Cervical Screening Pathway
Cervical Screening Pathway.
Referral to PRT from GP surgery requesting support.
Check on EPEX for any open episodes. This will give an indication of the individuals needs.
Phone call to individual or carers, ascertain level of need.
If screening refused by carer, inform that a Best Interest Discussion must be had with GP and nurse (preferably LD). Reassure that this can be done over the phone or via correspondence if a visit is not possible.
Consent. Assessment is made by using the Capacity pathway. You must be able to evidence your capacity decision by using the Mental Capacity Act 2005 (Copy in this folder). If you are unsure then seek further advice from a competence colleague or a referral for a capacity assessment may be needed from psychology. Please remember that you are only making a judgement on someone’s capacity to make a decision for cervical screening and NOT making the Best Interests decision.
If individual is able to consent and does not present with difficulties.
Practice nurse performs at surgery. No further action required by LD team.
If individual has a physical disability and can consent:
Check that surgery can meet the physical needs (hoists, raised bed) if not request that GP refers to Colposcopy, Derriford. May need support with process from LD team.
If individual can consent but is anxious:
Meet with individual, assess anxiety, offer desensitisation with the use of photo’s, symbols, visits to practice, equipment. Possible sedation prior to screening, if unsuccessful request GP to refer to Colposcopy clinic, Derriford, support appointment. Repeat until either successful or refused by individual. If refused by individual record reasons for audit purposes.
If individual is unable to consent:
Assess risks and Best Interests decision to be made with individual, GP, Nurse and /or carers/family. Decision to include levels of distress, previous sexual history, (including possible sexual abuse,) physical difficulties and ascent to procedure. Rational for decision to be recorded in both GP and LD notes.
If outcome is not to proceed in Best Interests, individual is not invited for screening but will remain on register and will be invited as per protocol (3 yearly or 5 yearly)
If outcome is to proceed in Best Interests GP may refer to Derriford for screening under GA, LD team to offer support with screening according to need.
If individual is symptomatic GP should refer to Gynaecology, Derriford, requesting colposcopy, depending on need this may require a GA.
An individual has the right to refuse screening at any part through the process and this should be respected. Written records evidencing what has been done to meet the individual needs of that person should be made.
When supporting with screening the individual should be mid cycle so that the cells can be gathered effectively.
Risks include numerous sexual partners, Contraceptive Pil, Past sexually transmitted diseases.