CHS37 Obtain cervical cytology samples from individuals

Overview

This standard covers taking cervical cytology samples for screening.  The aim of cervical screening is to identify conditions that might otherwise develop into invasive cancer so that preventative treatment can be provided.  The sample taker should take care to explain the aim, procedure and possible outcomes of the screening programme and acknowledge and address women’s concerns and anxieties.  Women and their families should have confidence in the screening programme.  The nature, urgency and efficacy of any follow-up actions are dependent upon the reliability of the screening results.  It is important therefore that the sample taking procedure results in high quality samples which can be screened effectively. This standard is for qualified practitioners who have completed a recognised training programme for taking samples for cervical screening. This standard does not cover the taking of vault samples. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. The legislation which relates to your actions within the healthcare environment including:
1. confidentiality and information sharing
2. the provision of services
3. human rights
4. anti-discriminatory practice
2. The statutory and professional standards and codes of practice for your area of work and how to interpret and apply these
3. The importance of working within your own sphere of competence and seeking advice when faced with situations outside your sphere of competence
4. The importance of applying standard precautions and appropriate health and safety measures and the potential consequences of poor practice
5. Local protocols for patient identification
6. Local policy and protocol for arranging and working with a chaperone
7. Legislation and legal processes relating to consent
8. The principles of valid consent, including implied consent and expressed consent
9. The relevant national and organisational policies and guidelines on consent
10. Why it is essential to maintain the individual’s confidentiality
11. The national cervical screening programme guidelines including eligibility for screening
12. The importance of complying with the national cervical screening guidelines and the potential consequences of poor practice
13. The epidemiology and natural history of cervical cancer
14. The risk factors for cervical cancer
15. Human papilloma virus (HPV) and its links with cervical cancer
16. The effectiveness and limitations of cervical screening
17. National and local guidelines for the clinical management of women on the national cervical screening programme
18. Colposcopy procedures
19. Sources of authoritative information on cervical screening, including evidence based information
20. The current and emerging issues, research and developments for cervical screening
21. Information and educational resources for practitioners, and methods for accessing them
22. The appearance of normal female genital anatomy
23. The appearance of benign/harmless abnormalities of female genital anatomy
24. An in-depth understanding of the:
1. position of the cervix
2. anatomy and physiology of the cervix
3. cellular structure of the cervix
4. development of and changes in the transformation zone
25. The physical manifestations of common genital tract infections
26. The presentation and appearance of genital tract malignancy
27. How to communicate with individuals to explain procedures and reassure, including those with special needs
28. The aim, risks, benefits and limitations of cervical screening and how to explain these to individuals
29. Customs and health beliefs of local minority ethnic groups and the implications for taking cervical cytology samples
30. Signs of anxieties in women and how to respond to these
31. The meaning and implications of different test results, including normal, inadequate and abnormal results, and how to explain these to women
32. National and local information materials and how to access these
33. Materials and equipment required for taking cervical cytology samples
34. Contraindications for the use of equipment e.g. latex allergy
35. The factors to take into account in selecting specula and samplers
36. The correct storage and type of container for cervical cytology samples
37. The national and local call and recall system and failsafe procedures
38. The types of information required in taking a history, and why each is required
39. The steps you would take to clarify and confirm any relevant information which is ambiguous or missing from the woman’s history
40. Specific preparation for women prior to taking cervical cytology samples
41. Circumstances when it would be inappropriate to take a cervical cytology sample
42. Appropriate use of the speculum to visualise the cervix
43. How to avoid unnecessary discomfort or distress to women during consultation and sample taking for cervical screening
44. The laboratory screening process and the implications for the type, quantity and quality of samples required
45. Potential problems in obtaining cervical cytology samples and what you should do in response to these
46. The possible adverse reactions that may occur when taking cervical cytology samples and how to respond to these
47. Local procedures for reporting incidents and concerns
48. The full and complete labelling of samples and the implications of incorrect or incomplete labelling
49. The requirements for safe and secure transfer of samples to the laboratory for screening
50. When and how to refer women for further opinion, examination or intervention
51. The importance of, and procedures and timescales for, emergency referral to an appropriate clinician when malignancy is suspected
52. Arrangements and approximate timing for notifying women of their test results
53. The importance of recording information clearly, accurately and in a systematic manner
54. The importance of confirming the woman’s address and arrangements for her to receive her test results
55. The information that is required to ensure accurate labelling of samples
56. The relevant test request form and the information required
57. The information which must be recorded in the woman’s notes

Performance Criteria

You must be able to do the following:

1. comply with the national cervical screening programme guidelines
2. receive the woman and check her identification details in accordance with local protocols
3. clearly explain who you are and your role in the cervical screening programme
4. communicate with individuals in a supportive and approachable manner consistent with their:
1. understanding
2. culture and background
3. preferred language and ways of communicating
5. ensure that the woman is due for cervical screening and has received a copy of the national leaflet explaining the screening programme
6. establish any specific requirements to achieve effective consultation and sample taking
7. clearly explain the screening process and possible outcomes, including benefits and limitations
8. offer, and arrange if appropriate, the services of a chaperone in accordance with local policy
9. answer any questions from individuals accurately and promptly consistent with your professional role and responsibilities, and refer any questions that you cannot answer to the appropriate person
10. obtain the woman’s valid consent to cervical screening and the sample taking procedure
11. take and record a relevant history
12. complete the appropriate documentation fully, clearly and accurately
13. stop the procedure if the necessary preparations have not been followed by the individual or staff
14. ensure the correct positioning of the woman to minimise discomfort and facilitate the sample taking procedure
15. carry out the sample taking procedure correctly to obtain an adequate sample
16. act with discretion, sensitivity and respect throughout the consultation and sample taking procedure
17. ask the woman to indicate if she wishes to stop the procedure at any time
18. ensure the woman’s privacy, dignity and confidentiality at all times, taking into account the woman’s ethnic and religious background which might influence certain aspects of taking cervical cytology samples
19. apply standard precautions for infection control and take other appropriate health and safety measures
20. recognise and take appropriate action in response to:
1. any condition or behaviour which may signify adverse reactions to the sample taking procedure
2. inability to visualise or sample the cervix
3. any signs of genital tract infection
4. clinical suspicion of malignancy
21. preserve and store the sample with due regard for sample quality, safety and security
22. carefully remove and dispose of the speculum
23. label the sample clearly and correctly, and attach the relevant documentation
24. store the sample in the correct place for collection or transport
25. report any problems or concerns to the relevant person
26. 26.  check that the woman understands:
1. how and when she will receive her result
2. possible results and follow up
3. how to obtain help, support, advice and further information if required
27. keep accurate, complete and legible records of the sample taking procedure and outcomes in accordance with local policies and procedures

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension:  HWB7 Interventions and treatments