Quality Issues

Cervical Sample Taker Training

Quality Assurance

The NHSCSP is one of the best quality assured screening programmes

QA guidelines cover all aspects of the programme

Limitations of Cervical Screening

No screening test can provide 100% protection

Non-attendance Sampling error Screening error Interval cancers

Samples

Ensure correct patient/details Good quality sample (Good

technique & Audit) Result must be back to patient

within 2 weeks

How to measure sample quality?

Monitor inadequate samples

Monitor whether samples contain evidence of transformation zone sampling

Possible reasons for inadequate samples

Excess Blood Menstrual samples Large ectropion Excess mucus Atrophic cervix Lubricant Poor sampling technique/sample transfer

Should all be covered during practical session

Auditing the quality of your samples

Transformation Zone Sampling

It is important that the TZ is sampled as this is the area where abnormalities may arise

Transformation Zone Sampling

A sample does not have to have TZ material to be called negative

Why do some samples not contain TZ material? Position of TZ in post-menopausal

women Poor sampling?

Transformation zone sampling Audit of TZ gives an indication of the

quality of your sample taking

In women aged 25-50, 80% of samples should contain evidence of TZ sampling

This is your target during training period

Must see reports of all samples taken

Auditing Quality Sample Taker 1 : Inadequate rate 0% Sample Taker 2: Inadequate rate 2% Who would you rather took your sample? Sample Taker 1: TZ sampling 30% Sample Taker 2: TZ sampling 85% Who would you rather took your sample? Unless they audit TZ sampling,

sample taker 1 thinks they are doing a brilliant job

Transformation zone sampling

This audit will be done for you during your training period

You should continue to audit this once qualified

How?

TZ sampling – Bath Feedback sheets TZ listed as Y, N or PM (postmenopausal)

Reports: Adequate cellular content. TZ cells present Adequate cellular content. TZ cells absent PM: adequate cellular content Inadequate: Unsatisfactory

Assessment of TZ sampling - Southmead Laboratory

Sample quality codes located towards the bottom of the report form indicate presence or absence of TZ sampling

Usually 2 digits

Southmead Lab - TZ sampling

11 First digit - refers to TZ sampling

0 = no TZ cells 1 = TZ cells present

Squamous cell content

11 Second digit - refers to squamous

cell content 0 = Insufficient squamous cells 1 = Sufficient squamous cells

Reprocessed samples (2 slides made from one sample)

5 digits will be seen:00411

TZ slide 2

Background material

Sample Taker Registers

Sample taker register

Different areas have separate sample taker registers

Outside BNSSG? Check with your local laboratory about obtaining a

sample taker code asap

Bristol sample takers: Please register before taking a sample at:

nww.avon.nhs.uk/phnet/cervical.htm Upon registration a unique sample taker code is issued Inform register if you move practices (keep code unless

you move out of Bristol)

nww.avon.nhs.uk/phnet/cervical.htm

Enter your details

Sample Taker Register

Monitor initial training & update training Sample Taker Profiles

Bristol: Updated annually onto CTC website No. of samples taken No. of inadequates No. samples with TZ sampling (work out %age)

Bath: Need to request information from lab Best practice is on-going self-audit