D.23 MANANAGEMENT OF BREAST CANCER SCREENING.pdf

D.23 MANANAGEMENT OF BREAST CANCER SCREENING

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DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER

OKLAHOMA CITY, OKLAHOMA

Service Memorandum 111AC-17-2

October 12, 2017

111AC/GM/pm

MANAGEMENT OF BREAST CANCER SCREENING

1. Summary: All prior standard operating prcedures (SOPs) for breast imaging are rescinded. This document is submitted in accordance with the requirements of VHA

Handbook 1330.1 VHA Services for Women Veterans and VHA Handbook 11-4.1

Mammography Standards. Sections include Primary Care, Non VA Care, and

Radiology. Diagnostic and screening mammography will be available to eligible female and male Veterans as clinically indicated through Non-VA Care Services.

2. Purpose: To establish policy and guidelines for the management of breast imaging for patients treated at the Oklahoma City Veteran's Affairs Healthcare System

(OKCVAHS) to include the Community Based Outpatient Clinics (CBOCs).

3. Scope: This policy applies to all Ambulatory Care associates at the main

Oklahoma City VA Health Care System (HCS) and CBOCs.

4. Responsibility:

a) Non-VA Care (NVCC)

i) Obtain imaging results from contracted facilities.

ii) Scan mammography reports received into CPRS.

iii) Notify the mammogram coordinator and the ordering provider when mammography reports are scanned and available for review.

Notification sent as view alert through CPRS progress note or consult.

iv) Close out consult requests when process is completed.

v) Notify Radiology Service that consult is completed and image has been scanned.

b) Mammogram Coordinator

i) Track results of mammography consults and notify the patient of normal mammogram results within 14 calendar days from date of receiving the results. The Mammogram Coordinator is identified by the facility as the designee for the ordering provider to notify veterans of normal mammography results.

D.23 MANANAGEMENT OF BREAST CANCER SCREENING

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ii) Ensure provider is notified of any incomplete or abnormal results.

Center Memorandum 111AC-17-2 Management of Breast Cancer Screening

iii) Send reminder notifications to providers for short term follow-up mammograms or ultrasounds.

iv) Inform the Women Veteran Program Manager (WVPM) of any abnormal mammograms that have not been communicated to the patient within the timeframes specified. The WVPM will give this information to the Chief of Primary Care for further action.

c) Provider

i) Review and follow up on all mammogram results and order additional views/biopsy as indicated.

ii) Notify patient of abnormal mammogram results (Bi-Rads 4, 5, 6) as well as document notifications within five (5) business days of receipt of abnormal results.

iii) Order short-term (3 month, 6 month) follow-up on mammogram or ultrasound. The order must be placed within 30 days of desired imaging date. Provider will instruct team to create chart check reminder for upcoming imaging desired.

iv) Ordering provider is responsible for follow-up on any no-shows or cancellations of mammograms to ensure patients complete their exams.

d) Radiology

i) Upload report to the radiology package to include the Birad result.

Reports uploaded to the radiology package become available for tracking and future care management within the Breast Cancer

Registry (BCR) tracking system.

5. Procedures:

a) Periodic Examinations: All eligible female Veterans will be offered breast exams through their primary provider or through the Gynecology Clinic in accordance with the United States Preventative Services Task Force

(USPSTF) and the American Cancer Association (ACA) guidelines. All mammograms are requested through a NVCC consult request. Annual screening mammography will be offered to all average risk women veterans age 45 to 54. Women 55 years and older will be offered mammogram screening every two years or have the option to continue screening annually.

For patients in their 40s, screening mammography will be offered and screening mammogram will begin from age 45 to 54 utilizing the National

Mammogram Clinical Reminder. Screening of high-risk patients will be done on an individual basis. The ordering healthcare provider will discuss the indications and limitations of mammography with individual patients. Staff are to document any patient refusals of breast cancer screening in a CPRS progress note or consult note. In the event of patient no-shows and/or cancellations, notification is sent by view alert to the Primary Care Provider by the Mammogram Coordinator.

b) Mammogram Orders: All screening mammogram orders are electronically entered as a Non-VA Care consult by the provider or nurse. The urgency of the order should be indicated on each order. Nurses can order screening mammograms using the clinical reminder package. Diagnostic mammograms will be ordered by the provider as well as any screening mammograms for veterans younger than age 45.

c) Instructions for CPRS Mammogram Orders: To order mammograms for female veterans, providers are to complete the mammogram request utilizing either the screening or diagnostic consult and clearly indicate the procedure(s) requested. This is to be done through the mammogram orders in the ambulatory care order menu in CPRS. Nurses are to order the screening mammograms using the mammogram screening clinical reminder.

To order mammograms for male veterans, providers are to complete the consult request utilizing the diagnostic mammogram consult in the ambulatory care orders menu and clearly indicate the procedure(s) requested. Once the request is submitted, NVCC reviews the request, sends the authorization to the patient/facility for scheduling, and ensures consults are closed with appropriate documentation.

d) Follow-up for Positive/Negative Results Request: Copies of mammogram result reports will be faxed from contract mammography facilities to NVCC service. The Mammogram Coordinator will notify patients of all normal results, all incomplete exams and the follow-up interval of next mammogram or ultrasound within 30 days. The provider is to notify patients of abnormal results within 5 business days or sooner as appropriate. These notifications are to be documented in CPRS.

e) Patient Education: Education regarding periodic health examinations/female health issues (to include, but not limited to self-breast examination) will be made available to female veterans through pamphlets or verbal education.

f) Quality Control: Monitoring of all abnormal mammograms will be conducted on a quarterly basis by the mammogram coordinator and risk management.

Quality control issues will be addressed as identified.

6. References: VHA Handbook 1330.1, VHA Services for Women Veterans &

VHA Handbook 11-4.1 Mammography Standards

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7. Follow-up Responsibility: Chief, Ambulatory Care Service; Women Veteran

Program Manager; Chief Nurse, Ambulatory Care.

8. Renewa aOt ceto:9er12,2021 v-;t/ ', George szky, MD Chief, Ambulatory Care Service