Cervical smears

 

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Step Action Notes
Patient sees nurse for smear. Enter or select current problem Cervical neoplasia screening.
Answer any previous Cervical smear due reminder.		 If this current problem is not present it should be added.
Take smear. Enter read code .6859 Ca Cervix screen done Smear exemptions:
  • .7E04 Abdominal hysterctomy
  • .7E05 Vaginal hysterectomy
  • .7E000 Amputation of cervix
  • …and .6853 Cervical smear not wanted if patient signs written declaration saying she does not wish a smear (very exceptional circumstances only).
Results back. Smear result added using the appropriate results code.
  • Add smear identification number to free text.
  • Add report in free text if appropriate.
  • Add attribute Elsewhere non payment if not a GMS claim.
  • Add .@!B3 Cx cytology recall due reminder for appropriate interval.
    • .@!B3 Cx cytology recall due
    • .@!B31 Cx cytology normal recall due
    • .@!B32 Cx cytology abnorm recall due
    • .@!B33 Cx cytology infect recall due
    • .@!B34 Cx cytology inadeq recall due
    • .@!B3z Cx cytology other recall due
  • Generate and print appropriate patient letter from System 6000 according to which nurse took the smear and the smear result.
  • Attach result to letter and pass to PN for checking.
 Use only these codes for results:
  • .4K21 Cervical smear: inadequate specimen
  • .4K22 Cervical smear: negative
  • .4K23 Cervical smear: mild dyskaryosis
  • .4K24 Cervical smear: severe dyskaryosis
  • .4K25 Cervical smear: severe dyskaryosis ?inv ca
  • .4K26 Cervical smear: ?gland neoplasia
  • .4K27 Cervical smear: atrophic change
  • .4K28 Cervical smear: mod dyskaryosis
  • .4K29 Cervical smear: borderline changes
  • .4K2Z Cervical smear result NOS

If an infection (eg thrush) is detected, this should be added as an additional code.

All patients are informed of their smear result by letter.
Results to practice nurse. Nurse checks report against attached letter, and signs smear letters. Normal results then go to reception for filing and letter posted. Send appropriate cervical smear advice leaflet if smear abnormal.
Abnormal results Referral made
Filing Results filed electronically

New patients

  • All smear results are entered by Anne on receipt of records.
  • Regional centre is notified of all results if the patient has moved from another region.

Patients who default smears

The practice has a policy of not excluding any eligible women from asmear except under very exceptional circumstances, so the practice has no”smear refusal” form. This is to ensure that patients are given theopportunity to formally change their mind about having a smear at least every 3years if they have previously declined a smear and are never removed permanentlyfrom the smear system. Computer reminders prompt doctors and nurses to discusscervical smears opportunistically with patients who default appointments.

Patients who do not attend or persistently cancel smear appointments:

  • 1st DNA: recall in 3 months with letter and smear advice leaflet.
  • 2nd DNA: recall in 3 months with letter and smear advice leaflet.
  • 3rd DNA: recall in 3 years with final letter and smear advice leaflet.

Failsafe procedures

  • All patients who have had abnormal smears are also separately logged in the abnormal smear diary.
  • Patients’ individual smear requirements are matched against lists from the regional database monthly to ensure practice and region database accuracy.

Monitoring

  • Auditing of smear uptake via the report schedule.
  • Auditing of abnormal smears regularly performed.
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