcare professionals perceive major barriers to involvement The healthcare professionals interviewed were broadly positive about research; however they cite workload, time and lack of local trial information as constraints on discussion of research with patients. Better trial information was also identified as something that would increase the likelihood of discussing trial options with patients. Clinicians self-segregate themselves into `researchers' (an academically orientated minority) and `practitioners', with the latter positive about the benefits of clinical research and open to research referrals/facilitation but unlikely to have direct involvement in, or lead their own, research. Direct involvement in research by clinicians is limited by lack of programmed/sanctioned time within work plans, perceptions of excessive bureaucracy and lack of support. Recommendation 2: Local Clinical Research Networks, local research infrastructure and Trusts' senior leadership should support NHS clinicians' engagement with local clinical trials, and to explore management and education interventions to make communication with patients about trials a routine part of all NHS consultations. 1.1.4 The public need information, of immediate relevance to their health Public participation motivations centred on potential benefits to one's own health or that of close friends and family, whilst perceived risk of harm and receiving the `unknown' alongside concerns over time commitments and time off work were the biggest barriers to participation. Only 9% of respondents reported that they felt they understood clinical research very well, with this group the least likely to agree that risk was a significant barrier to participation. Generic online searches, condition-specific online sources of information and healthcare professionals were the primary sources of information, with a high degree of trust in the information provided by professionals. Recommendation 3: Public communications and engagement should have a greater emphasis on informing and empowering people at the point of care or enquiry, to enable discussion of trials with clinicians. Engaging for increased research participation ? key findings and recommendations 4 1.1.5 Time and fitting participation into life is a concern Concerns over time commitments needed to participate in studies, including taking time out of work and fitting such activity into daily/family life were significant barriers to participation. Recommendation 4: Changes to clinical research delivery to improve convenience and flexibility for participants, alongside interventions that lower the practical threshold to participation should be investigated and evaluated. Engaging for increased research participation ? key findings and recommendations 5 2. Introduction and Methodology 2.1 Introduction The partnership between University Hospital Southampton NHS Foundation Trust (UHS) and the University of Southampton enables clinical-academics to perform clinical research through quality assured support, facilities and resources embedded at the heart of a major teaching hospital trust. This partnership hosts, and participates in the National Institute for Health Research Clinical Research Network Wessex (NIHR CRN:Wessex), one of 15 regional CRNs that coordinate and support clinical trial activity across the UK on behalf of the NIHR. Participation in clinical research by the public, patients and clinicians is essential to advancing medicine and care, and access to such trials is a right conferred to patients under the NHS constitution1. Because of this, recruitment to trials is the primary measure by which NIHR manages performance of CRNs and their member organisations. Rapid, complete recruitment to open trials remains challenging for Trusts and CRNs nationwide, indicating a significant issue relating to public and patient engagement with trial treatment options and research participation. Against this background UHS, with match-funding from NIHR CRN:Wessex, commissioned Alterline Research Ltd. to conduct a programme of market research to better understand the perceptions, motivations and barriers to participation in clinical research across the region. This research is intended to inform more effective communication and engagement aimed at increasing participation, primarily focussed on interventional clinical research. 2.2 Key objectives The research was conducted with three audiences: ? The public (18 years and older across all demographics and geographies) ? Primary care professionals including GPs and community nurses across the region. ? Hospital clinical staff including consultants, nurses, midwives and allied health professionals across the region's trusts. The research outputs are intended to provide an evidence base to help: ? ? ? ? Shape and inform effective engagement strategies with these audiences Build an evaluation framework against which engagement can be assessed and developed for greater efficacy Ensure coherence and commonality in engagement approaches and messages across Wessex Provide a reference point and baseline data for long-term tracking and evaluation. 2.3 This report This report details findings of the research with the public and healthcare professionals, exploring their attitudes towards clinical research, their likelihood to participate and the drivers and barriers to increasing participation and recommending actions for increasing research participation. > > > 1 NHS Constitution, 2013 http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/2013/the-nhs-constitution-forengland-2013.pdf Engaging for increased research participation ? key findings and recommendations 6 2.4 Method Review of literature and pilot A review of the existing literature was conducted to help inform the design of research materials including the quantitative and qualitative questionnaires. Quantitative questionnaire development A questionnaire comprising predominantly closed questions and a small number of open-ends was developed in partnership with the Trust. Quantitative public survey by telephone In total 1101 interviews were completed by telephone using specialist computer assisted telephone interviewing (CATI) software and an automated dialler system. The interview sample for the telephone survey was sourced from a specialist data provider using relevant postcodes. In order to ensure a representative survey sample of the Wessex population interview completions were monitored by key demographics such as gender, age and location. See appendix one for details of the demographic sample. Public depth survey Following the quantitative survey, key emerging themes were used develop a qualitative, in-depth survey which was administered by telephone. In total, 30 people took part in in-depth interviews including a mix of men and women, different ages and geographies. Clinician depth survey To explore perceptions, motivations and barriers of clinicians, an in-depth survey was designed and administered by telephone. In total, 25 healthcare professionals took part in the survey, including 6 GPs, 10 nurses, and 9 hospital consultants. Analysis The quantitative survey data was exported to SPSS (Statistical Packages for Social Sciences) where it was quality checked. Frequencies and cross-tabulations exploring differences between respondents were produced and key questions were charted and included in this report. Demographic differences have been included in this report following the application of tests of statistical significance. Open-ended data was themed, with key verbatim quotes pulled out and included in the report. The in-depth interviews were audio recorded and transcriptions were made. Key themes were identified from the focus group transcripts and representative verbatim quotes have been pulled out and included in the report. Engaging for increased research participation ? key findings and recommendations 7 3. Review of the literature 3.1 General background Clinical research is central to advancing medicine, developing and evaluating medications, treatments, and practices. The purpose of this review is to examine perceptions of clinical research, willingness to participate and motivations and barriers to taking part. As the research in the area is limited, it will also look at motivations and barriers to taking part in related, voluntary activities (i.e. giving blood and organ donation) in order to identify any commonalities. Generally, reports in the literature show support for clinical research to be high. The Wellcome Trust notes that 95% of adults and 93% of 13-18 year olds think that medical research should be supported2. Further 88% of those surveyed by the National Institutes of Health3 in the USA think that clinical trials are important for advancing knowledge about treating disease. A 2011 UK national survey of 990 adults by IPSOS-MORI, commissioned by the Association of Medical Research Charities, reported similarly strong public support for research with 97% believing the NHS should support research into new treatments, whilst 93% wanted their local NHS to be encouraged or required to support research. These figures are corroborated by a 2014 national survey of 3,000 adults commissioned by the National Institute for Health research, indicating that 95% of people said it was important to them that the NHS carries out clinical research4.5. Reported willingness to participate in research is also strong. In a monitor of people's views on science and research, 60% said they would be willing to take part in clinical trials6. 72% of those polled in the 2011 AMRC survey would want to be offered opportunities to be involved in trials of new medicines or treatments if they suffered from a health condition that affects their day-to-day life; 80% would consider allowing a researcher confidential access to their medical records, and 88% would be happy to be asked to talk to researchers about their family history or give a sample of their blood for laboratory testing. 89% of people surveyed in the 2014 NIHR national survey would be willing to take part in clinical research if they were diagnosed with a medical condition or disease, with only 3% saying they would not consider it at all5. Comis et al7 report that, in relation to cancer trials, 32% of adults would be willing to take part and 38% would potentially be interested, but would hold some reservations. Further, willingness to participate is not static and much depends on the nature of the trial. For example, 74% of people would be willing to allow access to their medical records, whereas only 30% would be willing to test a new drug2. These figures showing positive perception and willingness to participate are however in stark contrast to reported and actual participation rates. In two monitors by the Wellcome Trust, lifetime participation varied from 10%6 to 23%2, whilst a further 10% of people have a family member who has taken part6. These findings support National Institute for Health Research official figures indicating that annual recruitment to clinical trials in the English NHS stands at 0.94% of the English population (2013-14 figures)8, with CRN Wessex reporting recruitment of 1.15% of the regional population in the same period9. > > > Butt, S., Clery, E., Abeywardana, V., Phillips, M. (National Centre for Social Research). Wellcome Trust Monitor 1. London: Wellcome Trust; 2010 National Institutes of Health, National Cancer Institute. (1997). Results from Quarterly Omnibus Survey: Clinical Trials Questions-April 22, 1997. Bethesda: National Cancer Institute. 4 IPSOS-MORI / Association of Medical research Cahrities J11-02572 Public support for research in the NHS, http://www.ipsos-mori.com/ researchpublications/researcharchive/2811/Public-support-for-research-in-the-NHS.aspx 5 National Institute for Health Research, 2014, http://www.crn.nihr.ac.uk/blog/news/nine-out-of-ten-people-would-be-willing-to-take-part-inclinical-research/ 6 Clemence, M., Gilby, N., Shah, J., Swiecicka, J., Warren, D. (2013). Wellcome Trust Monitor Wave 2: Tracking public views on science, biomedical research and science education. London: Wellcome Trust. 7 Comis, R.L., Miller, J.D., Aldige, C.R., Krebs, L. and Stoval, E. (2003). Attitudes toward participation in cancer clinical trials. Journal of Clinical Oncology. 21: 830-835. 2 3 Engaging for increased research participation ? key findings and recommendations 8 3.2 Why do people take part in clinical research? By far, the most reported reason for taking part in clinical research in the literature was a sense of altruism and helping others. Mattson et al10, found that 65% of participants took part for altruistic reasons. Rosenbaum et al11 noted that 46% of people who participated in clinical research reported altruism as the reasons for doing so. Of those people, just under half (45%) provided an altruistic reason as their only motivation. Those who gave altruistic reasons were more likely to have higher levels of social support, have a college education, and were less likely to say they had a disability. Specifically in cancer trials, altruism is often reported as a reason for taking part12. Jenkins et al13 report that 23% of those who consented to take part in clinical research did so because others would benefit from their participation. Many people also said that they took part because of healthcare professionals. Some report that this was because of a recommendation from their doctor3 and others report that it was through the doctor's influence that they decided to take part14. Jenkins et al13 looked solely at people who had decided to take part after being asked by their doctor. Of those who were asked, 72% decided to take part, of which 21% said it was because they trust their doctor. Further, it is apparent that some people also take part in clinical research because of the benefit that it will have to them. Such motivations include a hoping that there will be a therapeutic benefit or because there is no other treatment available12. Further, in Mattson et al10 74% of participants for aspirin and beta-blocker trials said they were motivated by non-altruistic motivations. These motivations included better medical monitoring and reassurance, physical improvement and preventions of further illness. 3.3 What stops people from taking part in clinical research? A concern about side effects and risks present a significant barrier to participation in the literature. Looking into cancer trials, a fear of making the cancer worse presented a significant barrier when being asked to participate15. Further, when testing a new drug, 93% of those with concerns in the Wellcome Trust study said they were worried about the possible risk to their own health from participating2. As with many factors, concerns about the side effects and risks of a trial are not stable across all groups. Basche et al16 spoke to seniors who were asked to participate in cancer trials. They found that those ages 65?75 were more likely to participate in the trial when the side effects were likely, than those aged over 75. Further, many studies report that issues related to the time commitment of clinical research and logistical difficulties also present a significant constraint on participation. A quarter of people asked about their attitudes to participation in clinical research said that they did not have the time to participate17. Further, a third of people in Basche et al16 said that they were concerned about the time commitment and other issues, such as getting to the trial facility. Many other barriers have been reported in the literature. These include: a dislike of randomisation13 and the potential to be in a placebo group; lack of knowledge of both the processes involved in clinical research19 and the trials that are available18, and a lack of trust in medical research19. > > > NIHR Clinical Research Network Annual Report 2013/14 http://www.crn.nihr.ac.uk/wp-content/uploads/About%20the%20CRN/13_14%20Annual%20Performance%20Report_PUBLIC_FV.pdf 9 CRN Wessex Performance Report May2014, www.odp.nihr.ac.uk/default.htm 10 Mattson, M.E., Curb, J.D., and McArdle, R. (1985). Participation in a clinical trial: The patients' point of view. Controlled Clinical Trials. 6: 156-167 11 Rosenbaum, J.R., Wells, C.K., Viscoli, C.M., Brass, L.M., Kernan, W.N., and Horwitz, R.I. (2005). Altruism as a reason for participation in clinical trials was independently associated with adherence. Journal of Clinical Epidemiology. 58: 1109-1114. 12 National Institutes of Health, National Cancer Institute, Working Group on Enhancing Recruitment to Early Phase Cancer Clinical Trials. (2004). Enhancing Recruitment to Early Phase Cancer Clinical Trials: Literature Review. Bethesda: National Cancer Institute. 13 Jenkins, V. and Fallowfield, L. (2000). Reasons for accepting or declining to participate in randomised clinical trials for cancer therapy. British Journal of Cancer. 82(11): 1783-1788. 14 Chu, S.H., Jeong, S.H., Kim, E.J., Park, M.S., Park, K., Nam, M., Shim, J.Y., and Yoon, Y. (2012). The views of patients and healthy volunteers on participation in clinical trials: An exploratory survey study. Contemporary Clinical Trial. 33: 611-619 15 Solomon, M.J., Pager, C.K., Young, J.M., Roberts, R., and Butow, P. (2003). Patient entry into randomized controlled trials of colorectal cancer treatment: Factors influencing participation. Surgery. 133(6): 608-613. 16 Basche, M., Baron, A.E., Eckhardt, S.G., Balducci, L., Persky, M., Levin, A., Jackson, N., Zeng, C., Brna, P., and Steiner, J.F. (2008). Barriers to enrollement of elderly adults in early-phase cancer clinical trials. American Society of Clinical Oncology. 4(4): 162-168 8 Engaging for increased research participation ? key findings and recommendations 9 Although little literature looks into healthcare professionals' motivations regarding clinical research, several have looked at the barriers to getting involved. The research suggests that concerns for patients represent significant barriers to participation. In in-depth interviews with clinicians in South-west England, clinicians suggested that concerns for individual patients and respect for patients' preferences for different treatments prevented them from approaching patients and getting involved20. Further, concern for patients and a worry about the impact on the doctor-patient relationship was shown to be a significant barrier in Ross et al's meta-analysis21. 3.4 Why do people take part, or not take part, in related activities? Many reasons, both similar and dissimilar to those expressed above, are noted in the literature that motivate blood and organ donation. Coad et al22 found that those who knew someone who had donated or received an organ were more likely to agree with donating an organ to a family member or friend. Further, Wildman and Hollingsworth23 note that those who have donated blood before are more likely to donate again. Further, Cohen and Hoffner24 note that self-interest explains motivations to become an organ donor. 40% said they would be willing to sign a blood donor card. Self-interest motivations were the most important predictor of willingness to sign the card, including pride and satisfaction with the decision, otherwise known as the `warm glow' feeling. A questionnaire of university students in Japan showed that being in good health, having time to donate, being given opportunity to donate and helping others were the most important motivations for those who both had given blood before and those who had not25. The same study also looked at barriers to taking part. These were very much the opposite of the motivators, and included having time to donate, not knowing when and where to donate and not being given the opportunity to donate were considered barriers to taking part25. Lack of knowing where to go and it not being in a convenient place was corroborated by a further study of American adults, as well as a fear of needles and pain26. 3.5 Summary In summary, although many people believe that clinical research is important and are willing to take part, this is not reflected in rates of participation. Reasons why people take part in clinical research include altruism, the influence of a healthcare professional and a benefit to themselves. Major barriers to participation include the risk to themselves and time commitments. Clinician barriers generally revolve around a concern for their patients. Significantly different motivators and barriers to taking part in related activities include knowing someone who has taken part, taking part before and knowing what opportunities were available. > > > Bevan, E.G., Chee, L.C., McGhee, S.M. and McInnes, G.T. (1993). Patients' attitudes to participation in clinical trails. British Journal of Clinical Pharmacology. 35(2): 204-207 18 Mills, E.J., Seely, D., Rachlis, B., Griffith, L., Wu, P., Wilson, K., Ellis, P., and Wright, J.R. (2006). Barriers to participation in clinical trials of cancer: a meta-analysis and systematic review of patient-reported factors. Lancet Oncol. 7: 141-148 19 Lovato, L.C. and Kristin, H. (1997). Recruitment for controlled clinical trials: Literature summary and annotate bibliography. Controlled Clinical Trials. 18: 328-357 20 Langley, C., Gray, S., Selley, S., Bowie, C., and Price, C. (2000). Clinicians' attitudes to recruitment to randomised trials in cancer care: A qualitative study. Journal of Health Services Research and Policy. 5(3): 164-169 21 Ross, S., Grant, A., Counsell, C., Gillespie, W., Russell, I., and Prescott, R. (1999). Barriers to participation in randomised controlled trials: A systematic review. J Clin Epidemiol. 52(12): 1143-1156 22 Coad, L., Carter, N., and Ling, J. (2013). Attitudes of young adults from the UK towards organ donation and transplantation. Transplantation Research. 2: 9-14 23 Wildman, J., and Hollingsworth, B. (2009). Blood donation and the nature of altruism. Journal of Health Economics. 28: 492-503 24 Cohen, E.L. and Hoffner, C. (2012). Gifts of giving: The role of empathy and perceived benefits to others and self in young adults' decisions to become organ donors. Journal of Health Psychology. 18(1): 128-138 25 Ngoma, A.M., Goto, A., Yamazaki, S., Machida, M., Kanno, T., Nollet, K.E., Ohto, H. and Yasumura, S. (2013) Barriers and motivators to blood donation among university students in Japan: Development of a measurement tool. Vox Sanguinis 105(3): 219-224 26 Adelbert, J.B., Schreiber, G.B., Hillyer, C.D., and Shaz, B.H. (2013). Blood donations motivators and barriers: A descriptive study of African American and white voters. Transfusion and Aphresis Science. 48(1): 87-93 17 Engaging for increased research participation ? key findings and recommendations 10 4. Likelihood to participate in clinical research 4.1 The public view clinical research as important To provide a background to people's perceptions of clinical research, we asked respondents to tell us how important they thought it was for the NHS to support research into new treatments. As figure 1 below shows, the overwhelming majority of people (90%) think that it is either important or very important. However, of those who responded to the survey, only 10% have actually taken part in clinical research. There is a clear gap between how important the area is seen to be, and how many people are taking part. Figure 1 g1 How important do you think it is, if at all, for the NHS to support research into new treatments for patients? Base: 1101 3% 6% 13% 77% Very unimportant g3 unimportant Neither important nor unimportant Important Very important 4.1.1 Demographic Differences Age Belief that supporting research is important is lowest in 18-24 year olds (73%). As people get older, they are more likely to believe that it is important, peaking at 96% for 75-84 year olds. Gender Females (95%) a more likely to say supporting research is important than males (85%). Educational attainment Those who have qualifications other than a degree are the most likely to view research as important (97%). Those who have no educational qualifications are least likely (80%). Employment status Students (90%), retired people (83%) and those who are employed (76%) are more likely to see clinical research as important, compared to those who are self-employed (69%), home-makers (67%), or gout of work and not looking for work (55%). 7 Dependents Those with dependents (96%) are more likely to view clinical research as important than those without dependents (90%). Health Those with good (80%) or very good health (80%) are more likely than those with fair (70%) or very bad (54%) to view research as very important. Previous participation Those who have participated in clinical research (99%) are more likely to say supporting research is important than those who have not (89%). g8 Knowing someone who has taken part Those who know someone who has taken part in clinical research (97%) are more likely to see supporting research as important, compared to those who don't (89%). > > > Engaging for increased research participation ? key findings and recommendations 11 g7 g7 4.2 Few people have been asked to take part in clinical research g8 g8 Importantly, of those surveyed, only 15% recalled a time when a healthcare professional had discussed involvement in clinical research with them. Further, of the 43% who had seen a healthcare professional in the last month, only 5% had clinical research discussed with them (Figure 2, below). Figure 2 Did the healthcare professional you saw discuss involvement in clinical research with you? Base: 367 5% Do you recall a time at any point in your life when a healthcare professional has discussed clinical research with you? 15% Base: 799 Yes No 95% Yes No 85% Increasing the number of conversations taking place between clinicians and their patients about clinical research is likely to increase the number of people who take part. In the in-depth interviews, people often said they reason they had not taken part before was because no-one had ever asked. "I just haven't been asked." "No-one's ever asked me." Further, previous research has shown that trust in healthcare professionals is high, with 72% of adults saying that they trust a medical professional to provide them with information about clinical research27. This was also seen in the in-depth interviews, where many respondents expressed a great deal of trust for their doctor. "So if they said `blardy blardy blah', would you take part? Then I probably would have done, because we gained that much trust." g1 "Yes I would trust them if they talked about clinical research because the consultant I've been under for four years now, my GP I've known for over 20 years now so they're people that I've known long enough to trust." 4.3 Likelihood to participate Although only 10% of people have taken part in clinical research, the results would show appetite for participation is higher than this. When respondents were asked if they would consider taking part in clinical research, just under half (47%) agreed that they would be likely or very likely to (Figure 3, below). Figure 3 How likely is it that you would be willing to participate in clinical research in the future? g3 Base: 1101 15% 16% 22% 31% 16% Very unlikely 27 unlikely Neither likely nor unlikely likely Very likely Butt, S., Clery, E., Abeywardana, V., Phillips, M. (National Centre for Social Research). Wellcome Trust Monitor 1. London: Wellcome Trust; 2010 g7 > > > 12 Engaging for increased research participation ? key findings and recommendations 4.3.1 Demographic differences The demographic differences below explore whether some people are more likely than others to participate. Characteristics of people who are more likely to participate include: ? ? ? ? ? ? ? ? ? Having previously participated (64%) or knowing someone who has (63%) Having a good understanding of clinical research (63%) Students (58%) and those unable to work (63%) Having a degree or equivalent level of education (58%) Registered organ donors (58%) People in very good health (57%) People who do regular volunteer work (55%) People who have given blood (54%) People aged 35-64 (52%). Age People aged 35-64 (52%) are most likely to agree that they would be willing to take part in clinical research, this decreases amongst 25-34s (48%), 16-24s (46%), 65-74s (49%) and in particular 75-84s (32%) and 85+ (12%). Understanding of clinical research Those who have a very good understanding of clinical research (63%) are the most likely to say they would take part in clinical research, followed by those that have some (54%), little (40%) or none (39%). Previous participation Those who have participated before (68%) are more likely to say they would be willing to take part than those who have not (45%). Knowing someone who has taken part People who know someone who has participated in clinical research (63%) are more likely to say that they are willing to take part than those who don't (44%). Educational attainment Those with a degree or a degree equivalent (58%) and those who have other qualifications (52%) are more likely than those with no qualifications (35%) to say they would take part. Employment status Students (66%), those who are unable to work (62%), and those who are employed for wages (52%) are more likely to say they are willing to take part than those who are those who are retired (37%) and out of work and looking (26%). Volunteers Those who give help as a volunteer to clubs or organisations weekly (55%), monthly (53%) or occasionally (54%) are more likely to say they are willing take part than those have volunteered in the last year (46%) and those who give unpaid help on an individual basis (36%). Giving blood People who have previously given blood (54%) are more likely to say they would participate than those who have not given blood (45%). Organ donors Those who are registered as organ donors (58%) are more likely to say they would participate than those who are not (42%). Health Those who have very good (57%), good (49%) and bad health (47%) are more likely to say they are would take part than those who have very fair (35%) or bad health (32%). > > > Engaging for increased research participation ? key findings and recommendations 13 4.4 Likelihood to participate in various types of research To expand on people's likelihood to take part, we asked people about different scenarios they would be willing to take part in. As shown in Figure 4 (below), the scenarios that might improve their own health or care are those in which people were most willing to participate . Likelihood to participate extends to 61% in the scenario where it may help prolong a respondents' own life, or where it is looking at new forms of care and exercise to regain movement after a knee injury. In contrast, the scenarios which people were least willing to take part reflected those which were at earlier stages of the research process. This may be because research into new medications or treatments is seen as riskier. Figure 4 How likely is it you would be willing to take part in clinical research if...? Base: 1101 The study might help prolong or improve your life because you have a condition, significant illness or injury The study is looking at a new form of care and exercises to regain movement after knee injury The study is observing how your condition, illness or injury develops or responds to current treatments, over time The study is looking at how the way care is given affects you and your health (e.g. care at home versus staying in hospital) The study is looking at a new medical device 9% 6% 9% 9% 9% 10% 8% 11% 12% 11% 11% 9% 9% 11% 12% 15% 17% 18% 24% 19% 22% 23% 21% 23% 24% 22% 22% 40% 42% 43% 44% 44% 39% 39% 40% 39% 21% 19% 17% 15% 14% 17% 12% 9% 10% The study is looking at a treatment at a very advanced stage of development The study is looking for healthy volunteers The study is looking at a new vaccination The study is looking at a new drug The study is looking at a treatment in the very early stages of development 11% 19% 25% 35% 10% Very unlikely Unlikely Neither likely nor unlikely Likely Very likely Engaging for increased research participation ? key findings and recommendations 14 5. Motivations for taking part 5.1 Why do other people take part in clinical research? In order to understand what motivates people to take part in clinical research, we asked respondents to tell us what they thought motivated other people to take part. The most commonly cited reasons were: ? Helping others/altruism ? A positive impact on their own health ? A personal interest in a particular disease/condition. 5.2 What would motivate you to take part? To look into motivations further, we asked people what would motivate them (rather than others) to take part in clinical research. When people are speaking about their own motivations, they tend to agree more with statements which are related to personal motivations, i.e. helping to improve their own, or a close relative's, health. However, altruistic motivations are still important, with 72% agreeing that they would be motivated by helping others. Respondents also indicated that other things would motivate them, beyond those factors seen earlier. Knowing that aftercare would be available (67%) and an interest in a particular disease (67%) are both seen as important to respondents. Just 32% of respondents said that money would motivate them to take part. Figure 5 To what extent do you agree or disagree that the following would motivate you to take part in a clinical trial? Base: 1101 g5 Supporting research into a condition a close family member suffers from A positive impact on my own health Getting access to the latest treatments for a condition I have Helping others by helping to find new treatments Knowing that there would be continued aftercare and follow-up A personal interest in a particular disease / condition I would find the process of being involved interesting Money / financial gain 6% 5% 12% 6% 5% 6% 5% 6% 7% 7% 6% 7% 8% 8% 10% 13% 15% 15% 19% 17% 22% 36% 42% 48% 44% 51% 45% 44% 47% 15% 35% 28% 30% 21% 22% 23% 14% 25% 7% 17% Strongly disagree Disagree g6 Neither agree nor disagree Agree Strongly agree > > > Engaging for increased research participation ? key findings and recommendations 15 5.2.1 Demographic differences Understanding of clinical research Those who have no understanding of clinical research (58%) are the least likely to agree that they would be motivated by getting the latest access to treatment for a condition they have. Age 35-44 year olds (76%) are more likely to agree that they would be motivated by helping others by finding new treatments than 16-24 (70%) and 25-34 (64%) year olds. 34-44 (86%), 44-54 (85%) and 55-64 (84%) years olds are more likely to agree that they would be motivated by a positive impact on their own health than 16-24 (64%), 25-34 (70%) and 75-84 (64%) year olds. 35-44 (77%), 45-54 (80%) and 55-64 (78%) year olds are more likely to agree that they would be motivated by getting access to the latest treatment for a condition they have than 16-24 (64%), 25-34 (67%), 75-84 (70%) and 85+ (53%) year olds. Gender Women (80%) are more likely than men (75%) to agree that supporting research into a condition a close family member suffers from would motivate them to take part. Educational attainment Those with a degree of degree equivalent and those with other qualifications are more likely than those who have no qualifications to say they are motivated by helping others by helping to find new treatments, a positive impact on their own health, getting access to the latest treatment for a condition they have and supporting research into a condition a close family member suffers from. Employment status Students (90%) are more likely to agree that they are motivated by helping others by helping to find new treatments than those who are employed (76%), self-employed (70%), retired (66%) and out of work and looking (50%). Employed persons (77%) are more likely to be motived by getting access to the latest treatment for a condition they have than those who are retired (71%). Students (96%) are more likely than any other group to strongly agree that they are motivated by supporting research into a condition a close family member suffers from. 5.3 Exploring motivations in more depth When exploring what would motivate people to take part some clear themes emerged from both the open survey questions and the in-depth interviews,. The key motivations are summarised below. It would have a positive impact on my own health Many felt that they would be motivated to participate because it may have a positive impact on their own health. "I've got a few health problems so I would like to take part to see if there any treatments or information in regards to arthritis that would help me" "I have arthritis - anything new to improve life or find a cure." "Finding a drug that helps me." "If anybody could help me with my lifestyle and my health, I'm in a lot of pain, I'm overweight, so that would help." Although some people who responded did not currently suffer from a condition, they suggested they would be motivated to take part if they did and it would help that condition. "I still think the key motivation for me to do it would be if there was something detrimental to my health or something for my health and well-being to improve my lifestyle." "Of course I would, if I had a condition that required treatment and was offered something that would alleviate that." > > > Engaging for increased research participation ? key findings and recommendations 16 Further, some suggested that they would take part as a last resort if nothing else would help their condition. "If I had something that was as of yet untreatable I'd give it a go, but otherwise no." "If I was in an unfortunate situation of having a life threatening illness then I tend to think you grasp at anything." Altruistic motivations and helping the people around me A willingness to help with clinical research relating to a condition that those close to them suffer from was evident in people's responses. "Because my mother has dementia." "In recent years a lot of people I know have suffered from cancer and arthritis." "I suppose its family history, we have had a run in with cancer so I suppose we would be interested in getting involved." "My son's diabetic, anything that would help." Respondents also suggested that they were motivated by a more general altruistic sense of helping others. "Because I want to help people." "If it helps give people a better life." "It's being out there trying to help somebody that is unable to help themselves." It will help advance medical science Some respondents expressed that they would be likely to take part because it may help improve medicine and medical science. "Because it is interesting and it helps the process of medical science." "I feel if people don't participate then science will not advance, for everyone's benefit." "It is important to help the development of medicine and if people aren't helping then there would be no progress and it wouldn't get anywhere." I would find it interesting Respondents said that they would be motivated to take part in various types of trials because they found it interesting. "I find that really quite interesting, I quite like a bit of psychology myself, I'd like to see what goes on in their heads to make it go one way or the other." "Yeah that's a fascinating thing, it's just so clever!" "I'm quite interested in exercise and diet." "Because it would be interesting to see how your health can be affected by those types of things." > > > Engaging for increased research participation ? key findings and recommendations 17 Because I've taken part before Those who had already taken part in clinical research suggested they would again because of their previous experience. "Previous experience in a clinical trial." "Already have been part of a clinical trial for cancer. So far it is a beneficial experience." "I have already taken part and thought it helped." "I have previously been part of a clinical trial and had a good experience." Money Earning money through participating was a clear motivation for a minority of people. "Depending on what the cash incentive was. I wouldn't participate in it if there was no financial gain because of the dangers behind it." "It would depend what it was in aid of and if it was for money." "If there was a large pay out I would take part." Engaging for increased research participation ? key findings and recommendations 18 6. Barriers to taking part 6.1 Why don't other people take part? We also looked into the barriers to taking part in clinical research. When asked what may stop other people from taking part, respondents mentioned: ? Being worried about the risks ? Lack of knowledge/information ? Lack of time to be involved. 6.2 What stops you from taking part? In order to explore this further, respondents were asked what would stop them personally (rather than others) from taking part. Respondents' answers reflected concerns about the risks involved in clinical research, a lack of knowledge and information, and practical issues with time and having to take time off work. When prompted, it was clear that there were other issues which concerned respondents. For some, the involvement of private drug companies (33%) and stories they have seen in the media (31%) would stop them from taking part in clinical research. Figure 6 To what extent do you agree or disagree that the following would stop you from taking part in a clinical trial? Base: 1101 g6 I'm worried about the risks g5 4% 11% 8% 7% 10% 12% 10% 20% 24% 28% 27% 32% 19% 19% 19% 28% 25% 42% 32% 35% 32% 25% 25% 19% 16% 32% 46% 14% 15% 14% 10% 6% 8% 6% 6% 5% 5% I might need to take time off work I don't have time to participate I don't know enough about clinical trials The involvement of a private drug company Stories I have seen in the media I wouldn't pass the medical screening test 37% 32% 44% 34% 20% 34% My family and friends would disapprove I'm not the type of person the NHS want to participate in clinical trials My religious or moral beliefs 18% 12% 25% 17% 16% 11% 5% Strongly disagree Disagree g9 Neither agree nor disagree Agree Strongly agree > > > Engaging for increased research participation ? key findings and recommendations 19 6.2.1 Demographic differences Understanding of clinical research Those who have a very good understanding (41%) are the least likely to agree they are worried about the risks, rising with some understanding (55%), little understanding (60%) and no understanding (62%). Those who have no (50%) or little understanding (48%) are more likely to agree that they don't have the time to take part than those with some (40%) or very good understanding (37%). Age Those aged 85+ (70%) are the most likely to say that not knowing enough about clinical research stops them from taking part. Those ages 75-84 (43%) and 85+ (59%) are the most likely to think that they are not the type of people the NHS want to take part. Gender Women (62%) are more likely to say that a worry about the risks would stop them from participating than men (52%). Women (48%) are also more likely to worry about needing time of work than men (43%). Educational attainment Those with no qualifications are least likely to agree that they are worried about the risks of participating (50%), that they don't have the time to participate (39%), and that they may need to take time off work (33%). However, this group are the most likely to agree (27%) that they are not the type of person the NHS wants to participate. Employment status Those who are unable to work are least likely to agre
Url
/Media/Southampton-Clinical-Research/Marketresearch/Engaging-for-increased-research-participation-full-report-v2.pdf
Papers Trust Board - 13 January 2026
Description
Date Time Location Chair Apologies Agenda Trust Board – Open Session 13/01/2026 9:00 - 13:00 Conference Room, Heartbeat Education Centre Jenni Douglas-Todd Diana Eccles 1 Chair’s Welcome, Apologies and Declarations of Interest 9:00 Note apologies for absence, and to hear any declarations of interest relating to any item on the Agenda. 2 Patient Story The patient story provides an opportunity for the Board to reflect on the experiences of patients and staff within the Trust and understand what the Trust could do better. 3 Minutes of Previous Meeting held on 11 November 2025 9:15 Approve the minutes of the previous meeting held on 11 November 2025 4 Matters Arising and Summary of Agreed Actions To discuss any matters arising from the minutes, and to agree on the status of any actions assigned at the previous meeting. 5 QUALITY, PERFORMANCE and FINANCE Quality includes: clinical effectiveness, patient safety, and patient experience 5.1 Briefing from the Chair of the Finance, Investment & Cash Committee 9:20 David Liverseidge, Chair 5.2 Briefing from the Chair of the People and Organisational Development 9:30 Committee Jane Harwood, Chair 5.3 Briefing from the Chair of the Quality Committee 9:40 including Maternity and Neonatal Safety 2025-26 Quarter 2 Report Tim Peachey, Chair 5.4 Chief Executive Officer's Report 9:50 Receive and note the report Sponsor: David French, Chief Executive Officer 5.5 Performance KPI Report for Month 8 10:20 Review and discuss the report Sponsor: Andy Hyett, Chief Operating Officer 5.6 11:00 5.7 11:15 5.8 11:25 5.9 11:30 5.10 11:45 5.11 11:55 5.12 12:05 5.13 12:15 6 6.1 12:25 7 12:35 8 Break Finance Report for Month 8 Review and discuss the report Sponsor: Ian Howard, Chief Financial Officer ICB System Report for Month 8 Receive and discuss the report Sponsor: Ian Howard, Chief Financial Officer People Report for Month 8 Review and discuss the report Sponsor: Steve Harris, Chief People Officer Learning from Deaths 2025-26 Quarter 2 Report Review and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: Jenny Milner, Associate Director of Patient Experience Infection Prevention and Control 2025-26 Quarter 2 Report Review and discuss the report Sponsor: Natasha Watts, Acting Chief Nursing Officer Attendees: Julian Sutton, Clinical Lead, Department of Infection/Julie Brooks, Deputy Director of Infection Prevention and Control Medicines Management Annual Report 2024-25 Receive and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: James Allen, Chief Pharmacist Annual Ward Staffing Nursing Establishment Review 2025 Discuss and approve the review Sponsor: Natasha Watts, Acting Chief Nursing Officer CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL Annual Assurance for the NHS England Core Standards for Emergency Preparedness, Resilience and Response (EPRR) Review and discuss the report Sponsor: Andy Hyett, Chief Operating Officer Attendee: John Mcgonigle, Emergency Planning & Resilience Manager Any other business Raise any relevant or urgent matters that are not on the agenda Note the date of the next meeting: 10 March 2026 Page 2 9 Resolution regarding the Press, Public and Others Sponsor: Jenni Douglas-Todd, Trust Chair To agree, as permitted by the National Health Service Act 2006 (as amended), the Trust's Constitution and the Standing Orders of the Board of Directors, that representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. 10 Follow-up discussion with governors 12:45 Page 3 Agenda links to the Board Assurance Framework (BAF) 13 January 2026 – Open Session Overview of the BAF Risk 1a: Lack of capacity to appropriately respond to emergency demand, manage the increasing waiting lists for elective demand, and provide timely diagnostics, that results in avoidable harm to patients. 1b: Due to the current challenges, we fail to provide patients and their families / carers with a high-quality experience of care and positive patient outcomes. 1c: We do not effectively plan for and implement infection prevention and control measures that reduce the number of hospital-acquired infections and limit the number of nosocomial outbreaks of infection. 2a: We do not take full advantage of our position as a leading University teaching hospital with a growing, reputable, and innovative research and development portfolio, attracting the best staff and efficiently delivering the best possible treatments and care for our patients. 3a: We are unable to meet current and planned service requirements due to the unavailability of staff to fulfil key roles. 3b: We fail to develop a diverse, compassionate, and inclusive workforce, providing a more positive staff experience for all staff. 3c: We fail to create a sustainable and innovative education and development response to meet the current and future workforce needs identified in the Trust’s longer-term workforce plan. 4a: We do not implement effective models to deliver integrated and networked care, resulting in sub-optimal patient experience and outcomes, increased numbers of admissions and increases in patients’ length of stay. 5a: We are unable to deliver a financial breakeven position, resulting in: inability to move out of the NHS England Recovery Support Programme, NHS England imposing additional controls/undertakings, and a reducing cash balance impacting the Trust’s ability to invest in line with its capital plan, estates/digital strategies, and in transformation initiatives. 5b: We do not adequately maintain, improve and develop our estate to deliver our clinical services and increase capacity. 5c: Our digital technology or infrastructure fails to the extent that it impacts our ability to deliver care effectively and safely within the organisation, 5d: We fail to prioritise green initiatives to deliver a trajectory that will reduce our direct and indirect carbon footprint by 80% by 2028-2032 (compared with a 1990 baseline) and reach net zero direct carbon emissions by 2040 and net zero indirect carbon emissions by 2045. Agenda links to the BAF No Item Linked BAF risk(s) 5.5 Performance KPI Report for Month 8 5.7 Finance Report for Month 8 5.8 ICB System Report for Month 8 5.9 People Report for Month 8 5.10 Learning from Deaths 2025-26 Quarter 2 Report 5.11 Infection Prevention and Control 2025-26 Quarter 2 Report 5.12 Medicines Management Annual Report 2024-25 5.13 Annual Ward Staffing Nursing Establishment Review 2025 6.1 Annual Assurance for the NHS England Core Standards for Emergency Preparedness, Resilience and Response (EPRR) 1a, 1b, 1c 5a 5a 3a, 3b, 3c 1b 1c 1b 1b, 3a 1b Appetite (Category) Minimal (Safety) Current risk rating 4x5 20 Cautious (Experience) Minimal (Safety) 4x4 16 4x4 16 Open (Technology & Innovation) 3x4 12 Open (workforce) Open (workforce) Open (workforce) 4x5 20 4x3 12 4x4 16 Cautious (Effectiveness) 3x3 9 Cautious (Finance) 5x5 25 Target risk rating 4 x 2 Apr 6 27 3 x 2 Apr 6 27 2 x 3 Apr 6 27 3 x 2 Mar 6 27 4 x 3 Mar 12 30 4 x 2 Mar 8 30 3 x 2 Mar 6 29 3 x 2 Dec 6 25 3 x 3 Apr 9 30 Cautious (Effectiveness) Open (Technology & Innovation) Open (Technology & Innovation) 4x5 20 3x4 12 2x4 8 4 x 2 Apr 8 30 3 x 2 Apr 6 27 2 x 2 Dec 4 27 Does this item facilitate movement towards or away from the intended target risk score and appetite? Towards Away Neither x x x x x x x x x Minutes Trust Board – Open Session Date 11/11/2025 Time 9:00 – 13:00 Location Conference Room, Heartbeat Education Centre Chair Jenni Douglas-Todd (JD-T) Present Diana Eccles, NED (DE) Keith Evans, Deputy Chair and NED (KE) David French, Chief Executive Officer (DAF) Paul Grundy, Chief Medical Officer (PG) Steve Harris, Chief People Officer (SH) Jane Harwood, NED/Senior Independent Director (JH) Ian Howard, Chief Financial Officer (IH) Andy Hyett, Chief Operating Officer (AH) David Liverseidge, NED (DL) Tim Peachey, NED (TP) Alison Tattersall, NED (AT) Natasha Watts, Acting Chief Nursing Officer (NW) In attendance Craig Machell, Associate Director of Corporate Affairs and Company Secretary (CM) Lauren Anderson, Corporate Governance and Risk Manager (LA) (item 6.2) Martin de Sousa, Director of Strategy and Partnerships (MdS) (item 6.1) Lucinda Hood, Head of Medical Directorate (LH) (item 5.13) Diana Hulbert, Guardian of Safe Working Hours and Emergency Department Consultant (DH) (item 5.12) Vickie Purdie, Head of Patient Safety (VP) (item 7.3) Kate Pryde, Clinical Director for Improvement and Clinical Effectiveness (KP) (item 5.13) Scott Spencer, Health and Safety Advisor (SS) (item 7.3) 4 governors (observing) 2 members of staff (observing) 1. Chair’s Welcome, Apologies and Declarations of Interest The Chair welcomed attendees to the meeting. There were no interests to declare in the business to be transacted at the meeting. It was noted that no apologies had been received. The Chair provided an overview of meetings she had held and events that she had attended since the previous Board meeting. 2. Patient Story Item deferred to the next meeting. 3. Minutes of the Previous Meeting held on 9 September 2025 The draft minutes tabled to the meeting were agreed to be an accurate record of the meeting held on 9 September 2025, subject to a minor correction at 5.10. Page 1 4. Matters Arising and Summary of Agreed Actions The matters arising and actions were noted. • Actions 1281, 1283 and 1284 were closed. • Action 1282 was to be addressed through item 5.6 below. • In respect of action 1285, the Quality Committee would monitor progress on complaints response times. 5. QUALITY, PERFORMANCE and FINANCE 5.1 Briefing from the Chair of the Audit and Risk Committee Keith Evans was invited to present the Committee Chair’s Report in respect of the meeting held on 13 October 2025, the content of which was noted. It was further noted that: • In terms of the internal audit reports, which had been received by the committee, whilst there were a number of points for the Trust to address, no areas of significant concern had been identified. • There was a focus on ‘imposter fraud’ whereby individuals who had turned up to carry out a shift were not who they claimed to be. Whilst there had been no reported incidents at the Trust, the Trust had implemented controls at the ward level, which would be subject to testing during 2025/26. 5.2 Briefing from the Chair of the Finance, Investment & Cash Committee David Liverseidge was invited to present the Committee Chair’s Reports in respect of the meetings held on 22 September and 3 November 2025, the contents of which were noted. It was further noted that: • In September 2025, the Trust had reported that it was in line with its Financial Recovery Plan. Of the £110m Cost Improvement Programme (CIP) target, 76% had been fully developed. • The committee had reviewed the Finance Report for Month 6 (item 5.8), noting that the Trust had reported an in-month deficit of £5.4m, which was in line with the Financial Recovery Plan. • The committee had expressed concern that 17% of the CIP target was not fully developed and that the Trust was £2.5m off-track in terms of delivery of the target at Month 6. • Whilst progress had been made in terms of addressing patients with no criteria to reside and mental health patients, this remained an area of concern. • The committee considered the NHS England Medium Term Planning Framework, noting that the first submission by the Trust was due prior to Christmas 2025. 5.3 Briefing from the Chair of the People and Organisational Development Committee Jane Harwood was invited to present the Committee Chair’s Reports in respect of the meetings held on 22 September and 3 November 2025, the contents of which were noted. It was further noted that: • There continued to be little improvement in terms of the number of patients with no criteria to reside or mental health patients, which impacted staffing numbers. • The Trust was adopting a harder line in respect of its approach to violence and aggression, which included a greater willingness to exclude individuals. • The current participation rate in the Staff Survey was lower than the national average, which was likely indicative of staff morale and engagement. Page 2 • The Trust’s workforce numbers remained above plan, with limited options available to address this issue, especially in the absence of funding for restructuring costs. 5.4 Briefing from the Chair of the Quality Committee Tim Peachey was invited to present the Committee Chair’s Report in respect of the meeting held on 13 October 2025, the content of which was noted. It was further noted that: • The committee received an update in respect of mental health patients, noting that although there were significant issues in the Emergency Department, the whole pathway for these patients remained a problem. • The committee carried out a six-monthly review of the Trust’s progress against its Quality Priorities, noting that good progress had been made on four of the six priorities and two were slightly behind. 5.5 Chief Executive Officer’s Report David French was invited to present the Chief Executive Officer’s Report, the content of which was noted. It was further noted that: • NHS England had published the Medium Term Planning Framework, which was intended to encourage organisations to think beyond a 12-month time horizon and to progress the NHS 10-Year Plan. The Trust was expected to provide its first submission prior to Christmas 2025, but the detailed planning assumptions had yet to be received from NHS England. It was noted that a more detailed report on the Medium Term Planning Framework was to be received as part of the closed session of the meeting. • The Strategic Commissioning Framework had been published by NHS England, which provided welcome clarifications about the future role of integrated care boards. • The Trust had been placed into Tier 1 for both Urgent and Emergency Care and for Elective performance. There was a national expectation that trusts would have no patients waiting over 65 weeks for elective care by 21 December 2025. Where organisations had more than 100 such patients at the end of October 2025, they had been placed into Tier 1. The Trust was taking steps, including mutual aid, to attempt to address the number of long waiters, but there was insufficient capacity in the system. • Resident doctors were due to strike for a further five-day period commencing on 14 November 2025, having rejected the Government’s latest offer to resolve the ongoing dispute with the British Medical Association. • The Hampshire and Isle of Wight Integrated Care Board and NHS England South East Region had carried out a visit to the Trust’s paediatric hearing services in May 2025. The report, received in October 2025, had been positive about the service. • The Trust and the University of Southampton had been awarded £16.3m by the National Institute for Health and Care Research. The Trust was one of only four organisations out of 15 applications to receive an award. • The NHS Business Services Authority had announced the award of a £1.2bn contract to Infosys to deliver a new and enhanced workforce management system for the NHS to replace the existing Electronic Staff Record system. The 2030 target date for implementation was considered ambitious. Further details would be considered by the People and Organisational Development Committee when available. Page 3 5.6 Performance KPI Report for Month 6 Andy Hyett was invited to present the ‘spotlight’ report in respect of Diagnostics, the content of which was noted. It was further noted that: • Diagnostics performance was a key element of the pathway, as delays in diagnosis had a consequential impact on the overall length of pathways such as those for cancer and patients on a Referral To Treatment pathway. • Although there were some concerns with Diagnostics in the Trust, the Trust, generally, performed better than other organisations. The Board discussed the matters raised in the Diagnostics ‘spotlight’. This discussion is summarised below: • There had been a long-standing issue with waiting times for cystoscopy due to insufficient capacity. However, a plan was being developed to improve the situation, although it was considered appropriate that the plan should also address broader issues with urology as a whole. • There was concern regarding the availability of magnetic resonance imaging (MRI) scanners, particularly as two scanners were out-of-action. It was noted that the current set-up in terms of MRI scanners was not fit for the longer term and a strategy for the future needed to be developed. • There was a disparity between capacity and demand in respect of the neurophysiology service, as this service had previously relied on outsourcing. • Generally, activity was increasing, but overall performance appeared to be declining. There was also the additional financial challenge that Diagnostics was funded under a ‘block’ contract arrangement which did not fully take into account the demand for these services. • There were concerns about the electrical supply capacity at the Southampton General Hospital site and the ability of the Trust to expand its Diagnostic capacity with this limitation. It was considered that a better longer-term model would be for scanners at local community diagnostics centres. Actions Andy Hyett agreed to work on and present at either a future Board meeting or Trust Board Study Session the Trust’s longer-term strategy with respect to MRI scanners and imaging. Andy Hyett agreed to develop a longer-term plan for cystoscopy/urology and to report back to the Board during Quarter 4. Andy Hyett agreed to develop a long-term solution to the neurophysiology service. Andy Hyett was invited to present the Performance KPI Report for Month 6, the content of which was noted. It was further noted that: • The Trust’s Emergency Department had recorded performance of 67.6% against the four-hour standard during September 2025. The department remained busy with c.450 patients and 120 ambulance attendances per day. • There had been some initial performance impacts with the roll out of the MIYA system in the Emergency Department, but this appeared to have now been addressed with performance up to previous levels. • A number of initiatives were being introduced into the Emergency Department in order to improve performance. These included the layout of the service, pathway re-designs, having General Practitioners in the department, and arranging with non-urgent patients to attend at a scheduled time rather than waiting in the department. Page 4 • In October 2025, the Trust had recorded 363 patients waiting over 65 weeks on a Referral To Treatment pathway against a national target of no such patients by the end of December 2025. • The Trust was making use of the independent sector, weekend working, and was requesting capacity from other providers to address the number of patients waiting over 65 weeks. • The planned industrial action by resident doctors posed a challenge, noting that the national expectation was that trusts maintain 95% of their capacity during this period. It was noted that, in contrast to previous instances of industrial action, resident doctors were apparently less forthcoming in terms of whether they intended to participate in the industrial action. • The Trust continued to report one of the lowest Hospital Standardised Mortality Rates in England. • The Trust’s cancer performance, based on a BBC article, was 21 out of 121 trusts. It was noted that whilst the number of patients being referred on a cancer pathway had increased significantly, the number of patients diagnosed with cancer had not materially changed. • There appeared to have been an increase in the number of pressure ulcers and ‘red flag’ incidents. Work was ongoing to address the findings of the pressure ulcer audit which had been presented to the Quality Committee on 2 June 2025. • The number of patients having no criteria to reside and mental health patients remained high. Actions Andy Hyett agreed to clarify the basis of the calculation of the ‘Watch & Reserve antibiotics usage per 1,000 adms’ metric. 5.7 Break 5.8 Finance Report for Month 6 Ian Howard was invited to present the Finance Report for Month 6, the content of which was noted. It was further noted that: • The Trust had submitted its Financial Recovery Plan to NHS England in August 2025, which committed to an additional £23m improvement in the Trust’s financial position to deliver a full-year position of a £54.9m deficit. In the absence of these additional improvements, the Trust had been forecasting a year-end position of a £78m deficit. The revised target was subject to a number of assumptions, including the need for demand management and improvements in non-criteria to reside and mental health patient numbers. • There were a number of risks to the achievement of the Financial Recovery Plan, including whether there would be improvements in mental health and non-criteria to reside and/or steps taken to manage demand, high levels of activity, and whether it would be possible to reduce the workforce and close theatres. The need for the Trust to focus on achieving the 65-week wait target in particular could impact the Trust’s ability to close capacity. • The Trust had reported an in-month deficit of £5.4m (£30.8m year-to-date), which was in line with the trajectory set out in the Financial Recovery Plan. The Trust’s underlying deficit had seen some marginal improvement during the period. • The Trust’s cash position remains an area of significant concern. Cash requests had been made to NHS England, but the latest request for November 2025 had been rejected. It was therefore likely that the Trust would need to manage its supplier payments in accordance with its available cash. Page 5 5.9 ICS System Report for Month 6 Ian Howard was invited to present the ICS System Report for Month 6, the content of which was noted. It was further noted that: • The Hampshire and Isle of Wight Integrated Care System had reported a year- to-date deficit of £48m. • A significant improvement in the run-rate would be required for the system to be able to deliver its 2025/26 plan. • The system was one of the worst in England in terms of the number of beds occupied by patients having no criteria to reside with approximately 23% of beds being occupied by such patients compared with a national average of 12%. • The system was also below plan in terms of its targets for access to General Practitioners and targets relating to mental health patients. It was noted that the performance in these areas had a consequential impact on the Trust’s performance in areas such as urgent and emergency care performance. 5.10 People Report for Month 6 Steve Harris was invited to present the People Report for Month 6, the content of which was noted. It was further noted that: • The overall workforce fell by 73 whole-time-equivalents (WTE) during September 2025 and was reported as being 54 WTE above the Trust’s 2025/26 plan. The reduction in workforce had been driven through a combination of the impact of the recruitment controls, mutually agreed resignation scheme (MARS) leavers, and a significant drop in use of temporary staff during the month. • On 15 October 2025, the Trust had heard the collective grievance brought by the Royal College of Nursing in respect of the removal of enhanced NHS Professionals rates. It was decided not to reverse the decision in order to maintain equity with the rest of the workforce and consistency across other local providers. A number of actions had been agreed following the hearing. • Sickness rates had increased to 3.8%, although the Trust still benchmarked well against peers. • There were concerns about the potential impact of influenza during the winter period and therefore the Trust was taking a number of actions to promote vaccination of staff. The Trust was currently third in terms of uptake in the Region. • The level of participation in the national Staff Survey remained a challenge with only 32% of staff having completed the survey compared with a national average of 38%. It was considered likely that the recent difficult decisions taken and the impact on staff was impacting staff experience and engagement. • The People and Organisational Development Committee would be examining statutory and mandatory training levels together with the latest proposed national changes. Page 6 5.11 NHSE Audit and review of 'Developing Workforce Safeguards' including UHS Self-Assessment Return Natasha Watts was invited to present the NHS England audit and review of ‘Developing Workforce Safeguards’ (2018), including the Trust’s Self-Assessment Return, the content of which was noted. It was further noted that: • ‘Developing Workforce Safeguards’ was published in October 2018 and included a range of standards to assure safe staffing across the workforce. NHS England had initiated an audit, review and improvement plan amidst concern about a national reduction in compliance. • The Trust had submitted a self-assessment as part of this NHS England review. This assessment showed that the Trust continued to comply with the majority of the standards. • The audit exercise has been used as an opportunity to identify opportunities for improvement. Twelve recommendations have been developed, of which nine were assessed as ‘green’ and three as ‘amber’. 5.12 Guardian of Safe Working Hours Quarterly Report and Update on 10-Point Plan Diana Hulbert was invited to present the Guardian of Safe Working Hours Quarterly Report and Update on the 10-Point Plan, the content of which was noted. It was further noted that: • Resident doctors were due to strike for five days from 14 November 2025. This would be the thirteenth strike in recent years. It was noted that, in addition to pay, the dispute also concerned working conditions and the shortage of posts and consequent risk to resident doctors of unemployment. • The Trust had performed a self-assessment against the 10-Point Plan and it was noted that the majority of the plan’s contents had been considered by the Trust for some time. There were also a number of dependencies on the part of NHS England in areas such as lead employer models. • A national review of statutory and mandatory training was expected to enable portability of training records to facilitate staff moving between NHS organisations. • There had been significant improvements in respect of gaps in rotas. 5.13 Annual Clinical Outcomes Summary Luci Hood and Kate Pryde were invited to present the Annual Clinical Outcomes Summary Report, the content of which was noted. It was further noted that: • The paper provided an overview of the clinical outcomes reviewed by the Clinical Assurance Meeting for Effectiveness and Outcomes (CAMEO) over the 12-month period to September 2025. • The majority of specialities provide reports to CAMEO, although outcome data can be more difficult in some areas to capture than in others. • The outcomes reviewed by the CAMEO and outputs from this body were also influencing the development of the Trust’s clinical strategy. • The strains on the capacity of services posed a risk to clinical outcomes. Page 7 • There was potential that a ‘quality’ override could form part of the NHS Oversight Framework in the future, operating in a similar manner to the ‘financial’ override by limiting the segmentations available to an organisation. 6. STRATEGY and BUSINESS PLANNING 6.1 Corporate Objectives 2025-26 Quarter 2 Review Martin De Sousa was invited to present the review of Corporate Objectives 2025/26 for the second quarter, the content of which was noted. It was further noted that: • Of the 12 objectives agreed for 2025/26, six were rated ‘green’, four were ‘amber’ and two were ‘red’. • The ‘red’ rated risks were that relating to the Trust’s financial performance and that relating to the Trust’s achievement of its workforce plan for 2025/26. 6.2 Board Assurance Framework (BAF) Update Lauren Anderson was invited to present the Board Assurance Framework update, the content of which was noted. It was further noted that: • BDO had completed its audit of the Trust’s risk maturity and had presented its report to the Audit and Risk Committee on 13 October 2025. The audit had highlighted a number of strengths including the Board Assurance Framework, risk definition, and use of risk in decision-making. In terms of opportunities for improvement, the audit report suggested some improvements in articulation of operational risks and use of ‘SMART’ methodology for actions. • The Board Assurance Framework had been reviewed by relevant executive directors and committees since it was last presented to the Board. There had been no changes to the ratings or target dates. 7. CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 7.1 Feedback from the Council of Governors’ (COG) Meeting 28 October 2025 The Chair presented a summary of the Council of Governors’ meeting held on 28 October 2025. It was noted that the meeting had considered the following matters: • Chief Executive Officer’s Performance Report • Governor attendance at Council of Governors’ meetings • Review of the Council of Governors’ Expenses Reimbursement Protocol • Appointment of Jane Harwood as Deputy Chair with effect from 1 October 2025 • Membership engagement • Feedback from the Governors’ Nomination Committee It was noted that the Trust’s work on violence and aggression received particular attention from the Governors. 7.2 Register of Seals and Chair’s Action Report The paper ‘Register of Seals and Chair’s Actions Report’ was presented to the meeting, the content of which was noted. Page 8 It was further noted that one further item had been sealed on 7 November: Deed of Guarantee between University Hospital Southampton NHS Foundation Trust (Guarantor) and CHG-Meridian UK Limited (Beneficiary) regarding the payment and due performance obligations of UHS Estates Limited (UEL) under the Guaranteed Contract and specifically the Stryker Power Tools delivered to UEL under the pre-contract open build period with CHG. Seal number 307 on 7 November 2025. Decision: The Board agreed to ratify the application of the Trust Seal to the documents listed in the ‘Register of Seals and Chair’s Actions Report’ and to the additional document referred to above. 7.3 Health and Safety Services Annual Report 2024-25 Spencer Scott was invited to present the Health and Safety Services Annual Report 2024/25, the content of which was noted. It was further noted that: • The number of incidents reportable pursuant to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) had increased substantially to 68 such incidents compared to 39 in 2023/24. The majority of these incidents related to moving and handling or exposure to infectious diseases. • There was a concern that there had been a reduction in the number of health and safety related reports and escalations whilst at the same time the number of RIDDORs had increased. • Four areas of concern were highlighted: Entonox surveillance of maternity staff, display screen equipment compliance, the Southampton General Hospital loading bay, and workplace temperatures during the summer. 8. Any other business There was no other business. 9. Note the date of the next meeting: 13 January 2026 10. Items circulated to the Board for reading The item circulated to the Board for reading was noted. There being no further business, the meeting concluded. 11. Resolution regarding the Press, Public and Others Decision: The Board resolved that, as permitted by the National Health Service Act 2006 (as amended), the Trust’s Constitution and the Standing Orders of the board of directors, that representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. The meeting was adjourned. Page 9 List of action items Agenda item Assigned to Deadline Status Trust Board – Open Session 15/07/2025 - 5.11 Freedom to Speak Up Report 1267. Data Mbabazi, Christine 10/03/2026 Pending Explanation action item Christine Mbabazi to include data from other mechanisms for reporting concerns in future Freedom to Speak Up reports. Trust Board – Open Session 09/09/2025 - 8 Any other business 1286. Organ donation Machell, Craig 03/02/2026 Pending Explanation action item Craig Machell agreed to add organ donation to the agenda of a future Trust Board Study Session. Update: Scheduled for TBSS on 03/02/26. Trust Board – Open Session 11/11/2025 - 5.6 Performance KPI Report for Month 6 1293. MRI scanners and imaging Hyett, Andy 13/01/2026 Pending Explanation action item Andy Hyett agreed to work on and present at either a future Board meeting or Trust Board Study Session the Trust’s longer-term strategy with respect to MRI scanners and imaging. 1294. Cystopscopy/urology Hyett, Andy 13/01/2026 Pending Explanation action item Andy Hyett agreed to develop a longer-term plan for cystoscopy/urology and to report back to the Board during Quarter 4. Page 1 of 2 Agenda item Assigned to Deadline Status Trust Board – Open Session 11/11/2025 - 5.6 Performance KPI Report for Month 6 1295. Neurophysiology Hyett, Andy 13/01/2026 Pending Explanation action item Andy Hyett agreed to develop a long-term solution to the neurophysiology service. 1296. Watch & Reserve antibiotics usage Hyett, Andy 13/01/2026 Pending Explanation action item Andy Hyett agreed to clarify the basis of the calculation of the ‘Watch & Reserve antibiotics usage per 1,000 adms’ metric. Page 2 of 2 Agenda Item 5.1 i) Committee Chair’s Report to the Trust Board of Directors 13 January 2026 Committee: Finance, Investment and Cash Committee Meeting Date: 24 November 2025 Key Messages: Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) Any Other Matters: • The committee received an update in respect of the Trust’s commercial activities, noting that the Trust had robust systems in place to maximise cost recovery for private patient and overseas visitor income. The Trust’s private patient unit project continued to progress. The Trust was also seeking a partner to manage its parking provision. • The committee received the Finance Report for Month 7. The Trust had reported a £5.1m in-month deficit (£35.9m year-to-date), which was in line with the trajectory contained in the Financial Recovery Plan. The underlying deficit remained flat at £6.4m. Whilst there had been a slight reduction in the number of mental health patients, there were c.240 patients having no criteria to reside at any point during the period. There was an increased level of scrutiny in respect of non-pay expenditure. • The committee reviewed an update on the Trust’s measures for financial improvement, noting that the Trust was forecasting achievement of £85-95m against its target of £110m Cost Improvement Programme delivery for 2025/26. • The committee noted the Trust’s approach and the timelines associated with the Medium Term Planning submission. It was noted that the framework set ambitious financial and performance targets. • The committee received an update in respect of the Trust’s Theatre Experience Programme, noting that there had been a 3% increase in utilisation and a 3% reduction in cancellations. • The committee reviewed the Trust’s productivity, noting that the Trust’s productivity had fallen by 3.3% compared to the prior year due to high-cost growth. • The committee received an update in respect of the Trust’s cash position and forecast and supported a proposal to request further cash support for January 2026. • The committee received an update on Capital Planning for 2026/272029/30. It was noted that it was expected that the Trust would be allocated c.£40m per annum, although there were concerns about the impact of the Trust’s cash position and the ability of the Trust to meet this level of expenditure. N/A N/A Page 1 of 2 Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Not Applicable Where assurance is not required and/or relevant. Risk Rating: Low Medium High Not Applicable Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.1 ii) Committee Chair’s Report to the Trust Board of Directors 13 January 2026 Committee: Finance, Investment and Cash Committee Meeting Date: 15 December 2025 Key Messages: • • • • • • The committee received the Finance Report for Month 8 (see below). The committee discussed the Trust’s future transformation programmes, noting that the areas of focus would be: urgent and emergency care, elective care, and automation of administrative processes. The committee was assured that the programmes were felt to be suitably ‘bold and ambitious’ and were grounded in realistic opportunities, rather than ‘blue sky’ ideas. The committee reviewed the draft capital plan for 2026/27 – 2029/30, noting that the Trust had been allocated c.£40m of capital departmental expenditure limit (CDEL) per year. It was noted that the Trust’s cash position could place constraints on the Trust’s capital programme. The opportunity to secure funding from national programmes outside of CDEL should be pursued vigorously. The plan was to be discussed in a Trust Board Study Session prior to submission in February 2026. The committee reviewed, challenged and discussed the Trust’s medium-term plan ahead of the first submission to NHS England on 17 December 2025. The committee provided feedback in respect of the proposed submission noting that some of the assumptions within the 2025/26 plan had not materialised with regard to matters such as reductions in non-criteria to reside numbers and the committee sought assurance that learnings had been applied to the development of the medium-term plan submission. The committee was assured that such assumed reductions within the 2026/27 plan were based purely on actions which were deemed to be within the Trust’s control. The committee suggested some changes with regard to the plan, particularly around growth assumptions in the cost base, and agreed to recommend the revised plan to the Board for approval. It was noted that more detail and reviews would be required prior to the final submission date in February 2026. The committee received an update in respect of the Trust’s cash position and supported a proposal to make a further request for cash support from NHS England for January 2026. The Trust reviewed and supported a proposal for transforming the Southern Counties Pathology network. Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) 5.7 Finance Report for Month 8 Assurance Rating: Risk Rating: Substantial High • The Trust had reported an in-month deficit of £4.9m (£40m year-todate), which was consistent with the Trust’s Financial Recovery Plan. • November 2025 had been a challenging month due to costs associated with industrial action, patients with no criteria to reside and mental health patients. • The Trust had received c.£3m of income out of £6.1m for elective over-performance. • There had been a slight improvement in the Trust’s underlying deficit. Page 1 of 2 Any Other N/A Matters: Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. No Assurance There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Not Applicable Where assurance is not required and/or relevant. Risk Rating: Low Medium High Not Applicable Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.2 i) Committee Chair’s Report to the Trust Board of Directors 13 January 2026 Committee: People & Organisational Development Committee Meeting Date: 21 November 2025 Key Messages: • • • • The committee reviewed the People Report for Month 7 including progress against the workforce plan. During October 2025, the overall workforce grew by 14 whole-time-equivalents (WTE). Although the substantive workforce had reduced by 15 WTE, there had been lowerthan-expected turnover and increased temporary staffing usage due in part to high sickness levels. The Trust remained on track, however, with respect to its Financial Recovery Plan trajectory. There were concerns about the response rate to the Staff Survey, which was below the national average. The Trust’s vaccination campaign for staff had started well with the uptake rate for the flu vaccine amongst staff at 43%. The committee considered the outputs of the review by NHS England of statutory and mandatory training and the implications for UHS. It was noted that a revised framework would facilitate passporting of training between NHS organisations. The Trust was aligned to the Core Skills Training Framework across six out of eleven areas and ten out of eleven areas for the Utilising E-Learning for Health material. The committee received an update in respect of the Trust’s Inclusion and Belonging strategy. It was noted that resource constraints and the impact of the current financial and operational environment on staff morale had impacted progress towards achievement of the objectives set out in the strategy. The committee reviewed the People risks contained within the Trust’s Board Assurance Framework. Assurance: N/A (Reports/Papers reviewed by the Committee also appearing on the Board agenda) Any Other N/A Matters: Assurance Rating: Substantial There is a robust series of suitably designed internal controls in place upon Assurance which the organisation relies to manage the risk of failure of the continuous and effective achievement of the objectives of the process, which at the time of our review were being consistently applied. Reasonable There is a series of controls in place, however there are potential risks that Assurance may not be sufficient to ensure that the individual objectives of the process are achieved in a continuous and effective manner. Improvements are required to enhance the adequacy and effectiveness of the controls to mitigate these risks. Limited Assurance Controls in place are not sufficient to ensure that the organisation can rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Significant improvements are required to improve the adequacy and effectiveness of the controls. Page 1 of 2 No Assurance Not Applicable Risk Rating: Low Medium High Not Applicable There is a fundamental breakdown or absence of core internal controls such that the organisation cannot rely upon them to manage the risks to the continuous and effective achievement of the objectives of the process. Immediate action is required to improve the adequacy and effectiveness of controls. Where assurance is not required and/or relevant. Based on the report considered by the committee, there is little or no concern that the Trust will be unable to meet its stated objectives and/or plans. There is some concern that the Trust might not be able to fully meet its stated objectives and/or plans based on the information contained in the report considered by the committee. There is a significant risk that the Trust will not be able to meet its stated objectives and/or plans based on the information contained in the report considered by the committee. Where risk rating is not relevant. Page 2 of 2 Agenda Item 5.2 ii) Committee Chair’s Report to the Trust Board of Directors 13 January 2026 Committee: People & Organisational Development Committee Meeting Date: 15 December 2025 Key Messages: Assurance: (Reports/Papers reviewed by the Committee also appearing on the Board agenda) • The committee reviewed the People Report for Month 8 (see below) including progress against the workforce plan and Financial Recovery Plan. • The committee considered the workforce implications of the Trust’s medium term plan submission, noting that there were a number of national expectations and targets, such as those relating to sickness rates and elimination of agency spend. In addition, the committee noted the risks associated with the plan, including those where the Trust was reliant on progress with respect to non-criteria to reside and mental health numbers. • The committee received an update regarding the Trust’s Violence and Aggression workstream, noting that the Trust had adopted a revised approach to violence, aggression and abuse directed at staff with a greater willingness to take action against violent/abusive patients and members of the public. A violence and aggression board had been established to provide executive oversight and leadership, and the Trust’s policy was being revised. This work would be accompanied by a comprehensive communication plan for both staff and members of the public. • The committee reviewed the Trust’s progress against its objectives for Year 4 of its People Strategy. 5.9 People Report for Month 8 Assurance Rating: Risk Rating: Substantial High • The overall workforce fell during November 2025, with substantive numbers falling by 52 whole-time-equivalents (WTE). However, temporary staffing use had increased during the month due to increased sickness and operational pressures, which offset much of the reduction in substantive numbers. • The Trust was over its original plan by 214 WTE despite a decrease of nearly 400 WTE since 31 March 2025. In order to hit the Trust’s Financial Recovery Plan target, the overall workforce would need to fall by a further 137 WTE (including a 72 WTE reduction in temporary staffing) by the end of March 2026. • A forecast based on the previous year’s temporary staffing usage for the remaining months of the year indicated that the Trust would end the year approximately 500 WTE above the Trust’s 2025/26 plan. • The Trust had submitted a baseline assessment against the 10 Point Plan to improve Resident Doctors’ working lives in August 2025, which indicated that the Trust compared favourably against other organisations in the South East. The main issues concerned space available for doctors to work in and timeliness of reimbursement of course-related expenses. • The Trust was expected to meet a target of 95% of job plans having been signed off prior to 31 March 2026. At the start of December 2025, 55% of job plans had been signed off. Page 1 of 2 Any Other Matters: • Sickness absence had increased in November 2025 to 4.2% in month due to seasonal illnesses. • The staff survey closed on 28 November 2025. The completion rate for the staff survey had been lower t
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Commercial filming protocol
Description
Commercial and production filming policy 1 Introduction University Hospital Southampton NHS Foundation Trust is a popular location and requests for filming from various commercial companies and television production companies are received throughout the year. News and media filming is not part of this policy and is managed separately by the communications team (023 8120 8756 or media@uhs.nhs.uk). This document outlines the Trust protocol for processing external enquiries and bookings, agreeing charges where appropriate and establishing guidelines for filming at Trust premises. This filming protocol has been developed in consultation with University Hospital Southampton NHS Foundation Trust's commercial development and communications teams. 2 Filming requests and application procedure To manage requests for full-scale television productions or commercial filming events the Trust engages the services of commercial team to facilitate the management of the production. The commercial team will be responsible for collecting the location fee from the licensee, obtaining a signed licence agreement, collating public liability insurance, risk assessments, method statements and health and safety information required from the licensee. The commercial team will facilitate bookings which will be presented to the Trust. The Trust reviews each submission. We will try to help where we can, but please be aware that during busy times or for clinical reasons we may not be able to accommodate your request. 3 Charges for commercial and production filming Charges will be levied for any filming or photography at our premises for purposes other than relevant news footage or for UHS's own purposes. Fees are charged to cover all administration, staff costs and cost of using our location. These are discretionary and further details are available on request from the commercial development team. If filming does not take place after the initial or secondary recce, a charge of �250 will be incurred. Any changes to the day or time of filming must be relayed to the commercial team as soon as possible. This should be at least two working days before the original date/time agreed otherwise a 25% cancellation fee will be due. If filming should take longer than first agreed, the organisation will be invoiced for the additional time incurred. This payment will be due within one week of filming. 4 Use of images and other media Images and filming must not contravene copyright and must only be published with the permission of the image owner. In the case of photographs, videos and other media items featuring people, permission to use the media item must be obtained and we would expect any external film-makers to have their own consent forms and processes. Copies should be shared and retained by the trust. If contracts are awarded to "external" production companies they will be required to waive ownership of copyright and moral rights in the recordings they prepare, although they may still be allowed to retain the right to reproduce the recording by arrangement and special permission from the communications team at UHS. Filming of a patient who has not given appropriate consent that are accidentally or inadvertently picked up must not be published under any circumstance and, unless detrimental to the care of the subject patient, must be destroyed. 5 Authorisation Commercial filming requests should be referred to the commercial team, via the Commercial Director-Nael Clarke, via email in the first instance to: (nael.clarke@uhs.nhs.uk), cc. (Nichola.cookson@uhs.nhs.uk) who will manage them in conjunction with clinical teams, care groups and divisions. Production filming requests should be referred to the communications team (media@uhs.nhs.uk) who will engage the commercial team and, if appropriate, seek opinions and feedback from clinical teams and departments. The Trust reserves the right to refuse permission for any event for any reason. Filming will only be permitted, for example, if it will not cause undue disturbance to the working life of the Trust and/or the subject matter is not likely to portray the Trust inappropriately or conflict with Trust ethics/opinion. Filming events may take place throughout the year although account will be taken of the possible impact on the working life of the trust. Generally, filming requests will not be accepted during peak periods. Filming of individuals may not take place without their express permission; therefore, general filming in public space within the hospital premises or grounds is restricted. 6 Site protocol The Trust has a standard protocol which all production companies and broadcasters must follow regardless of purpose. This includes the following: Names of all visiting crew members must be submitted before any filming begins Security, reception and site team must be notified of filming set to take place on site (internal responsibility of commercial development and communications) All visiting crew members must bring their company ID badges AND sign in at main reception upon arrival to obtain trust visitor passes Crews must have a key point of contact in any department they are visiting Any production crews must have agreed a designated filming area and should not be granted access to any separate/secure areas at any time without confirmation from the relevant trust team that it has been agreed and that the staff working in those areas feel it is appropriate.
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Last updated: 14 September 2019
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