Best Practice for Cervical Screening Updates To Maintain Competence: NHSCSP Good Practice Guide No 2 (2011) recommends that all cervical sample takers should maintain their competence in cervical sample taking, in accordance with professional codes of conduct. Sample takers should: Conduct continuous self-evaluation Audit and reflect on their individual rates of inadequate tests and abnormal test results compared with the rates reported by the local laboratory Undertake a minimum of one half day s recognised update training every three years. E- learning does not currently cover all of the necessary criteria Update Training: Update training should address all of the following issues: Current developments in the cervical screening programme nationally and locally Recent literature relevant to sample taking, sampling devices and women s needs Changes to local screening policies and procedures Personal learning needs and a qualitative assessment of 20 consecutive recent samples Ideally there should be representation from Colposcopy and the Laboratory to identify and answer local clinical queries Recording update training: It is important that the employer and the NHS England Screening and Immunisations Team are aware that update training is completed. The training provider will send a list of all staff who attended an update to NHS England Screening and Immunisations Team. They should ensure that this occurs for all trainees, even if the trainee comes from a location distant from the local NHS England Team. It is the responsibility of the trainee and their employer to keep training records for themselves. The trainees should be reminded of this as part of the training by the training provider. References: NHSCSP (2011) Interim Good practice guidance for cervical sample takers NHSCSP (2006) Taking Samples for Cervical Screening a resource Pack for Trainers Summary information approved by a task and finish group with representation from PHE and NHS England for interim use in the North West. 1
Cervical Screening Failsafe Responsibilities All GPs or other clinicians responsible for requesting cervical samples are responsible for the following failsafe procedures: Maintaining a register of smear tests taken Auditing the tests taken on a monthly basis to ensure a test result has been received from the laboratory for every sample taken Ensuring there is a system for notifying women of their test results in writing. It is deemed best practice for Primary Care Support Services to administer the call/recall process Ensuring that arrangements are made for women who fall outside the call/recall system to be given their test results in writing (e.g. temporary residents, women who do not have a GP, or women requesting no correspondence ) Acting on non-responder notifications for women who have not responded to an invitation for a routine test Acting on non-responder notifications for women who have not responded to invitations for an early repeat test Acting on non-responder notification from the colposcopy clinic for women who have not attended for colposcopy Providing women with their test result in person when urgent referral is required Ensuring referral to colposcopy takes place if required (e.g. if a woman has opted out of Direct Referral or has had a sample taken out of the area which requires referral for further investigation) Responding to cervical cytology failsafe enquiries by laboratories; ideally a response should be returned to the laboratory within 2 weeks from receipt Reporting any serious untoward incidents to the Screening and Immunisation Team Based on recommendations from NHSCSP GOOD PRACTICE GUIDE NO 2 JULY 2011 Dr. Graham Wardman September 2014, reviewed by Kath Bainbridge, QA, December 2015 2
Best Practice for Cervical Screening Training According to the NHSCSP Good Practice Guide No 2, (2011), the resource pack for trainers NHS Publication No. 23 represents current best practice and is available at: www.cancerscreening.nhs.uk Organisation of training should be in 2 parts; a theoretical course followed by a period of practical training Arrangements should be made for cytological testing of all samples of trainees in an HPV Primary testing area A mentor agreement should be in place prior to commencing The SIT should be aware of trainees in their area commencing on training course Theoretical Training: The theoretical training should be delivered by a trainer who is an experienced and practicing sample taker The length of the theoretical course will depend on prior knowledge and experience of the trainee so is likely to differ for Nurses and Doctors The theoretical course must be at least one full day (or equivalent) The theoretical course should cover: - The NHSCPS, it s background and context, equality of access to cervical screening, understanding test results, anatomy and physiology of the pelvic organs, the practical aspects of taking a cervical sample and how to complete the practical workbook The training provider should invite different speakers with specialist knowledge about varying aspects of the programme Trainers and training supervisors should have good teaching and communication skills and should undertake regular update training and maintain awareness of developments in the cervical screening programme Practical Training: Practical training should take place in the practice or clinic where the trainee is employed Practical training must be supervised by an approved cervical screening mentor Trainees must keep a record of their training in the practical training record provided Trainees should make arrangements with their mentor for an initial session for observation and training. They should be accompanied by their mentor and identify their training needs, observe 2 samples being taken and then take a minimum of 5 samples under supervision until they feel confident to proceed without direct supervision Once the trainee feels confident they should take, document and audit 20 adequate, unsupervised samples Trainees should be supported in practice and given additional time for sample taking and to complete documentation There must always be access to a trained colleague during this period for support Trainees must document and reflect on their visits to colposcopy and the laboratory The mentor and trainee should maintain regular contact throughout training to identify any training needs 3
A final assessment must be held as soon as possible once the trainee has completed 20 adequate unsupervised samples A final assessment must be held and the mentor must supervise the trainee taking at least an additional 2 samples, plus assess the workbook has been fully completed and all elements are complete Once a final assessment has been completed a copy of the training workbook should be sent to the training provider for final sign off Practical training should be completed in 9 months, an extension can be granted in extenuating circumstances to enable a trainee to complete in 12 months If a trainee or mentor moves out of the area the trainee and mentor must notify the training provider immediately If a trainee fails to complete, sample taking must be stopped immediately 4
Information for employers of sample takers This information has been developed to support the employers of sample takers in ensuring that they have had adequate training for sampling within the NHS Cervical Screening Programme. Adequate sample taker training plays an important role in incident prevention reducing the need for repeat sampling which can cause unnecessary distress to women and delays in the screening pathway. It has been identified as an area of concern that practitioners are undertaking cervical sampling despite having failed to adequately complete initial sample taker training. There have also been incidents that could have been avoided if a better induction on returning to practice or moving to another practice location had been in place. A good orientation programme is essential for new sample takers, those returning to practice, Locums and those transferring from another practice area. This information has been developed based upon available guidance and approved by a task and finish group with representation from commissioners and providers facilitated by Screening Quality Assurance. Summary of employer s responsibilities: The employer should ensure that they have a copy of a Practitioners Cervical Screening Training Certificate and when they last updated. This may be required for CQC visits If no update attended in the last 3 years they need to ensure that they are booked on the next available update Good Practice guidance (2011), recommends that any sample takers should undertake a minimum of one half day s update training every three years To facilitate continued competence in accordance with their professional codes of conduct, cervical sample takers should conduct continuous self-evaluation and audit 20 samples to check their individual inadequate rates Work places need to have a good induction procedure and the sample taker needs to be aware of: The local LBC Technology i.e. Surepath or Thin prep The local lab sample acceptance protocol and how specimens are transported Whether this is an HPV Primary testing site or Test of Cure and Triage Call and Recall and how to contact them Awareness of, and access to, Open Exeter for checking a woman s screening history An up to date practice protocol/s for taking samples, administration and receiving results What Practice Fail safes are in place for cervical screening? References: NHSCSP (2011) Interim Good practice guidance for cervical sample takers NHSCSP (2006) Taking Samples for Cervical Screening a resource Pack for Trainer 5