Wales Abdominal Aortic Aneurysm Screening Programme (WAAASP) Policies

Transcription

1 Wales Abdominal Aortic Aneurysm Screening Programme (WAAASP) Policies Author: Llywela Wilson, Programme Lead Policy lead: Llywela Wilson, Programme Lead Executive lead: Dr Rosemary Fox, Acting Director Screening Division Version: Approved Work Plan reference: AAA QA & Policy sub-group Page: 1 of 8

2 Table of Contents 1 AIM OF THE WALES ABDOMINAL AORTIC ANEURYSM SCREENING PROGRAMME (WAAASP) The Aim POLICIES Invitation Frequency of Invitation Inclusion Criteria Exclusion Criteria Confirmation of Identification Mental Capacity Act Informed Choice Equal Access Screening Episode Non-visualised Aorta Screening Results Normal Result Identification and Surveillance of AAA Discharge from the AAA Screening programme Large AAA Identified Referral to Multidisciplinary Vascular Network Multidisciplinary Vascular Networks Evaluation REFERENCES... 8 Page: 2 of 8

3 1 Aim of the Wales Abdominal Aortic Aneurysm Screening Programme (WAAASP) 1.1 The Aim The aim of the WAAASP is to reduce AAA related mortality by up to 50% in the invited population by 2025 through the provision of a systematic population based screening programme for men resident in Wales during their 65 th year. Screening also has the potential to cause both physical and psychological harm to men invited. It is essential that this harm is minimised, so that the benefits of screening outweigh the costs. 2 Policies 2.1 Invitation Men in their 65 th year and resident in Wales will be offered abdominal aortic aneurysm screening. Men who are invited for screening are informed that the Wales AAA Screening Programme holds certain information on them and are given an opportunity to find out more about the information kept. 2.2 Frequency of Invitation Men found to have a normal size aorta (<3cms) on their screening ultrasound scan will be discharged from the screening programme. 2.3 Inclusion Criteria All men resident in Wales will be offered an ultrasound scan in their 65th year. Criteria for inclusion are that the man is: a. in his 65 th year; b. resident in Wales; c. screening will also be available for male to female transgender persons. Page: 3 of 8

4 Men who have declined AAA ultrasound scan initially will be able to re- enter the programme (re-referral) Exclusion Criteria The criteria for exclusion from the Wales AAA Screening Programme are: a. Men under the age of 64 b. Women of any age 2 c. Men who have previously undergone surgery for AAA repair d. Men who have requested to be permanently removed from the AAA screening programme although men will be able to opt back in to the programme at any time. e. Men who have been previously screened in the Wales AAA Screening Programme and were found to have an aortic diameter of less than 3 cms f. A man who does not give consent: I. to store and keep information about him and his visit(s) to the screening clinic on the Information System, and to use this information to ensure the Wales AAA Screening II. III. Programme offers safe and effective screening; to be screened for an AAA (which involves ultrasound scan(s) of his abdomen) and to inform him of the result(s); if at any time the man is registered with a GP Practice, to inform the GP Practice of all results from the abdominal ultrasound screening scan(s); 1 When there is capacity within the Wales AAA Screening Programme: Men over 65 who have not received an NHS ultrasound scan for AAA can self-refer by contacting the screening programme to request an appointment. 2 The prevalence of AAA is six times lower in women than in men. Research evidence suggests that over five and ten year follow-up intervals, the incidence of rupture was the same in the screened and control groups of women, therefore screening women for AAA is neither clinically indicated nor economically viable(scott et al, 2002) Page: 4 of 8

5 2.5 Confirmation of Identification AAA will ensure processes are in place to ensure correct identification of men at all stages in the screening process. 2.6 Mental Capacity Act Health Boards will follow local procedures for the Mental Capacity Act in line with current legislation. An advocate may have been assigned to a participant if there is concern about their ability to make informed decisions. All discussions will be held with the participant and their advocate. 2.7 Informed Choice The Wales AAA Screening Programme will ensure information is available at all stages of the screening process to enable informed choice. The Wales AAA Screening Programme will provide a telephone contact number for people with additional queries. Provisions will be made for people with sensory impairment and for information in different languages. 2.8 Equal Access The Wales AAA Screening Programme will aim to provide an equitable service for the eligible resident population of Wales, including information, communication and access to services. The Wales AAA Screening Programme recognises the need to ensure that screening is available to eligible groups irrespective of male to female transgender, disability, race, religion and sexual orientation. According to the eligibility criteria sex and age are restricted. 2.9 Screening Episode The model for the service will be for an abdominal ultrasound scan of the aorta to be undertaken within community health care facilities. Ultrasound scans in the Wales AAA screening programme will be undertaken by a workforce who has received appropriate training and who attend annual training updates/ CPD events. Page: 5 of 8

6 Ultrasound images should be stored for twenty years after the first abdominal ultrasound screening scan or eight years after the last surveillance scan, whichever is later. Procurement and use of ultrasound scan equipment takes account of the advice issued by the NHS Wales Shared Services Partnership (NWSSP) and Public Health Wales Medical Devices and Equipment Management Policy Non-visualised Aorta The Wales AAA Screening Programme will offer a further scan appointment for men whose aorta was not visualised on the abdominal ultrasound scan Screening Results The AAA Screening Programme will ensure that men attending screening are provided with written results Normal Result An aortic diameter of less than 3.0cm is accepted to be within normal limits Identification and Surveillance of AAA Men who have a small or medium AAA following an abdominal ultrasound scan at the screening clinic will be offered a surveillance appointment dependent on the size of the AAA. Men identified with a small AAA ( cm diameter) at screening scan appointment will be offered an annual surveillance scan. Men identified with a medium AAA ( cm diameter) at screening scan appointment will be offered surveillance every three months Discharge from the AAA Screening programme The Wales AAA Screening Programme will discharge the following men from the programme: Men with an aortic diameter of less than 3.0cm. Page: 6 of 8

7 Men who after 15 scans at one year intervals have an AAA that remains below 4.5cm in diameter, with less than 1cm expansion annually and the absence of tenderness (symptomatic). Men on surveillance who have had three consecutive scans showing the aortic diameter to be less than 3cms on ultrasound where the initial scan was 3cm or greater Large AAA Identified The end point of the AAA screening programme is when a man with an AAA of 5.5cms or larger is referred to a multidisciplinary vascular network. A diagnosis is not made at the completion of a screening test. The diagnosis of an AAA will be made by the Vascular Surgeon. It is the responsibility of the AAA Screening Programme to ensure that the referral has successfully reached the Multidisciplinary Vascular Network Referral to Multidisciplinary Vascular Network Men found to have an aneurysm measuring 5.5cm or larger are referred to an identified multidisciplinary team within a vascular network for treatment options Multidisciplinary Vascular Networks Surgeons/radiologists/anaesthetists treating patients identified through the Wales AAA Screening Programme will be required to submit data to the National Vascular Database of the Vascular Society for Great Britain and Ireland (VSGBI) Evaluation The Wales AAA Screening Programme will be subject to evaluation to gauge the impact on mortality and to quality assure the Wales AAA Screening Programme. Agreed key performance indicators will be used. Page: 7 of 8

8 3 References Scott, RAP, Bridgewater, SG, Ashton, HA (2002) Randomizes clinical trial of screening for abdominal aortic aneurysm screening in women. British Journal of Surgery, 89; Page: 8 of 8