Title: Department Of Pathology Handbook · Bruce Michie 2.5 Laboratory Handbook Annette Riley...

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Department Of Pathology Handbook

Pathology 4143

Bruce Michie

2.5

Laboratory Handbook

Annette Riley

06-Sep-2013

06-Sep-2014

Haem/Chem/Path/Micro Shared Drive

BMS 3 Office- Pathology

06-Sep-2013 13:07

27-Nov-2013 12:12

Department of Pathology

Authorised

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Department Of Pathology Handbook - Version: 2.5. Index: Pathology 4143. Printed: 27-Nov-2013 12:12

Authorised on: 06-Sep-2013. Authorised by: Annette Riley. Document Unique Reference: 112-36275479. Due for review on: 06-Sep-2014

Author(s): Bruce Michie

Index

1.0 Opening Times And Contact Details 2-3 2.0 On Call Details 4 3.0 Health And Safety 5 4.0 Sample Acceptance Criteria 6 5.0 Time Limits for Requesting Additional Tests 7 6.0 Routine Surgical Samples 7 7.0 Frozen Sections 8 8.0 Specific Tissue Biopsies 9 8.1 Liver Biopsies 9 8.2 Lymph Node (or Tonsillar) Biopsy for? Lymphoma 9 8.3 Breast Tissue 9 8.4 Skin Biopsy For Immunoflourence Studies 9 9.0 Turnaround Times 11 10.0 Gynaecological Cytology – Liquid Based Cytology 12 11.0 Non-Gynaecological Cytology 12 11.1 Key Factors Which Affect Performance Of NGC Tests 12 11.2 Respiratory Specimens 13 11.3 Fine Needle Aspirate Specimens 13 11.3.1 Breast Clinic/Neck lump clinic 13 11.4 Fluids 13 12.0 Seminal Analysis 14 12.1 Post Vasectomy Specimens 14 12.2 Infertility Specimens 14 13.0 Reference Labs Used By Pathology Department 15 14.0 Hospital Autopsies 16 14.1 Guidance For Requesting Doctors 17 14.2 Introduction 17 14.3 Reason For Autopsy Examination 18 14.4 The Autopsy 18 14.5 Tissue Samples And Organ Retention 18 14.6 Limited Autopsy Examination 18 14.7 Timing Of The Autopsy 19 14.8 Transport Of Bodies For Autopsy 19 14.9 Viewing The Deceased 19 14.10 The Agreement/Authorisation 19 14.11 Feedback To Relatives 20 14.12 If An Autopsy Is Required 20 15.0 Procurator Fiscal Autopsies 21 15.1 Notifying The Procurator Fiscal 22

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1.0 Opening Times, Contact Details and Location Opening Times: Monday – Friday 8:30am – 5:00pm Saturday 8am-12pm (N.B No Consultants available on Saturdays) Sundays Closed

Contact Details: Name Designation Extension Dr. A. Riley Consultant Pathologist/

Department Clinical Lead 66667

Dr. K. Morton Consultant Pathologist 66671 Dr. T. MacLeod Consultant Pathologist 66669 Dr. B. Michie Consultant Pathologist 66668 Dr. M. Brown Consultant Pathologist 66672 Dr. S. Balnave Consultant Pathologist 66675 Dr. N. Melquiot Consultant Pathologist 66670 Dr. L. Leonard Cytology Co-ordinator 66644 Mr. J. McEwan Department Manager 66643 Department Office 67114

66657 66656

Histology Laboratory 66713 66800 66806

Cytology Laboratory 66921 66653

Cytology Reporting Room

66651

Mortuary* 66015

A consultant can be contacted during laboratory opening hours (except Saturdays) for clinical advice and interpretation. * If you need access to the mortuary please telephone in advance to ensure that someone is available to assist you.

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Location

Dept of Pathology

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2.0 On Call Details Out of Hours: the department operates an on-call system to allow access to the mortuary only. There is no on call system for the routine pathology service. The duty BMS/MTO for the mortuary must be contacted through the switchboard and only in relation to the following mortuary issues;

• Viewing of deceased by relatives. • To allow access of medical staff to remove tissue for transplantation.

• To manage mortuary capacity issues. • To allow access of funeral directors only where this cannot be postponed

until normal opening hours. The duty BMS/MTO is not to be contacted regarding any issue, which is not directly related to the mortuary. Access for medical staff in relation to identification of deceased to enable completion of cremation papers should be conducted during normal opening hours. All other general mortuary or pathology department enquiries should wait until normal opening hours resume. For Urgent enquiries out with normal operating hours contact the department manager through the switchboard.

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3.0 Health And Safety

• The majority of samples for histological examination will be immersed in a fixative known as 10% NEUTRAL BUFFERED FORMALIN (10% NBF). 10% NBF is harmful by inhalation and irritating to eyes, respiratory system and skin. Avoid contact with skin and eyes and avoid inhalation. If contact with the skin does occur then wash the area with copious amounts of water. If 10% NBF accidentally gets into the eyes or is swallowed, rinse eyes or wash mouth out with water and seek immediate medical attention.

• If a spillage of 10%NBF occurs during transport of specimens to the laboratory. Telephone the laboratory on 66800/66806/66713 immediately to request assistance. Do not touch the formalin or attempt to mop it up. Evacuate the area and if safely possible, open windows to allow ventilation.

• All specimens for histological examination should be considered as potentially

hazardous and care must be taken when handling these specimens.

• Known Danger of Infection specimens MUST be highlighted as such and date and time of specimen collection must be included for the safety of laboratory staff.

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4.0 Sample Acceptance Criteria

• Unlike other specimens submitted to the laboratory biopsies often cannot be repeated and the diagnosis may have serious implications for the management of the patient concerned.

• Please label both the form and specimen accurately to prevent confusion about the

patient’s identity. Unlabelled specimens, or specimens without completed forms, will not be accepted.

The request form MUST contain the following information: Essential Information Comments Full Name of Patient

Initials are not acceptable

CHI Number

Mandatory

D.O.B.

Source/Location

Name of Dept/Ward/GP

Person to whom report is to be Sent

Report will be sent to this person

Nature/Location of Specimen

e.g., Biopsy, Resection, anatomical site

Time and Date of Specimen Collection

Must be completed

Danger of Infection / High Risk

Must be marked if applicable

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5.0 Time Limit for Requesting Additional Tests If you require further tests or a review of archived material please contact the laboratory for specific advice. The table below indicates the timescales for keeping certain types of specimens/clinical material. Type of Specimen/material Time Limit Retained Tissue e.g. Surgical Specimens 1 month after reporting Retained Blocks 30 years Retained Slides 20 years Gynaecological Cytology Up to issue of report Aspirates/Fluids Up to issue of report Sputum Until processed – New sample normally

required Seminal fluid N/A Fresh specimen required 6.0 Routine Surgical Specimens

Requests for specimen containers with or without fixative

Departments within FVRH – Contact the mortuary on x 66015 to arrange collection. Departments in the community hospitals and GP surgeries contact the laboratory on (5)66800/ (5)66806/ (5)66713 to arrange delivery by lab vans.

Specimens for histological diagnosis (other than those which must be sent to the laboratory fresh – see below) must be placed into an appropriate container of a suitable size with sufficient 10% neutral buffered formalin (NBF) to completely submerge the specimen. Good preservation of the tissue is required for accurate histological assessment. Insufficient fixative or delays in fixation may lead to degradation of the tissue compromising its value for histological evaluation and subsequent specialist tests such as immunocytochemistry.

All specimen containers MUST be securely fastened and correctly labelled.

Include a fully completed histopathology request form. A brief but relevant clinical summary is essential. Request forms should be placed in a separate specimen bag to prevent the form being spoiled in the event of leakage or breakage and this should be attached to the specimen. Once tissue has been processed to paraffin wax, the blocks and corresponding slides are kept in the department in accordance with RCPath.Guidelines. Any remaining tissue is disposed of unprocessed one month after issue of the final pathology report.

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7.0. Frozen Sections

• A frozen section service is provided Mon – Friday 09:00 to 16:45

• There is no routine out of hours frozen section service

• Telephone the histology lab on x66713, x66800 or x66806 to arrange a frozen

section, if elective frozen section then at least 24 hrs notice to be given. If ad hoc

frozen section phone lab as soon as possible.

• Patient Name, CHI and Nature of Specimen and estimated time of arrival must be

given.

• Tissue must be sent fresh (not in formalin) immediately upon collection

• Notice must always be given to the laboratory before sending a frozen section

• If frozen section is cancelled the laboratory must be informed on the above

number/s.

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8.0. Specific Tissue Biopsies

8.1 Liver Biopsy

Specimens should be submitted in the same way as routine surgical biopsies, But include in the clinical summary the latest Liver Function Test results and results of ultrasound, ERCP or other investigations.

8.2 Lymph Node (Or Tonsillar) Biopsy For ? Lymphoma When lymph nodes are biopsied for suspected lymphoma, please telephone the Laboratory to let us know that the specimen is on its way, and send the biopsy fresh, not in fixative. This allows additional analysis to be carried out.

8.3 Breast Tissue

Mastectomy and breast lumps should be sent as soon as possible to the lab Fresh not in fixative.

8.4 Skin Biopsies For Immunofluorescence (IF) Studies If enough material is available, lesions should be excised and bisected, with one specimen sent for IF studies and the other for normal histological examination. Biopsies for Immunofluorescence studies Must Not be placed in the fixative 10%NBF, as this will render the specimen unsuitable. Instead specimens for IF studies should be placed immediately after collection into Michel’s Tissue Fixative which is specifically designed for this purpose. Specimens in this solution remain viable for IF studies for a Maximum period of 5 days. Delay in placing the specimen into this solution may lead to inaccurate results. Do not allow the tissue to dry out at any time. Specimen containers containing Michel’s Tissue Fixative will be supplied on request from the Histopathology Department (Ext 66674 or 66647) The specimen containers must be clearly labelled with the patients ID and a request form must be completed as with other specimens for histology and clearly marked that IF studies are required. Once the tissue has been placed into Michel’s Tissue Fixative it should be sent to the laboratory as with other histology specimens. Specimens for IF studies Do Not need to be dispatched urgently but similarly should not be delayed.

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Notes – Michel’s tissue fixative is viable for a period of one year at room temperature Please check expiry dates on containers before use. If expired contact the Pathology department for replacement stock (see above). If crystals form in the solution please do not use and discard immediately. Key components - N-ethylmaleimide, citrate buffer. In the event of spillage wear protective gloves and wipe up immediately with absorbent material and discard safely. In case of contact with skin wash with soap and water. In case of contact with eyes wash in water for at least 15 minutes. If a specimen for IF is taken when no Michel’s fluid is available, the specimen should be sent dry to the Pathology Department immediately upon collection. Any delay may affect the result of IF investigations.

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9.0 Turnaround Times Turn around times (TAT) the department defines turn around time as the number of days between the date of receipt of the specimen to the date that the report is authorised. Below are the annual average turnaround times for key specimen types during 2012. Request Type Average TAT 2012 Breast Needle Biopsy 3 Colonic Biopsy 9 Prostatic Needle Biopsy 4 Rectal Resection 7 Mastectomy 7 Semen Analysis 7 Post Vasectomy Follow Up 0 Non Cervical Cytology 2 Cervical Cytology 33 Immunocytochemistry 12 Hospital Post Mortem 10 (Working Days to final report) Fiscal Post Mortem 6 (Working days)

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10.0 Cervical Cytology - Liquid Based Cytology (LBC)

Enter the patient’s details and clinical history into the Scottish Cervical Recall System (SCCRS). Print off the label and attach to the vial. This label has the patient’s name, CHI and SCCRS number printed on it and is necessary for the sample to be processed by LBC. Place the vial in an individual specimen bag. The fluid in the vial is a preservative but sample should be sent to the lab as soon as possible. If you are unable to access the system, telephone the laboratory for instructions. Only in exceptionable circumstances, and with the agreement of the laboratory, can a sample be sent using the request form available from the following link. http://www.sccrs.scot.nhs.uk/Documents/sccrs/stccrform(Rev%202).pdf

11.0 Non-Gynaecological Cytology (NGC)

All specimens should be collected in suitable leak proof containers Without Fixative. Drain bags or bottles are not acceptable. Specimens should be sealed in plastic specimen bags and accompanied by a completed Histology/Cytology request form, as per the previous page. Ideally, a minimum of 1ml should be sent but when collecting large volumes, e.g. serous fluids and urine, it is not necessary to send an entire specimen. A representative sample one or two universals but no more then 250mls is all that is necessary. The total volume collected may be noted in the patient history section of the form. Specimens should be sent to the laboratory as soon as possible. If a specimen is unable to be delivered to the department before 5pm on weekdays and 12pm on a Saturday, please store in fridge until lab is open.

All High-Risk Specimens Specimen MUST Have Their Request Form And Container Labelled As Such.

11.1 Key Factors Adversely Affecting Performance Of NGC Tests

o Delay in sending to the lab

o Specimen not refrigerated outwith lab hours

o Leakage of specimens – causing contamination?

o Unclear request form

o Sputum sample collected after food consumption

o Prepared slides not identified whether Air Dried (AD) or Wet Fixed (WF) resulting in possible inappropriate preparation

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11.2 Respiratory Specimens

• Bronchial Aspirates/Washings/ Brushings/ EBUS

Containers should be labelled clearly with patient’s details and nature of specimen. Slides made from brushings should be labelled in pencil and noted whether they are air dried (AD) or wet fixed (WF)

• Sputum

Sputum specimens should be sent as soon as possible to the laboratory.

IN KNOWN CASES OF TUBERCULOSIS, DO NOT SUBMIT SPUTUM SAMPLES FOR CYTOLOGY.

11.3 Fine Needle Aspiration

The duty cytopathologist can provide an aspiration service at FVRH as required. Call x67114 or x66657 to arrange this.

Aspirates performed by other clinical staff should be smeared on slides (as in a blood film). Half of the slides should be fixed immediately with cytology spray fixative whilst the other half should be left to air dry. The slides must be labelled AD (air-dried) or WF (wet-fixed) and with the patient’s name. The needle and syringe should be rinsed out into normal saline (5ml in a 25ml universal container). Further advice can be obtained from the cytopathologist.

11.3.1 Breast Clinic/Neck Lump Clinic: The Cytology lab provides a rapid diagnostic service to these clinics, therefore it is imperative that the correct procedures are followed to ensure that the samples are processed and reported in as short a time as possible. When sending samples from the Neck Lump Clinic a member of the clinic staff must call the Cytology Lab on x66653 or x 66921 to inform the lab staff that a sample is on its way. It is also imperative that the clinic staff emphasise to the porter that he/she must deliver the sample directly to the Cytology Lab and NOT Central Reception.

11.4 Fluids

Ascitic, Pleural, Peritoneal, Breast cyst and Ovarian Cyst

Specimens should be sent as soon as possible to the laboratory - A maximum of 250mls (see note above concerning volume).

Urine A fresh voided sample should be sent. Do not send the first morning sample

Synovial Fluids (Uric acid crystals)

Joint aspirates should be submitted fresh and the form should be clearly marked “FOR CRYSTALS”

Cerebrospinal Fluid (CSF) These samples should be submitted to the department immediately.

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12.0 Seminal Analysis

12.1 Post Vasectomy Seminal fluid should handed into urology outpatients at FVRH in suitable container without fixative only on a Monday am. Always include a completed form. 12.2 Semen Analysis There is a semen analysis clinic held at FVRH on Thursday mornings. This is distinct form the sub-fertility clinic which is not a laboratory service. Arrangements for appointments for semen analysis are currently by letter to the Pathology Office at FVRH Seminal analysis specimens produced at home must be delivered to the clinic within 30-45 minutes and kept if possible at body temperature during transportation. Repeat samples will be requested by the laboratory if the first result is out with the normal reference range.

• Reference Values Based on the WHO Laboratory Manual for the examination and processing of human semen 5th Ed.

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13.0 Reference Laboratories Used By Pathology Department Are Detailed Below:

• Her2/Neu testing for Breast Specimens & EGFR analysis for Lung Cancer : Department of Pathology, Laboratory Medicine and Facilities Management Building, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF.

• Lymph Nodes for Lymphoma: LRF Virus Centre, Dept of Veterinary Pathology University of Glasgow, Bearsden, Glasgow, G61, 1QH

• Post Mortem Brain: Neuropathology Department, Southern General Hospital, Glasgow G51 4TF.

• LBC Cervical Screening: If a high volume of cervical smears are received by the department it may be that the slides are screened by another laboratory. The following laboratory will be used in this case: Dept of Pathology, Monklands Hospital, Monkscourt Avenue, Airdrie, ML6 0JS

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Mortuary Opening Times Monday –Friday 08:30am – 5pm

An out of hours on call service is available for emergencies only. Please see page 3 for details. 14.0 Hospital Autopsies Autopsies are of importance in clinical audit. Despite recent advances in diagnostic techniques, the post mortem remains a very important part of medicine, confirming or refuting the clinical diagnosis, assessing the effects of treatment and shedding light on unexplained symptoms and signs. There has been a national decline in the autopsies rate over the last decade, partly due to the belief that biochemical, radiological and other investigations generally explain all. Very Frequently, However, The Autopsy Diagnosis may Significantly Differ From The Clinical Impression and this is more evident in the elderly where multiple pathology abounds. It is recommended that all potential autopsies are discussed with a Pathologist prior to seeking consent. Please note we do not have facilities to perform autopsies on cases of potential hazardous cases such as HIV, Jakob-Creutzfeldt or Hepatitis C. If an autopsy is imperative arrangements can be made through the department with the Western General Hospital in Edinburgh or the Southern General in Glasgow. We would like to encourage Clinicians to request autopsies, which in general will augment the clinical diagnosis. Under normal circumstances there need be no delay to funeral arrangements as autopsies are performed promptly each morning.

Tissue samples (approximately the size of a 10p piece, approximately 10 in total) are retained from most hospital autopsies. These form part of the case record. Whole organ retention is extremely uncommon and will only be undertaken if the authorisation form includes consent for disposal of retained organs. A Post Mortem Authorisation Pack has been introduced and is self explanatory. This pack includes the Authorisation Form, Information Leaflets for Relatives, an Information Leaflet for the Requesting Doctor, a Request Form (for clinical summary and alike) and a Checklist Form. The packs are not stocked in the wards but are freely available from the Pathology Department Office (67114, 66656 and 66657) or from the Mortuary (66015). Authorisation for autopsies should be undertaken in ‘the cold light of day’ and so there is no requirement for time of death access to the Authorisation Pack.

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14.1 Guidance For Requesting Doctors Asking For Agreement For An Autopsy The purpose of these notes is to help healthcare professionals answer relatives’ questions when autopsy is being considered. It provides an account of good practice for further information to assist discussions that accompany a request for post mortem. It complements and should be read inconjunction with the Relatives’ Leaflet produced by the Trust. 14.2 Introduction The death of a patient can be a difficult time for involved healthcare professionals as well as for relatives. Asking relatives to agree to an autopsy is a delicate and challenging task. However, experience indicates that sensitively handled, well informed discussion is not distressing. Ideally, obtaining agreement should be the responsibility of an experienced fully registered member of the clinical team. Before discussion with relatives, the person requesting agreement for post mortem should know: • Whether the case should be discussed with the Procurator Fiscal. NB. Obtaining

permission for a hospital autopsy does not affect this. Some cases Must be reported to the Fiscal; e.g. see list at the back of this handbook and in the Death Certificate book. Even if there is agreement for a hospital post mortem, the Fiscal must still be informed about the death if appropriate.

• Where and by whom the examination will be performed. • Why a post mortem is proposed. • When results will be available. There are two types of autopsy: The Procurator Fiscal may order an autopsy without relatives’ agreement in medico-legal cases; in all other cases, hospital staff must ask permission of the relatives. If there are no relatives the hospital administration or the executor of the deceased’s estate can give permission. Relatives’ understanding of an autopsy should be such that their agreement is fully informed. This Means That The Relative Signing The Agreement Form Understands The Meaning Of Its Various Sections, Especially The Retention Of Tissues Or Organs For Diagnosis, Teaching And Research. In addition to more general information concerning the post mortem, professionals should know local autopsy practice and how this affects procedure.

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14.3 Reasons For Autopsy Examination Autopsy are a form of medical audit and education and they provide a wide range of information that extends beyond the cause of death: • Confirmation of clinical diagnoses • Additional significant diagnoses that were unsuspected • Information on effects of treatment However, even after the most careful examination, an anatomical cause of death may not be found. Nevertheless, negative information is still of value in counselling relatives. 14.4 The Autopsy All autopsy requests to the Pathologist should be accompanied by a clinical summary - in the space provided on the post mortem request form. The case notes are required by the Pathologist to allow the examination to be put in its clinical context. In all cases, it is preferable for catheters and drains etc. to be left in situ. The main incision is in the mid line from the neck to the pubis and second incision over the back of the head is used to examine the brain. A post mortem examination normally takes 1-3 hours. After the pathology team restores the body and the deceased is suitably dressed these incisions should not be visible. A Pathologist performs a post mortem with all of the care and respect that would be exercised during a surgical operation. 14.5 Tissue Samples And Organ Retention Post mortems often include retention of small tissue samples for microscopy. However, sometimes it is good practice to retain a whole organ for later examination by other specialists for complete diagnosis. Retention of the brain is the most common need. Where there is a diffuse or multifocal neurological disease such as dementia, motor neuron disease, multiple sclerosis etc., examination at the time of the post mortem may not reveal the problem and retention of the brain, and where clinically indicated, the spinal cord for specialised neuropathological examination is necessary for a precise diagnosis. An on-call Neuropathologist is available for discussion and advice via the Southern General Hospital switchboard. The Neuropathologist will NOT agree to examine a brain unless there is specific authorisation for brain retention and written consent for disposal or return of the brain (following neuropathology) to the family. It Is Necessary To Obtain Specific Agreement For Whole Organ Retention. While this may seem a difficult question to pose to relatives, experience has shown that relatives often agree if they are provided with a full explanation of the necessity to obtain a complete and accurate diagnosis. Extreme distress has been caused by later discovery that organs have been retained without the relatives’ knowledge. 14.6 Limited Autopsy Examination If relatives are reluctant to give agreement for a full autopsy, a limited post mortem directed to answering specific questions e.g. problems in the chest or abdomen may be valuable. Incisions can be limited and even recent surgical incisional can be used if appropriate. Needle biopsies can also provide useful information. Where a limited

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examination is being considered, discussion with the pathology team is advisable, since the more limited, the greater the chance of it being inconclusive. 14.7 Timing Of The Autopsy It is advantageous to perform a post mortem as soon as possible after death. Delay may influence the quality of some results but useful information can still be obtained some days after death. 14.8 Transport Of Bodies For Autopsy Occasionally a body will have to be transferred to another hospital for the post mortem. This is arranged by the pathology team and carried out by an undertaker designated by the hospital and carries no charge to the relatives who nonetheless, should be informed of the need for this transfer. 14.9 Viewing The Deceased Routine Cases: Viewing the body by relatives is now usual and considered good practice to aid the grieving process. High Risk Cases: Viewing and handling of the body after death but before an autopsy has been performed is acceptable for high-risk patients. After a post mortem has been performed, viewing of the body is acceptable but handling by friends and relatives should be discouraged because of the risk of infection. To prevent the spread of infection, the guidelines laid out in the Managing Infection Risks During Last Offices Policy must be followed. It Is Essential That The Pathologist Is Made Aware Of The High Risk Nature Of A Particular Case When A Post Mortem Is Requested. After the post mortem, the pathology team restores bodies carefully so that, with appropriate clothing, the deceased can be seen by their relatives. In some cases the appearances of the deceased can be improved. 14.10 The Agreement/Authorisation The agreement to post mortem must be fully informed. Relatives should have time for discussion and have their questions answered honestly and accurately. You should understand each part of the agreement form. If you are uncertain, it is better to consult with the pathology team. There should be permission for: • The post mortem with retention of small tissue samples for diagnostic histology. In addition permission may be obtained for: • Organ retention - the organs to be specified by the relative. • The use of tissue for research and/or teaching. It should be noted that any research on retained tissue is under the jurisdiction of the local ethical committee and follows national ethical guidelines. Parts of the permission relating to retention of organs and tissue can be deleted according to the relatives’ wishes. Retention of tissue for the treatment of others requires specific

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and separate agreement after discussion with the regional transplant co-ordinator. In some cases it may be appropriate to obtain agreement for transport of a body to specialist centres. 14.11 Feedback To Relatives Relatives usually want to know when they will have the results of the autopsy and other tests. The precise timing of reports will depend on local circumstances and may require discussion with the Pathologist. Normally, an autopsy report that includes histology should be issued within four weeks. An interim report based on naked-eye appearances will be available within days, but where specialised tests are performed a complete report may take months. Neuropahtological studies, for example may take up to three months. Information on the progress of other tests can be obtained from the pathology team. Final reports are sent to the consultant and general practitioner with whom the results can be discussed. After discussion, relatives are entitled to receive a copy of the report. 14.12 If An Autopsy Is Required 1. Make sure that the identification tags on the body are clearly marked indicating that a post mortem is contemplated and that the body should not be removed from the mortuary. 2. The name of the referring Clinician and the Consultant in charge should be clearly indicated. Also include a page number or telephone extension where the Clinician can be contacted. 3. It is important to obtain authorisation for an autopsy from the nearest relative. If you suspect that an organ be retained - please obtain consent for disposal of that organ (e.g. neurological disease). 4. This consent should also be documented in writing and witnessed as indicated in the official “autopsy authorisation pack”. 5. A concise clinical summary must be included. 6. The autopsy authorisation form (Pathology copy) and case notes should be sent to the mortuary expeditiously. 7. Every effort will be made to communicate the result to you and at the same time invite you to discuss the clinical pathological findings. 8. An initial autopsy report summary will be issued and sent to the wards as soon as the examination is completed.

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15.0 Procurator Fiscal Autopsies If a death falls within any of the undernoted categories, it Must be reported to the Procurator Fiscal (PF) to ensure that the PF has the opportunity to conduct an inquiry: 1. Any uncertified death. 2. Any death caused by an accident arising out of the use of a vehicle including an aircraft, a ship or a train. 3. Any death of a person while at work. 4. Any death resulting from an accident in the course of work arising out of industrial disease or poisoning. 5. Any death due to poisoning. 6. Any death where the circumstances indicate that suicide may be a possibility. 7. Any death where there are indications that it occurred as a result of medical mishap, i.e. a. Death, which occur unexpectedly having regard to the clinical condition of the disease prior to his receiving medical care; b. Deaths which are clinically unexplained; c. Deaths seemingly attributed to therapeutic or diagnostic hazard; d. Deaths where are apparently associated with lack of medical care; e. Deaths which occur during the actual administration of general or local anaesthetic; and f. Deaths which may be due to anaesthetic. 8. Any death resulting from an accident. 9. Any death following an abortion or attempted abortion 10. Any death where the circumstances seem to indicate fault or neglect on the part of any person. 11. Any death occurring while the deceased was in legal custody as defined in section 1 (4) of the 1976 Act. 12. Any death of a new born child whose body is found. 13. Any death (occurring not in a house) where a deceased’s residence is unknown. 14. Any death by drowning. 15. Any death of a child from suffocation including overlaying. 16. Any death which may be sudden death in infancy syndrome. 17. Any death occurring as a result of food poisoning or an infectious disease 18. Any death by burning or scalding or as a result of a fire or explosion. 19. Any death of a foster child. 20. Any other death due to violent, suspicious or unexplained cause. 21. Any death where a complaint received from the next of kin about the medical treatment given to the deceased, and where there is any suggestion that the medical treatment may have contributed to the death of the patient.

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15.1 Notifying The Procurator Fiscal Deaths can be notified to the Procurator Fiscal Office on:-

Scottish Fatalities Investigation Unit (East)

Edinburgh Procurator Fiscal's Office

29 Chamber Street

Edinburgh, EH1 1LA

Office Number: 0844 561 4110 or 08445613123.

The Procurator Fiscal will then either investigate the problem himself or be uninterested. By informing the Procurator Fiscal you will have fulfilled you legal obligation and protected the interests of the patient, yourself, your clinical colleagues and NHS Forth Valley. When in doubt discuss the case with the Fiscal.

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