Others learning from Dunedin colposcopy clinic’s quality control systems

Lead colposcopy and gynaecology oncology nurse Trudy Galer says the clinic has always been quality oriented, including doing a monthly audit of around 10 percent of new patient files across the clinic’s 9 colposcopists.

“Whatever service you’re providing, you have to be able to audit it and it doesn’t take long at all,” says Trudy. “It actually lessens your workload because you can identify problems early and address them before they get out of control. Everything runs more smoothly once you have an audit system.”

The audited files are reconciled with the database to ensure adequate and timely grading of referrals, delivery of care and documentation. A few items were added to the audit tool as a result of the updated National Cervical Screening Programme (NCSP) operational policies and quality standards.

While the patient files are mainly electronic, and can now include the patient’s screening history from the NCSP Register, hard copies are also kept for audit and back-up purposes. These also contain the original patient referral along with the clinic’s letter to the patient and the general practitioner acknowledging receipt of the referral and the estimated waiting time for an appointment. “This information is important for the audit but can’t be kept on our electronic database,” says Trudy.

The audit outcome is documented at the clinic’s monthly quality meeting, which has also evolved to be more formalised and now has wider representation from the hospital.

“It used to be just the charge nurse manager, the service manager and me,” says Trudy. “Now it includes the lead colposcopist, the clinical leader and other hospital departments such as health and safety and infection control.
 
“It means we can feed information straight back to the lead colposcopist who can take issues directly to the senior management and senior clinical meetings if necessary – for example, if there is a problem with waiting times for a high-grade referral. It works really well.

“Good communication is so important and sometimes it’s easy to forget who you should be giving information to. It’s much easier now because it’s all documented at the quality meeting and people can go back to it at any time and see where we’re at.

“We also have really good information technology systems which mean we can easily pull any information the auditors want.”

Trudy says colposcopy booking clerk Deborah Wilmshurst is an essential part of the clinic’s quality system. “She’s the one who talks to the women and gets them in.

“It’s a difficult job. As well as those women who are reluctant to come because they’re fearful, our clients are often students who sometimes don’t see colposcopy as important.

“We have to persuade them that having a colposcopy is really important and could save their life. The transient nature of the student population can also mean they’re difficult to track down if they don’t turn up for their appointment.

“We also have a large rural community, including shearing contractors, who come down from the North Island bringing an abnormal smear with them. It’s difficult for them to come in during working hours and our staff have to work very hard to ensure the service works for them.

“The NCSP, including our local branch, is really supportive and it would be very difficult for someone to fall through the cracks. We chase everyone. They don’t get away very easily!”