D.16 CERVICAL CANCER SCREENING.pdf

D.16 CERVICAL CANCER SCREENING

36C25922R0102

DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER

OKLAHOMA CITY, OKLAHOMA

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CERVICAL CANCER SCREENING

1. SUMMARY: To state the plan of this medical center on cervical cancer screening process for women veterans.

2. PURPOSE: To define the policy and procedures for the management of Papanicolaou smears at the Oklahoma City VA Medical Center and Community Based Outpatient Clinics (CBOCS).

3. POLICY: Cervical cancer screening will be available to all eligible female veterans as clinically indicated through a primary care physician or gynecological referral. The primary care provider or designated women's health providers will follow the current VHA guidelines for cervical cancer screening and the process defined for Cervical Cancer Screening in VHA Handbook 1330.01, Health Care Services for Women Veterans.

4. DEFINITION: Cervical cancer screening includes a speculum examination and cervical pathology evaluation performed by the provider in accordance with VHA guidelines. Cervical cancer screening is a way to detect abnormal cervical cells, including precancerous cervical lesions, as Yvell as early cervical cancers.

Cervical cancer screening includes two types of screening tests: cytology-based screening, known as Pap smear and HPV testing.

Papanicolaou Smear (Pap smear) is used to detect abnormal cells that may develop into cancer, if left untreated. The Pap smear can also find noncancerous conditions, such as infections and inflammation.

Human Papilloma Virus (HPV) testing is used to look for the presence of high-risk HPV types in cervical cells. HPV testing is recommended on all women over the age of 30 years of age.

5. RESPONSIBILITY: Providers (Physician/Nurse Practitioner/Physician Assistant) are responsible for obtaining Pap smears and HPV tests. Providers will also review Pap smear and HPV test results and notify patients in a timely manner (according to guidelines defined in VHA

Handbook 1330.01) by letter, in person or by telephone on recommended follow-up.

The results of normal (NEM-No Evidence of Malignancy) cervical pathology must be reported to.

the ordering provider by the lab within 30 calendar days of the pathology report being issued. The interpreting physician must ensure the ordering provider is contacted with abnormal results within 5 business days.

A. Attending physicians for medical residents in the GYN clinic will oversee Pap smear results and will ensure patient notification is completed per the guidelines mentioned in the VHA handbook

1330.01

B. Chief Laboratory & Pathology or designee will notify the Women Veterans Program Manager by written report each month of all pap smear results.

C. Registered Nurse (RN)/Licensed Practical Nurses (LPN) will chaperone and ensure that all specimens are sent to the Laboratory daily in a timely manner.

Ambulatory Care Cervical Cancer Screening

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6. PROCEDURES: Listed below are the procedures followed for cervical cancer screening.

A. Pap and Pelvic Examinations: All eligible female Veterans will be offered pap smears, pelvic exam and STD screening (if indicated) exams through their primary provider or through the Gynecology Clinic.

On a weekly basis, providers will be given a report by their PACT team containing all patients assigned to their specific panel that have a reminder due now for a pap smear. Pact team will review the list and document the date of the last Pap/Hpv and results for provider's to ensure Pap smear is clinically indicated. If indicated, Provider will request

PACT team schedule the Pap smear.

B. Instructions for pap smears: Providers who perform gender specific exams like pap, pelvic and breast exams will have a chaperone present.

1. RN/LPN will appropriately label Thin Prep bottle with Veteran's full name, Veteran's full social security number.

2. Providers will place electronic order in CPRS for the Pap smear, HPV, and STI testing as indicated

C. The lab notifies the provider and pap coordinator via a view alert when the results of pap and

HPV are available.

D. It is the provider's responsibility to follmv-up on these results and treat any pathology detected and also to refer to gynecology if needed. Pact teams will place a Recall Reminder for follow up pap smear as indicated by provider in the patients electronic record.

E. Patients referred to gynecology for abnormal exams will be followed by gynecology until they

. are released to be followed by primary care providers. GYN clinic will notify the provider of all recommendations. PACT team will place a Recall Reminder for any follow up as advised by GYN clinic to ensure timely follow-up

F. It is the provider's team responsibility to notify the patient of any abnormal pap v,1ith in 5 business days of receiving the result and also to notify the patient of a normal exam within 14 calendar days of receiving the results, and documenting notification of results and follow-up in their progress notes. This is monitored by the Pap Coordinator and reported to the WVPM monthly or as needed.

7. FOLLOW-UP FOR POSITIVE/NEGATIVE RESULTS REQUEST:

A. The provider performing pap smears is responsible for follow-up on normal or abnormal exams and to ensure patients get their follow-up exams.

Ambulatory Care Cervical Cancer Screening

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B. The cervical pathology report ofNonnal (NEM-No Evidence of Malignancy) results must be communicated to the patient in terms easily understood by a layperson within 14 calendar days from the date of the pathology report becoming available. Documentation of a letter and/or verbal communication with the patient must be entered into CPRS. If using the United States (U.S.) Postal

Service, confirmation of the receipt of these results is not required. For any abnormal cervical pathology report, the results must be communicated within 5 business days of the report being issued.

8. PATIENT EDUCATION: Education regarding periodic health examinations/female health issues is made available to female Veterans through pamphlets, educational programs, and one-to one educational sessions.

9. QUALITY CONTROL: Monitoring of all abnormal pap smears will be conducted on a quarterly basis by the women veterans program manager. Quality control issues are addressed as they arrive.

The Pap coordinator in collaboration with the women veterans program manager; pathology service and primary care service will oversee tracking and timeliness of follow-up of findings from cervical cancer screenmg.

Policy on compliance v-1ith reporting of cervical cancer screening results: A monthly list of all pap smears done at the medical center and CBOCs will be sent to the Women Veterans Program

Manager by the OKC Lab supervisor/clesignee. This list indicates the normal and the abnormal pap smears .The Women Veterans Program Manager will ensure that the abnormal pap smears have been followed up on and referred to the Gynecology clinic.

The Pap Coordinator or designee will review the timeliness of normal and abnormal results being reported to patients and inform the providers, WVPM and Chief of Primary care if the standard is not met.

10. REFERENCE: VHA Handbook 1330.1, VHA Services for Women Veterans elated May 2010.

11. FOLLOW-UP RESPONSIBILITY: Chief Ambulatory Care Service and Women Veterans

Program Manager.

12. RENEWAL DATE:

/J

GEORGE

th, 2022