Guidance

Topic 5: cervical screening sample requests

Updated 14 September 2023

Applies to England

1. Topic 5: learning objectives

The trainee should know about:

• the pre-populated HMR101 form on Open Exeter and how to access it
• when it is acceptable to use a non-Open Exeter request form
• the risks for potential incidents in the local sample taking process

The trainee should understand:

• their responsibilities for taking a cervical sample
• reasons why the laboratory will reject a sample
• events leading to the rejection of a sample

The trainee will be able to:

• report and reflect on any rejected samples
• reduce errors associated with cervical screening sample requests
• download a request form from Open Exeter or use any local electronic requesting system
• check that the person is eligible for a test
• highlight any clinical concerns (make sure appropriate referrals are made and investigations carried out)
• check the sample vial is in date, and has at least 14 days left before its expiry
• check the sample and request submitted relate to the correct person
• check the person’s details on the request form and vial match
• check the registration of the person’s address is correct
• make sure the person receives the appropriate follow up and management
• record adverse events and incidents (make sure these arediscussed and investigated)
• communicate appropriately with a person if the laboratory rejects their sample (and if appropriate, schedule a repeat sample)

1.1 Guidance for the trainer

Signpost the trainee to the programme guidance on accepting cervical samples in laboratories and the guidance on laboratory human papillomavirus (HPV) testing and cytology services.

1.2 Guidance for the mentor

The mentor should discuss with the trainee what the implications are for people if their samples are rejected by the cervical screening laboratory (using legal and ethical scenarios).

1.3 Teaching resource

Refer to PowerPoint presentation 5 for subject areas in Topic 5 .

2. Open Exeter

Open Exeter gives access to patient data held on the National Health Application and Infrastructure Services (NHAIS) systems, which holds information relating to cervical screening.

The programme recommends the Open Exeter web-based application for all administration. Open Exeter references data from the national call and recall system and holds the master screening history records. This gives the cervical screening laboratory immediate access to relevant data when reporting a test in order to specify an appropriate next action. This in turn minimises the likelihood of rejection of invalid test results by the call and recall system and reduces delays in issuing results to people.

3. Sample request forms

Sample takers should use the pre-populated HMR101 cervical cytology request forms (2009 version) available via Open Exeter.

Sample takers must know how to download the correct pre-populated HMR101 cervical cytology request form (2009 version) from the Open Exeter application. They should be an authorised user and follow the guidelines for completion of the form and produce the preferred size for their laboratory.

Failure to use Open Exeter forms may result in either delays due to the laboratory checking the full history on Open Exeter or the risk of issuing an inappropriate management recommendation by the laboratory.

If a sample taker uses a non-Open Exeter request form for a legitimate reason, for example, the patient is not yet registered or the Open Exeter system is unavailable, they must provide an explanation on the non-Open Exeter request form with the recent and relevant history.

Where laboratory electronic requesting systems are in use, there must be mechanisms in place to provide the past screening history as it is on Open Exeter. This ensures sample takers do not take unnecessary samples and that laboratories are able to give correct patient management recommendations.

4. Sample requirements

The sample taker is responsible for making sure a person is eligible for cervical screening and due a test. The sample taker takes the sample in the required manner and transfers into the sample vial. The sample taker sends the form and labelled vial on the same day to the assigned cervical screening laboratory.

5. Specimen rejection

Cervical cytology samples must satisfy the minimum requirements for processing and auditing. The laboratory rejects erroneous samples that compromise the safety of the patient.

The laboratory may reject a cervical sample for the following reasons:

One or more of the key patient identifiers is absent (the laboratory cannot confirm the person’s identity with full certainty)
There should be a minimum of 3 legible and correct patient demographics (ideally including the NHS number) to identify an individual and match them with any existing record on the pathology system.

There is major labelling discrepancy between the vial and the form
The request form and vial must match each other. Provide the laboratory with all the appropriate information to enable the test to be processed and then reported. There should be a minimum of 3 legible and correct patient identifiers to link a form and vial that arrive at the laboratory together.

The patient is not due a cervical sample
The sample taker must establish that a person is eligible for a test and that a test is now due.

The laboratory receives a sample in an out of date or inappropriate vial
Check the vial to make sure it has not passed its expiry date. The vial must have at least 14 days remaining. The laboratory cannot carry out HPV testing on expired vials.

The sample taker does not have a valid PIN code
Trainee sample takers should use the unique PIN assigned to them at the beginning of their training period that identifies them as a trainee.

Sample takers should take responsibility for communicating events leading to rejection of a sample to the person concerned in an honest and sensitive manner. The sample taker should advise the person when they can take another sample.

Do not take repeat samples within 3 months of a previous test. This allows sufficient time for the cervical epithelium to regenerate and avoids a false result.

6. Incidents

Sample takers should report and discuss any rejected samples with their cervical screening mentor. This should always include any sample where the laboratory has had to reject the test due to insufficient and or conflicting information, or because it was taken inappropriately.

Sample takers should reflect on such events, make sure they are formally recorded internally, and reported as necessary according to practice or clinic clinical governance policies. For situations that fulfil the criteria of a ‘screening incident’, manage them in line with national screening incident guidance.

Recording, auditing and reporting errors is important to identify any problems in the local sample taking process. This reduces the risk of potential incidents and gives an opportunity for learning and quality improvement.

7. Correct follow up and management

It is the sample taker’s responsibility to make sure a person has the correct follow up and management as advised in the cervical screening report. The sample taker should respond to any failsafe enquiries from the cervical screening laboratory or colposcopy clinic and document any correspondence or communication with the individual regarding follow up.