Sample Takers 2014 Cervical Sample Taker Training Quality Issues Cervical Sample Taker Training South West Regional Cytology Training Centre 1

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% Who would you rather took your sample? Sample Taker 1: TZ sampling 30% Sample Taker 2: TZ sampling 85% 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

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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