Back to Section 14 Selection Page

CLINICAL PHARMACIST DIRECT REFERRAL TO INFECTION SPECIALIST

Background

During 2005 it was proposed that more formal support was required for clinical pharmacists dealing with patients where there was concern over appropriate antibiotic management. After a period of data collection and discussions with the Medical Microbiologists and Infectious Diseases Physicians it has been agreed that clinical pharmacists can directly refer patients to these infection specialists. The Clinical Groups have been asked to support this initiative.

Suggested Criteria for Patient Referral

Initially the main reason for this initiative was to support the Alert Antibiotic Scheme but other criteria for suitable patients to refer are also listed below:

Patients prescribed an Alert Antibiotic outwith the permitted indications.
Patients prescribed an Alert Antibiotic that always requires prior authorisation and this is not documented in the medical notes e.g. linezolid, daptomycin, tigecycline.
Patients prescribed Alert Antibiotics (with or without infection specialist authorisation) where there has been difficultly with review in light of microbiology test results or length of course.
Irrational combination or choice of antibiotics e.g. levofloxacin + macrolide for pneumonia, rifampicin or fusidic acid prescribed as a single agent, co-amoxiclav + tazocin for sepsis.
Patients reviewed by Microbiology or Infectious Diseases where advice has not been followed.
IV route being continued for longer than necessary, particularly for well absorbed antibiotics e.g. quinolones or clindamycin.
Aminoglycoside (7mg/kg regime) prescribed for longer than 5 days without review.

Process for Referral

Step 1:
Prior to any direct referral to an infection specialist the medical team responsible for the patient should be offered advice by the ward pharmacist and requested to review their antibiotic prescribing and/or seek further advice from Microbiology or Infectious Diseases (see step 4 for contact details).

Step 2:
If the medical team looking after the patient does not resolve the problem or do not ask for Microbiology or Infectious Diseases advice the case should be discussed with a senior pharmacist working within the pharmacy department or Antimicrobial Prescribing Pharmacist.

Step 3:
If the senior pharmacist agrees that the patient is suitable for referral to an infection specialist then the pharmacist referral to infection specialists form below should be completed with the following information;

Patient name and CHI number
Hospital/Ward
Brief description of problem and antibiotics prescribed
Any relevant microbiology results

Step 4:
The referral form should be faxed to the appropriate infection specialist depending on which speciality is responsible for the patient (these are the same contact numbers that the medical team should be asked to use at step 1):

Medicine and Cardiovascular	Infectious Disease Oncall	Bleep 5075	Fax 496547
General Surgery	Infectious Disease Oncall	Bleep 5075	Fax 496547
Orthopaedic Surgery	Infectious Disease Oncall	Bleep 5075	Fax 496547
Specialist Services (inc Neuro ICU)	Microbiology Oncall	Bleep 4039	Fax 496462
Haematology/Oncology	Microbiology Oncall	Bleep 4039	Fax 496462
Critical Care ( ICU and Renal)	Microbiology Oncall	Bleep 4039	Fax 496462
Women and Child Health	Microbiology Oncall	Bleep 4039	Fax 496462
All patients at PRI	Microbiology Oncall	Bleep 5315	Fax 496462

NB. Microbiology should be contacted for all areas, to answer queries out-of-hours.

Step 5:
The infection specialist on-call will review the patient (usually within 24 hours), make any necessary recommendations to medical staff, document in medical notes (if possible) and complete the bottom part of the referral sheet.

Step 6:
Completed referral forms should then be faxed back to the Pharmacy Department.

Ninewells Pharmacy Fax	01382 632480
PRI Pharmacy Fax	01738 47333

Step 7:
Dispensary staff will bleep the relevant pharmacist using a **9 code to let them know that the form has been faxed back.

Step 8:
The pharmacist should follow up recommendations made by the infection specialist and note if the advice has been accepted on the bottom of the form.

Step 9:
Completed forms should be given to Kirsteen Hill, Lead Clinical Pharmacist, Ninewells Hospital.

Written by: Kirsteen Hill, Lead Clinical Pharmacist
Agreed by: NHS Tayside Antimicrobial Management Group
Date written: Feb 2006
Reviewed: June 2007
Review Date: June 2008

Back to Alert antibiotics selection