Cervical Smear Protocol

Eleanor Kidd instructs a computer list of all the patients in one practice due cervical smears. This is done weekly. The only variation is when Eleanor Kidd is on leave. As long as this is anticipated there is not a problem. Each practice is called about every two months, even if the doctor is on leave.

Exceptions to routine 3-yearly screening

Nulliparous women who are not and have never been sexually active. A temporary exclusion of ‘X’ years can be applied only on a doctor’s instructions and this must be entered onto the patient’s computer record. If the entry is not made by the G.P., it will be done by Eleanor Kidd. On the expiry date, this will be automatically released, but if it is still appropriate it will be reinstated on this doctor’s instruction.
Women under 20. If these women have had a smear then they will be automatically recalled.
Women aged 60-65. May be called up but should only be sent for if they have not had two consecutive normal smears in the previous ten years.
Women over 65 years. To be called only in exceptional circumstances.
Pregnancy –
(a) 3-year smear recalls should be delayed until 12 weeks post-natally. Therefore, a temporary exclusion until 12 weeks after the EDD should be made and this must be entered into the patient’s computer record. If the entry is not made by the GP, it will be done by Eleanor Kidd.
(b) Under 3-year recalls (includes abnormal follow-ups). These women should be recalled regardless of the gestation of the pregnancy.
(c) Those women who have not previously been called or who have never attended should still be recalled regardless of the gestation of the pregnancy.
Post-natal checks. A cervical smear should be offered if the patient has never had a smear or a normal smear is due (or overdue).
Colposcopy.
Once a patient has attended the Colposcopy clinic for the first time, her follow-up is the responsibility of the clinic, until she is discharged. Therefore, a temporary exclusion of ‘X’ months will be put on at the doctor’s instruction, but only after the initial clinic letter is received. This must be entered onto the patient’s computer record. If the entry is not made by the GP, it will be done by Eleanor Kidd. When a patient is discharged from the clinic, the doctor should instruct the exclusion to be lifted so that the appropriate recall interval can be set. Once a patient has been discharged from the clinic, she should receive annual recalls for a further four years then routine 3-yearly recalls.
After total hysterectomy.
No smear or recalls are necessary unless the hysterectomy was because of malignant disease or CIN, or CIN was found coincidentally. It is the gynaecologist’s responsibility to advise us if this routine is not to be followed.
Vault smears.
A separate call-up system is in place for the small number of women in this group. The call-up is done after each cycle of cervical smear recalls, i.e. every two months.
Severely immuno-suppressed women, e.g. transplant patients.
Annual smear recalls. This requires the doctor to actively instruct a shorter recall frequency.
Those women who have stated that they wish to be excluded from the recall system (for whatever reason). This should be recorded on the patient’s computer record and a document signed by them and this should be then added into the patient’s computer record

Defaulters

NORMAL RECALL – if a patient has not responded to 3 recall letters then their records are amended to state “screening invite – not replied” – this removes them from recall for 3 years. At that time they will automatically go back into routine recall and be sent letters again.

ABNORMAL RECALL – if a patient has not responded to 3 recall letters – the final one having been sent “recorded delivery” – then a message is passed to the doctor to see whether the patient should be called for again or removed from recall for 12 months. After the doctor’s decision a code is entered into the patient’s records to correspond with the decision.
Also every quarter we receive a list from the Cervical Screening Office regarding abnormal results for patients and this is used as a double check that no-one has been missed.

ELEANOR KIDD’S INPUT

Obtain computer-produced call/recall list and accompanying letters.
Check any results not received.
Check computer record for accuracy or most recent smears – particularly any Gynae clinic or occupational health letters and duplicate smear results from elsewhere. Update computer record and amend list, if necessary.
Temporarily exclude any 3-year recalls for women currently pregnant, until 12 weeks after the EDD.
Give list and letters to doctor for checking. Letter has computer signature on it.
Send letter to patient:
(a) No previous smear NEVER letter
(b) Most recent smear normal and on 3-year recall NORMAL letter
(c) Previous abnormal smear and/or not on 3-year recall ABN1/2/3 letter.
All third (a), (b), or (c) letters to be red-stamped with “THIS IS YOUR FINAL REMINDER”. If it is an ABN letter it is sent RECORDED DELIVERY.
Entry is made onto patient’s computer record using a GPASS User marker to show which letter has been sent and whether it is 1st, 2nd or 3rd.
Inform Primary Care monthly of eligible ghosts.

OFFICE STAFF INPUT

When booking appointments remember –
(a) to book a longer appointment
(b) to book practice nurse along with male doctors.
Once a smear result is received, this must be seen by the doctor and the note to patient completed.
Record the result onto the patient’s computer record and scan the result into the patient’s computer record and the original filed in the patient’s paper notes.
Send out the completed result.
The coloured report is to be passed to computer.
Keep copy report loose until coloured report is filed.
Once the coloured report has been dealt with by the computer, it should be filed along with the other investigation results, i.e. altogether and not chronologically with correspondence. Unless the copy result is needed for referral, destroy it.
If only the copy result is received, it should be dealt with as in 2,3 and 5 but the copy is not filed in the paper notes but kept in storage for one year. It is important to ensure that the computer has been updated with the result before it is stored.
When ghosting patients aged 20-65 inform Lorraine Hamilton so that Primary Care can be notified re next follow-up.
When the old notes of patients aged 20-65 come into the practice, if a previous smear history is available, this information is added to the patient’s computer record by Eleanor Newman to update the computer.

PRACTICE NURSE INPUT

When taking a smear, remember to complete the request form including the number, if available, and to indicate if the patient is on HRT.
After doing a smear please record it on the computer.
If a patient’s DNA’s record this on the patient’s computer record.
Opportunistically remind patients who are/will be due their smears to arrange appropriate appointments.

DOCTORS' INPUT

Remember to actively instruct computer to include/exclude women from recall according to list on first page.
After the list has been checked by Eleanor Kidd, the doctor must verify it before the appropriate letters are sent out. The list will include all women who have not responded to 3 letters in the past. These women will have a code added to their computer record that will recall them in three years’ time.
IF A PATIENT DNA’s, RECORD THIS ON THE PATIENT’S COMPUTER RECORD.
When taking a smear, remember to complete the request form including the CHI number if available, and to indicate if the patient is on HRT.
After doing the smear please record it on computer.
On receipt or the result, complete the patient note, and place this with the notes in the back team shelves.
Opportunistically remind patients who are/will be due their smears to arrange appropriate appointments.