Abridged version – Sections 1, 2, 3
Full version and annexes available from GP Portal or email to [email protected]
Section 1
1.1
Programme Workflow
Section 2
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
Screening
Screening Workflow
Registration and Instructions for Clients
Follow Up
Defaulter Tracking
Section 6
6.1
6.2
6.3
HealthLine
HealthLine Workflow
Call Handling
Voice Messages
Section 5
5.1
5.2
5.3
5.4
General Policies
Client Eligibility
Clients with High Risk Characteristics
Consent for Participation
Clients with Normal Result
Clients with Abnormal Result
Opting-Out of CRC
Request for additional FIT Screening
Duplication of Laboratory Report/ Screening result letter
Staff Briefing and Training
Operating Policies & Procedures/Staff Manuals
Request for Educational Materials
Use of Standard Programme Letters
Incident Reporting
Update of Client’s Mailing Address
Quality Assurance Framework
Data Management
Section 4
4.1
4.2
4.3
Roles & Responsibilities
HPB’s Colorectal Cancer (CRC) Screening Programme
Role of CRC Steering Committee
Role of CRC Quality Assurance and Screening Database Sub-Committee
Role of Clinics
Role of Appointed Vendors
Role of Restructured Hospitals
Role of HealthLine
Role of designated CRC Laboratory Director/Operations Manager
Role of designated CRC Clinical Director
Role of designated CRC Colonoscopist
Role of designated CRC Pathologist
Role of designated CRC Nurse Coordinator
Section 3
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
3.10
3.11
3.12
3.13
3.14
3.15
3.16
Screening Pathway
Appointed Vendors
Client FIT Results Letters
Vendor Notifications to HPB
Quality Assurance (QA) Framework for Laboratories
6.4
6.5
Data Collection and Submission Policy
Downtime Procedure
Section 7
7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
7.9
7.10
7.11
7.12
Hospital Workflow – Referral for Assessment
Appointment Booking for Specialist Consultation
Opt-out
Entry of final assessment outcomes
Clients Who Require Colonoscopy
Clients with Normal Results or Benign Findings
Clients Diagnosed with Colorectal Cancer
Clients with Interval or Missed Cancer
Clients Who Did Not Attend Colonoscopy Appointment
Data Collection and Submission Policy
Downtime Procedure
QA Framework for Hospital
Section 8
8.1
8.2
Collaterals
Guide to Further Assessment for Colorectal Cancer (English, Chinese, Malay version)
Guide to Further Assessment for Colorectal Cancer (Tamil version)
How to screen for CRC using Alfresa FIT kit
Screening for Colorectal Cancer: How to collect your stool sample
Screen for Life collaterals (FAQs for Health Professionals; booklet; summary of screening tests)
Screen for Life – FAQs for Healthcare Professionals
Invitation Screening Package – invitation letter samples
Annex 4


Forms
Data Protection Policy
Referral Form for Further Assessment
Incident Reporting Form
NCRCSP Opt-Out Form
Registration and Lab Referral Form
Screening Consent Form
Specimen Rejection Log
Annex 3







General Information
Collection points for FIT kits
Contacts List
FAQs for HealthLine Staff
Introduction to CRC
Annex 2







Forms and Data Management
HPB Data Protection Policy
Quality Control of Data Collection
Annex 1




Hospitals
Quality Assurance
Guidelines for Laboratories: QA for laboratories processing FIT samples
Guidelines for Hospitals: QA in colonoscopy for individuals with positive FIT results
Screen for Life (National Colorectal Cancer Screening Programme) Policy
Health Promotion Board
Page 1 of 1
Title:
Scope:
Programme Workflow
HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 1.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy & Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and Community
Outreach Division
Date of Original Issue : Jan 2012 Effective Date : March 2016
NATIONAL COLORECTAL CANCER SCREENING
PROGRAMME WORKFLOW
Wef Oct 2015
Screen for Life (National Colorectal Cancer Screening Programme) Policy
Health Promotion Board
Title:
HPB’s CRC Screening Programme
Scope: HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy and
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and Community
Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Management and implementation of the National Colorectal Cancer (CRC) Screening Programme (the Programme)
under Screen for Life, is the responsibility of the Screening Policy & Planning (SPP) Department, Regional Health and
Community Outreach Division of the Health Promotion Board (HPB). SPP is responsible for ensuring that the various
components run smoothly to meet the objectives and targets of the Programme.
PROCEDURES
1. General

Implement the Programme in accordance with the policy, quality and evidence-based framework and to
develop strategies and protocols for implementation of the Programme.

Make recommendations on the Recruitment for Screening, Reporting of Faecal Immunochemical Test (FIT)
results and Assessment Services.

Ensure that the HealthLine, Clinics, appointed Laboratories and participating Restructured Hospitals (RHs)
have a well-defined and documented management and service delivery structure.
2. Communication and Recruitment

Develop and promote various initiatives for education, information and public awareness, and disseminate
appropriate information, which is consistent with the Programme policies and strategies.

Ensure that recruitment and educational materials for the public and target groups are appropriate,
informative, culturally sensitive and accurately reflect the policies of the Programme.

Develop an engagement plan to systematically recruit target clients to the Programme.

Develop engagement strategies relevant to the various sub-groups within the target population.
3. Support Service Operations and Programme Implementation

Ensure that the Programme is managed efficiently and services are accessible to the target population.

Develop policies, guidelines and plans to ensure the implementation and management of the Programme.

Ensure that the HealthLine, Clinics, appointed Laboratories and participating RHs are kept informed of
matters pertaining to the plans, policies, protocols and operations of the Programme.

Seek appropriate representation on Committees, Working Groups and Advisory Groups in relation to the
Programme.

Review progress and make recommendations on policy issues relevant to the implementation of the
Programme.
4. Quality Assurance and Data Management

Consult CRC Quality Assurance (QA) & Database Sub-Committee to establish the quality assurance &
database framework.

Develop and execute a Quality Assurance programme to ensure minimum quality standards for the
Programme are met.

Provide up-to-date information on audit requirements and decisions made by the CRC QA & Database SubCommittee.

Ensure that all Clinics, appointed laboratories and participating RHs meet the standards and expectations of
the Programme.
5. Monitoring and Evaluation

Develop and maintain the Integrated Screening System (ISS) to record data for each client screened and
assessed, with data collected from the Clinics, appointed Laboratories and participating RHs.

The Registry will maintain linkages with the MHA’s Database, Singapore Cancer Registry and other relevant
registries.

Track and report on the performance of the Programme against the targets set.

Undertake ongoing monitoring and evaluation of the Programme to ensure aims and objectives of the
Programme are achieved.
6. Training and Development

Establish training requirements for key personnel in the Programme and ensure they meet the training
requirements set out in the accreditation requirements.

Work with the QA & Database Sub-Committee to develop a training plan to ensure that appropriate and
adequate training is available for key personnel employed in the Programme.

Coordinate training and development opportunities for personnel in accordance with the training plan.
Title:
Role of CRC Steering Committee
Scope: HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.2
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Colorectal Cancer (CRC) Screening Programme Steering Committee serves as the advisory board to the Health
Promotion Board’s (HPB) National Colorectal Cancer (CRC) Screening Programme (the Programme) under Screen
for Life. It comprises various stakeholders and clinical experts in the domain of colorectal cancer screening and cancer
management.
It has three sub-committees overseeing key aspects of the Programme, namely:



Quality Assurance and Training
Database
Delivery model and Workflow
Terms of Reference
The Terms of Reference of the CRC Steering Committee are:
1. To review the performance of the National Colorectal Cancer (CRC) Screening Programme, including, but not
limited to:
 monitoring the delivery of the Programme,
 reviewing and evaluating the clinical outcomes,
 assessing the effectiveness of the FIT kits used,
 ensuring a robust and structured quality assurance and quality improvement framework, and
 establishing and reviewing the national and programme-level indicators and targets.
2. To regularly review the CRC screening database functionalities and ensure screening and assessment data
collected for the Programme supports patient care under the Programme.
3. To review training needs and assessment for personnel involved in the Programme and advise on ongoing
manpower requirements related to the Programme.
4. To regularly monitor and advise on new screening technology or tools that may be relevant to the Programme.
Title:
Role of Quality Assurance and Database
Subcommittees
Scope: HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.3
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Quality Assurance and Database Sub-Committee develops:

National standards for the health professionals and a comprehensive quality assurance framework for both
the appointed laboratories and participating restructured hospitals involved in the National Colorectal Cancer
(CRC) Screening Programme (the Programme) under Screen for Life.

Relevant datasets and ensures appropriate data linkages between the stakeholders and the Programme to
enable accurate monitoring and tracking of the effectiveness of the Programme.
Terms of Reference
The Terms of Reference of the CRC Quality Assurance and Database Sub-Committee are:
1. To develop professional minimum national standards for health professionals with regards to qualification,
performance, experience and training on colonoscopy.
2. To establish a QA framework looking into clinical outcome measures, competency guidelines for
colonoscopists and quality standards for colonoscopy equipment.
3. To develop a standardised system and workflow for the reporting for pathological biopsies.
4. To develop relevant data sets on result outcomes for screening and assessment.
5. To ensure appropriate data linkages are established to promote seamless data collection for the Programme
and healthcare professionals.
6. To propose suitable reports for monitoring and tracking of the effectiveness of the Programme.
Title:
Role of Clinics
P&P Reference: 2.4
Scope: HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The National Colorectal Cancer (CRC) Screening Programme (the Programme) under Screen for Life ensures the
availability and accessibility of screening services at convenient locations for the target audience and will work with
partners towards having a comprehensive network of screening services located throughout Singapore.
Clinics, formerly referred to as screening centres, are defined as the following:
1. Participating Community Health Assistance Scheme (CHAS) General Practitioners (GP) offering Screen for Life
2. Singapore Cancer Society (SCS) Multi-Service Centre in Bishan, community events and participating pharmacies
in partnership with SCS.
3. National Healthcare Group Polyclinics (NHGP)
PROCEDURES
The main roles of the clinics are to:
1. Provide screening services that meet the standards and requirements of the Programme.
2. Develop an operational plan and operate within the Programme’s eligibility and funding criteria.
3. Follow up on their clients with abnormal results and refer them to the participating Restructured Hospitals (RHs)
for further assessment, if necessary.
Title:
Role of Appointed Vendors
P&P Reference: 2.5
Scope: HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Appointed Vendors
Appointed Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Health Promotion Board’s (HPB) personnel from the Screening Policy & Planning Department, will liaise with the
Appointed Vendors to ensure good quality of Faecal Immunochemical Test (FIT) processing and reporting of results
consistent with the minimum standards required by the National Colorectal Cancer (CRC) Screening Programme (the
Programme).
PROCEDURES
The main roles of the Appointed Laboratories are to:
1.
Maintain FIT Kit reagents.
2.
Process the completed FIT kits and provide FIT results which meet the minimum standards as outlined in the
Quality Assurance Guidelines for Laboratories under the Programme.
3.
Send the lab reports to the clients within 14 days of processing the submitted FIT kits.
The main roles of the Appointed Vendors are to:
1.
Liaise with HPB for the supply and distribution of FIT kits to the participating Community Health Assist Scheme
(CHAS) General Practitioner (GP) clinics offering Screen for Life.
2.
Maintain FIT Kit inventory and track utilisation of the FIT kits by the CHAS GP clinics participating in Screen
for Life and by other collection points.
3.
Submit data to the Enhanced Integrated Screening System (EISS) within 21 working days of kit processing.
4.
Send the lab reports to the referring GPs for clients under the GP Model; or to the Singapore Cancer Society
for clients under the Outreach Model, within 14 days of processing of submitted FIT kits.
5.
Submit a log sheet which tracks any FIT kits discarded by the appointed laboratories to HPB on a monthly basis
using the standard MS Excel template provided by HPB.
Title:
Role of Participating Restructured
Hospitals
Scope: HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.6
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Health Promotion Board’s (HPB) National Colorectal Cancer (CRC) Screening Programme (the Programme)
adopts a multi-disciplinary approach to assessment and ensures the availability and accessibility of such assessment
services to clients.
PROCEDURES
The main roles of the participating Restructured Hospitals (RHs) are to:
1. Provide appointments for clients who need further assessment after receiving a positive FIT result.
2. Administer HPB’s Consent Form, if it has not already been administered by the referring GP, participating
polyclinic or pharmacy, SCS outreach event, community health screening event or other; or not brought by the
client to the RH at the first appointment.
3. Provide specialist consultation services followed by colonoscopy where needed and ensure that requirements
for colonoscopy are fulfilled.
4. Communicate all information to clients in a sensitive and appropriate manner. Ensure that the client understands
all steps of the process, including costs of any investigation and follow-up, and guidance for access to financial
support if required.
5. Ensure that eligible clients (according to HPB’s means testing) receive colonoscopy and subsequent services for
the same episode at a subsidised rate.
6. Appoint a dedicated personnel (e.g. Registered Nurse, Senior Enrolled Nurse, Senior Assistant Nurse, other) to
manage and coordinate all appointments, queries and follow-up requirements regarding the Programme.
7. Follow-up on subsequent defaulters for further assessment. After three defaulted appointments, the NC may
consider the case closed.
8. Ensure that the results of colonoscopy are accurately recorded and validated according to required datasets for
the Programme before submitting it to HPB via web service every month.
Title:
Role of HealthLine
Scope: HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.7
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Health Promotion Board’s (HPB) National Colorectal Cancer (CRC) Screening Programme (the Programme)
under Screen for Life ensures the provision of relevant information and advice to potential and existing clients through
the HPB HealthLine.
PROCEDURES
The main roles of the HealthLine include, but are not limited to:
1. Providing a free and confidential telephone service providing advice from experienced Nurse Advisors to the
general public on any general health concern.
2. Attending to public enquiries and providing relevant information about the Programme. This function may be
performed by either the First Tier staff or Nurses after thorough training in the Programme specifics.
3. Providing counselling and follow-up services by the Nurses via telephone calls to the participants with
inconclusive results, especially those who have completed only one FIT kit for testing.
4. Entering relevant data to the Enhanced Integrated Screening System (EISS) through the Intranet follow- up
module after making the follow-up calls as above.
Title:
Role of the Designated Laboratory
Director/ Operations Manager
Scope: HPB - CRC Staff
HPB - HealthLine
HPB – Health Ambassadors
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.8
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Designated Laboratory Director/ Operations Manager is responsible for overseeing all Quality Assurance (QA)
matters related to the processing of the Faecal Immunochemical Test (FIT), from specimen receipt to laboratory report
generation for the Health Promotion Board’s (HPB) National Colorectal Cancer (CRC) Screening Programme (the
“Programme”) under Screen for Life, to ensure good quality FIT processing for participants of the Programme.
It is recommended that the consultant laboratory pathologist be the Designated Laboratory Director/ Operations
Manager.
PROCEDURES
1.
Qualifications and experience:




2.
Key roles and responsibilities of the Designated Laboratory Director/ Operations Manager include, but are not
limited to:






3.
Extensive experience in laboratory quality assurance
Excellent knowledge in FIT
Experience in staff supervision
Well-developed knowledge of the CRC Programme and an understanding of the Programme QA guidelines,
standards and requirements
Overseeing the work of all laboratory staff associated with the Programme
Orientation and supervision of training of laboratory staff new to the Programme
Encouraging laboratory staff to participate in continuing education programmes
Overseeing technical aspects of quality assurance
Performing data audit and quality assurance protocols
Overseeing specimen handling and reporting protocols
Other responsibilities of the Designated Laboratory Director/ Operations Manager include but are not limited to:
 Keeping abreast of latest developments in FIT and related QA issues.
Title:
Role of the Designated Clinical
Director
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.9
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Designated Clinical Director is responsible for overseeing all issues related to colonoscopy for the National
Colorectal Cancer (CRC) Screening Programme (the Programme). This requires the Designated Clinical Director to
work closely with the Designated Colonoscopist, Designated Pathologist and Designated Nurse Coordinator to deal
with issues of quality, and with all members of the multidisciplinary assessment team to ensure good quality clinical
care for the patients.
It is recommended that the Designated Colonoscopist or Designated Pathologist be the Designated Clinical Director.
PROCEDURES
1. Qualifications and experience:






MBBS or equivalent
Singapore Medical Council registered
Extensive experience in colonoscopy
Excellent knowledge in colonoscopy quality assurance
Experience in staff supervision
Well-developed knowledge of the Programme and an understanding of the Programme QA guidelines,
standards and requirements
2. Key roles and responsibilities of the Designated Clinical Director include but are not limited to:






Ensuring that all aspects of the endoscopy centre/restructured hospitals/institutions meet the highest QA
standards for colonoscopy
Ensuring adequate day to day monitoring via direct, regular and routine reporting from the Designated
Colonoscopist and Designated Pathologist.
Ensuring data collection is accurate, complete and provided regularly to Health Promotion Board (HPB)
Ensuring regular and appropriate multidisciplinary meetings occur and staff of all disciplines and levels
meet with their counterparts regularly
Ensuring that open communication with HPB is maintained
Ensuring that clinical practices of the endoscopy centre/restructured hospitals/institutions meet the
standards as defined under the Programme
Title:
Role of the Designated Colonoscopist
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.10
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Designated Colonoscopist is responsible for overseeing all issues of quality assurance related to colonoscopy
and/or surgery for the National Colorectal Cancer (CRC) Screening Programme (the Programme). This requires the
Designated Colonoscopist to work closely with the Designated Clinical Director, Designated Pathologist and
Designated Nurse Coordinator to deal with issues of quality, and with all members of the multidisciplinary assessment
team to ensure quality clinical care for the patients.
PROCEDURES
1. Qualifications and experience:






MBBS
Singapore Medical Council registered
Extensive experience in colonoscopy
Excellent knowledge in colonoscopy quality assurance
Experience in staff supervision
Well-developed knowledge of the Programme and an understanding of the Programme QA guidelines,
standards and requirements
2. Key roles and responsibilities of the Designated Colonoscopist include but are not limited to:







Overseeing the work of colonoscopists associated with the Programme
Orientation and supervision of training of colonoscopists new to the Programme
Encouraging colonoscopists to participate in continuing education programmes
Ensuring that colonoscopists fulfil the recommended requirements as set out under the Programme
Providing consultation and advice regarding colonoscopy procedures
Overseeing colonoscopy data audit and quality assurance processes
Participating in CME programmes
3. Other responsibilities of the Designated Colonoscopist include:

Keeping abreast with latest developments in colonoscopy.
Title:
Role of the Designated Pathologist
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.11
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Designated Pathologist is responsible for overseeing all issues of Quality Assurance (QA) related to histopathology
for the National Colorectal Cancer (CRC) Screening Programme (the Programme). This requires the Designated
Colonoscopist to work closely with the Designated Clinical Director, and Designated Nurse Coordinator to deal with
issues of quality, and with all members of the multidisciplinary assessment team to ensure quality clinical care for the
clients of the Programme.
PROCEDURES
1. Qualifications and experience:






MBBS or equivalent
Singapore Medical Council registered
Extensive experience in histopathology
Excellent knowledge in histopathology quality assurance (QA)
Experience in staff supervision
Well-developed knowledge of the Programme and an understanding of the Programme QA guidelines,
standards and requirements
2. Key roles and responsibilities of the Designated Pathologist include but are not limited to:









Overseeing the work of pathologists associated with the Programme
Orientation and supervision of training of pathologists new to the Programme
Encouraging pathologists to participate in continuing education programmes
Ensuring that pathologists fulfil the recommended requirements as set out under Programme
Providing consultation and advice regarding histopathology
Overseeing technical aspects of pathology quality assurance
Overseeing pathology data audit and quality assurance processes
Overseeing pathology specimen handling and reporting protocols
Participating in CME programmes
3. Other responsibilities of the Designated Pathologist include:

Keeping abreast with latest developments in histopathology related to colonoscopy.
Title:
Role of the Designated Nurse
Coordinator
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 2.12
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Designated Nurse Coordinator (NC) is responsible for assisting Health Promotion Board (HPB) in the coordination
of the National Colorectal Cancer (CRC) Screening Programme (the Programme) under Screen for Life at the
Restructured Hospitals (RHs) or Endoscopy Centre (Centre). This requires the NC to work closely with HPB and staff
of the Programme to ensure good quality of care for the clients of the Programme.
PROCEDURES
Key roles and responsibilities of the NC are to:

Arrange Clients’ appointments (including keeping track of any rescheduling of appointments in the event that
Clients miss or default on their appointments or arranging follow-up appointments whether for review or for
re-screening in accordance with the Programme protocols).

Ensure that all Clients referred for further assessment at the RH have been followed up.

Respond to any queries received from the public regarding the Programme.

Ensure that all Clients receive consultation from a specialist prior to the colonoscopy.

Follow the respective RH protocol (usual SOP) to coordinate bowel preparation for Clients.

Ensure that the colonoscopy services are being carried out within 5 weeks from the date of referral.

Convey the results of the assessment to the Client’s requesting doctor.

Ensure that follow-up screening services for each Client in accordance with accepted medical standards and
practice.

Fully cooperate with and assist HPB in the coordination of the Programme at the RH or Centre.

Ensure that all aspects of the RH or Centre meet the QA standards required by HPB.
Screen for Life (National Colorectal Cancer Screening Programme) Policy
Health Promotion Board
Title:
Client Eligibility
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospital (RHs)
Version/Revision : 1.1
P&P Reference: 3.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Eligibility for the National Colorectal Cancer (CRC) Screening Programme (the Programme) under Screen for Life is
based on the following criteria:



Singapore citizens or permanent residents (men and women)
Aged 50 years and above
Are asymptomatic
The eligible age range under the Programme is 50 years and above.
The screening interval with FIT kit is once every year; and with screening colonoscopy every 10 years.
Clients who fall under the following categories may be at higher risk of colorectal cancer and should be advised to see
a specialist:



Those with a family or personal history of the following cancer(s): Colorectal, Endometrial, Breast and/or Ovarian
cancer;
Those with inflammatory bowel disease or Crohn’s disease;
Those who have had blood in the stool in the past six months.
Title:
Clients with High Risk Characteristics
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 3.2
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Clients who report high risk characteristics to the National Colorectal Cancer (CRC) Screening Programme (the
Programme) are advised to see a specialist.
PROCEDURES
Clients who fall under the following categories are considered to have a high risk of colorectal cancer



Those with a family or personal history of the following cancer(s): Colorectal, Endometrial, Breast and/or Ovarian
cancer;
Those with inflammatory bowel disease or Crohn’s disease;
Those who have had blood in the stool in the past six months.
1. The specialist will decide on the frequency of recall for these clients.
2. If a client joins the Programme, the doctor or specialist must indicate the type of high risk characteristics present
in the Screen for Life Registration and Laboratory Referral Forms.
Title:
Consent For Participation
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 3.3
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), all clients are required to sign
the Consent to participate in Screen for Life Consent Form upon registration at the Clinic.
It is the responsibility of the clinics to explain to the clients the terms on the Consent Form and to ensure that the form
is signed prior to screening.
PROCEDURES
Clients who sign the consent form are to be made aware of the following Conditions of Consent (Refer to Annex 2):
1. Screen for Life consists of screening for chronic diseases (diabetes, hypertension and lipid disorders), obesity,
cervical cancer (for women) and colorectal cancer. I may be screened for one or more but not all of these
conditions (“Screens”).
2. The results of my Screens may require me to be referred to doctors or hospitals for further advice, investigation
and/or treatment and there may be additional medical information that may become available relating to my
assessment and medical status.
3. I consent to and authorise the relevant hospital(s) participating in Screen for Life to disclose and grant access to
the results of my Screens, identifiable personal information and any subsequent clinical findings or medical
information that may arise from any follow-up and or related medical appointments, visits and/or check-ups and
my participation under Screen for Life (collectively referred to as “Medical Information”), to the following parties:
a.
b.
My doctor as named in Section A of this form; and/or
The Ministry of Health (MOH) and/or the Health Promotion Board (HPB), as well as the relevant parties of
any healthcare institution participating in Screen for Life.
4. I acknowledge and understand that the Medical Information will be obtained from the designated laboratory that
reports the results of my Screens, as well as from other healthcare providers such as doctors, allied health
professionals who are participating in Screen for Life and the Restructured Hospitals (RHs) whom/which I may
subsequently be referred to.
5. I acknowledge and understand that:
a) I may be referred by my doctor to nurse educators, constituency managers, community health ambassadors,
community partners and other authorised Screen for Life partners, who may recommend suitable follow-up
to manage my medical condition(s). Follow-up may include invitations to counselling sessions and disease
management workshops, but the decision to take up these recommendations for follow-up will be entirely
mine;
b) There are limitations in the Screens, and none of the Screens are foolproof in detecting or ruling out chronic
diseases and/or cancer. There may also be inherent risks of false positives and false negatives associated with
any of the Screen results. I am advised to be vigilant in observing for any symptoms associated with any of the
conditions related to the Screens and to see my doctor promptly when in doubt or when I have any medical
concerns, even if the results of the Screens are normal;
c) My Medical Information will be recorded by HPB and the RHs in a secure and confidential manner so that I can
be notified of the results of my Screens, be invited for rescreening at the recommended times and be followed-up
where appropriate;
d) Neither HPB nor the RHs shall be held liable in any way whatsoever for any personal injury, mishap, accident,
loss or damage, however sustained as a result of or in connection with their invitation, facilitation or referral of my
screening tests under Screen for Life or any other programme.
Should the client not understand the consent, the staff responsible for administering the consent will be required to
explain the Conditions of the Consent Form to the client and ensure that the Consent Form is duly signed by the Client.
1. If a client requires translation, the appropriate staff attending to the client is required to explain the Consent using
the translations provided.
2. The Consent Form should be filed in the client’s case notes.
Title:
Client with Normal results
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 3.4
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), clients found to have normal
results i.e. Faecal Immunochemical Test (FIT) is negative, will be discharged to the routine re-screening cycle of once
a year using FIT.
PROCEDURES

The appointed vendors shall send a hard copy of the lab report indicating normal results to the client and a
hard copy to his/her referring clinic.

The appointed vendors shall submit data required by the Programme via web service to Health Promotion
Board’s (HPB) Enhanced Integrated Screening System (EISS) within 21 days of processing the results.
Title:
Client with Abnormal Results
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
P&P Reference: 3.5
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), clients found to have abnormal
results i.e. Faecal Immunochemical Test (FIT) is positive, should be informed of the results by receiving a hard copy
of the lab report within 14 days of the lab processing. The client should also be contacted within 14 days of receiving
the results, by his/her referring GP, who will discuss the follow-up options with the client.
Nurse Coordinators (NCs) of the participating restructured hospitals (RHs) nearest to the client’s home will be
electronically notified by the Enhanced Integrated Screening System (EISS) upon receipt of the abnormal results. NCs
should call the client by telephone within 3 working days of the results being entered into the EISS and assist the client
to make an appointment with the participating RHs for further assessment. Should clients prefer to go another
restructured hospital, the NC will make the electronic referral to the RH of the client’s choice though the EISS.
PROCEDURE
The appointed vendors shall send a hard copy of the abnormal results to the client and a hard copy to his/her
referring clinic within 14 days of the lab processing date.
Title:
Opting-Out of CRC
P&P Reference: 3.6
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
Version/Revision : 1.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Clients may choose to ‘Opt-Out’ of the Colorectal Cancer (CRC) Screening Programme (the Programme). By
choosing to withdraw from the Programme, they will not be reminded to go for their next screen.
PROCEDURES
Clients who wish to Opt-Out of the Programme should be made aware of the following Conditions of opting out
(Refer to the Opt Out form, found in Annex 2):
1. The client will no longer be invited for re-screening.
2. All information concerning the client’s previous tests and results will be retained by the Programme for statistical
and research purposes only; personal identification details will not be released.
PROCEDURE
1. Clients may sign the Opt-Out form at the Clinic when offered the Screen for Life Consent Form.
2. Clients who decide to opt out after the screening has been done may approach the Clinic at which screening was
done to sign the Opt-Out form.
3. All signed Opt-Out forms are to be returned to HPB.
4. If a client requires translation, the appropriate staff attending to the client is required to explain the conditions of
the Opt-Out Form using the translations provided.
5. Clients may also call HPB’s HealthLine or send an email to [email protected] to opt out of the
Programme.
Title:
Request for additional FIT Screening
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Version/Revision : 1.01
P&P Reference: 3.7
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), clients may request for
additional Faecal Immunochemical Test (FIT) screening only if the client was previously given a FIT screening kit
that has passed its expiry date.
When a client’s FIT screening has a FIT positive (abnormal) result, the client is not to be provided with further FIT
kits. The positive (abnormal) result needs further investigation by diagnostic colonoscopy. Refer to section 7.1 for
Hospital Workflow – Referral for Assessment.
PROCEDURE
1. All clients are required to sign the Consent to Participate in Screen for Life Consent Form (Refer to Annex 2) upon
registration at the clinic.
2. It is the responsibility of the Clinic to explain to the clients the terms on the Consent Form and to ensure that the
form is signed prior to screening.
3. Should the client not understand the consent, the staff responsible for administering the consent will be required
to explain the Conditions of the Consent Form to the client and ensure that the Consent Form is signed by the
Client.
4. If a client requires translation, the appropriate staff attending to the client is required to explain the Consent using
the translations provided.
Title:
Duplication of Laboratory Report
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
Laboratories
P&P Reference: 3.8
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), clients may request for a
duplicate copy of their screening result letter from the clinic.
PROCEDURE
1. All requests should be made in person or by phone call at the clinic that the client had attended.
2. Clinics will contact the laboratory to re-generate the screening result letter.
3. The processing time is approximately 7 working days from the date of request.
Title:
Staff Briefing and Training
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
Laboratories
P&P Reference: 3.9
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
All service providers under the National Colorectal Cancer (CRC) Screening Programme (the Programme) are to
provide relevant briefings and training to all staff involved in the Programme.
PROCEDURE
All staff, both medical and non-medical, must be briefed about the Programme, any changes to the policies or
procedures, minimum requirements of the Programme, and must be trained on their roles in supporting the
Programme.
Title:
Operating Policies & Procedures/ Staff
Manuals
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
Laboratories
P&P Reference: 3.10
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
All service providers under the National Colorectal Cancer (CRC) Screening Programme (the Programme) are
required to have their own operating procedures / staff manuals based on the Policies and Procedures of the
Programme. These operating procedures / staff manuals must be made available to all staff supporting the
Programme.
PROCEDURES
1. Where relevant, the Policies and Procedures of the Programme are to be cascaded down to operating policies
and procedures / checklists.
2. All service providers are to ensure that relevant staff has easy access to the operating policies and procedures /
checklists.
Title:
Request for Educational Materials
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
P&P Reference: 3.11
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
All Clinics supporting the National Colorectal Cancer (CRC) Screening Programme (the Programme) are responsible
for liaising with Health Promotion Board (HPB) to replenish their stock of relevant educational materials related to the
Programme.
PROCEDURES
Clinics are to ensure that there are adequate supplies of the following educational materials (Refer to Annex 3) for
distribution to the clients:



Screening for Colorectal Cancer: How to collect your stool sample (two versions, corresponding to either
Eiken or Alfresa FIT kits stocked at the Screening Centre)
Guide to Further Assessment for Colorectal Cancer
Screen for Life – What you need to know about health screening
Requests for materials are to be submitted
Requests will be processed within 14 working days.
to
HPB
by
email
at
[email protected]
Title:
Use of Standard Programme Letters
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
P&P Reference: 3.12
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The National Colorectal Cancer (CRC) Screening Programme (the Programme) is included under Screen for Life
and uses the standardised HPB-endorsed letters to invite clients to go for screening under Screen for Life (Refer to
Annex 3).
Screen for Life and Health Promotion Board letterheads shall be used in all written correspondence with clients.
PROCEDURES
1. Standard invitation letters shall be personalised by use of the client’s name, gender and subsidy status.
2. Each standard invitation letter has a 10-digit reference number shown on the upper left hand corner of the letter
if the addressee is eligible for subsidy.
Title:
Incident Reporting
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
Laboratories
RHs
NCs
P&P Reference: 3.13
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
1. An incident is defined as an operational/ service issue or client complaint regarding the National Colorectal
Cancer (CRC) Screening Programme (the Programme) and its services, including unsatisfactory client
screening experience. Incidents may include client complaints, missing forms, missing results, incorrect data
entry on forms, FIT kits received unlabeled, long waiting times for results or referral, etc.
2. An incident could occur at any point under the Programme e.g. from receipt of FIT kit, through to follow-up at the
Restructured Hospital (RH).
3. An incident handling procedure shall include the following actions by all parties concerned:
i)
ii)
iii)
iv)
Acknowledgement of the incident and alerting of the appropriate parties
Investigation and escalation to the appropriate parties for resolution
Satisfactory closure provided to parties concerned
Measures put in place to prevent future recurrence
4. All incidents involving Clinics should be resolved wherever possible at the centres concerned. Documented
procedures should be in place to handle incidents.
PROCEDURES
1.
The Clinic which discovers the incident shall alert Health Promotion Board (HPB) and handle the case as
appropriate. The HPB is to be informed using the Incident Report Form; the Clinic should then follow up by telephone
to confirm receipt of the Incident Report Form.
2.
The ‘Incident Report Form’ (Annex 2) shall be submitted to HPB electronically within 1 working day upon
completion of investigation and closure of the incident.
3.
HPB will review the incident and decide if it is to be used as a case study, for example to explain low uptake
of the Programme, etc.
4.
HPB will notify the Division Director and Corporate Communications Director for direction on action
required, depending on the nature of the incident.
Title:
Update of Client’s Mailing Address
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
Laboratories
P&P Reference: 3.14
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY AND PROCEDURES
1. Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), the Client may request to
update their mailing address at any time during a screening episode.
2. If a Client contacts the Clinic regarding a change in mailing address, the authorised personnel should proceed to
contact the HPB Programme Manager to update the Client’s mailing address in the Enhanced Integrated
Screening System (EISS) after verifying the caller’s identity by sighting NRIC.
3. If the Client contacts HPB regarding a change in mailing address, authorised staff should proceed to update the
Client’s mailing address in the EISS after verifying the caller’s identity by checking NRIC and personal
information.
4. The address will be recorded as the Client’s mailing address but will not overwrite the data stored in the EISS
received from the MHA. Future correspondence will be made using the mailing address unless there is any further
update by the Client.
Title:
Quality Assurance Framework
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 3.15
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The service providers participating in the National Colorectal Cancer (CRC) Screening Programme (the Programme)
shall provide a high quality of service and care for the clients.
PROCEDURES
1.
The Laboratories and Restructured Hospitals (RHs) participating in the Programme shall adopt the Quality
Assurance (QA) framework, which is developed by the QA Subcommittee.
2.
The QA framework is developed to ensure a high quality of service and care for clients and to help identify
gaps in practices, and how to achieve improvements.
3.
The QA framework encompasses (i) QA indicators, standards and guidelines as well as (ii) QA monitoring via
document and on-site audits. The framework is applicable to the Laboratories processing the Faecal
Immunochemical Tests (FIT kits), as well as to the RHs / Centres carrying out colonoscopy services for clients
tested positive for FIT under the Programme.
4.
Laboratories and RHs / Centres outside of the Programme are also encouraged to adopt the QA framework
on a voluntary basis.
Title:
Data Management
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 3.16
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Clinics supporting the National Colorectal Cancer (CRC) Screening Programme (the Programme) are to read,
understand and comply with the rules and regulations set up by Health Promotion Board’s (HPB) Data Protection
Policy in relation to the collection of data from the public, processing and maintenance of such data and the release of
such data to other Government departments and agencies, Statutory Boards, the healthcare sector, and other third
parties.
(Refer to Section 8.1 for the Data Protection Policy)
Screen for Life (Colorectal Cancer Screening Programme) Policy
Health Promotion Board
Title: HealthLine Workflow
Scope: HPB - HealthLine
P&P Reference: 4.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
Version/Revision : 1.1
HEALTHLINE
The Health Promotion Board (HPB) HealthLine (HL) is a helpline where the public can call in to seek information on
colorectal cancer or the National Colorectal Cancer (CRC) Screening Programme (the Programme).
HEALTHLINE WORKFLOW
Client expresses interest to get screened for colorectal cancer, or
Client asks where can he/she get FIT kits
Confirm client’s eligibility status for CRC screening (FIT kit):
- 50 years & older
- Singaporean / PR
- Last FIT screening is more than one year ago, or
screening colonoscopy is more than 10 years ago
No
If client is ineligible, HL to inform client
of Programme recommendations for
CRC screening.
Yes
Ask client:
‐
If client has any family/personal history of
colorectal, endometrial, breast or ovarian cancer
‐
If client is suffering from inflammatory bowel
disease or Crohn’s disease
If client has had blood in the stool in the past 6
months
Yes
If “yes” to any, HL to advise client to
see a doctor about colorectal cancer
screening as he/she is at a higher risk
of getting CRC. Screening using FIT
may not be suitable for client.
However, should client insist on
screening using FIT, proceed to next
step.
No
Inform client that FIT kit is available at several touchpoints across Singapore:
all year round at SCS Main Office and Multi-Service Centre, NHGD Polyclinics, Watsons Personal Care
Stores, participating Guardian Health and Beauty Stores, Unity Family Medical Centre.
at other distribution points during Colorectal Cancer Awareness Months in March and September each
year as advertised (check SCS website for updated list of touchpoints and addresses)
Community Health Assist Scheme (CHAS) GP clinics offering Screen for Life.
Title: Call Handling
Scope: HPB - HealthLine
P&P Reference: 4.2
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
HealthLine will attend to all calls received on the National Colorectal Cancer (CRC) Screening Programme (the
Programme).
Qualified nurses will handle all calls on the Programme.
PROCEDURES
(A) General Enquiries
The HealthLine nurse shall answer queries on the Programme based on HealthLine Frequently Asked Questions
(Refer Annex1).
(B) General Enquiry from General Practitioners
If the HealthLine nurse is unable to respond to the queries, the nurse will record the caller details and nature of
enquiry and forward by email to the following Programme personnel:
Ms June Huang ([email protected]);
Mrs Susanne Line ([email protected])
(C) Enquiry from Potential/ Existing Programme Participants (the Clients)
a) Client’s Response to Invitation
The HealthLine nurse is to update Programme personnel when receiving a response from the following groups:
i)
ii)
iii)
iv)
Client had a FIT test done within the last 12 months and provides the date of his/her last FIT test.
Client is currently on follow-up with his/her own doctor for colorectal cancer.
Client declines participation and does not wish to be invited in future (i.e. opt out).
Client has a history of colorectal cancer.
b) FIT Test Results
Nurses shall check the screening date of the Client.
i)
If the Client calls less than 4-weeks from the date of screening, nurses to inform client that lab results
will be sent to client and referring GP within 4 weeks from the screening date.
ii)
If the Client calls more than 4-weeks from the date of screening, nurses to advise the client to call the
GP clinic they attended to enquire on the results.
(D) Distressed Client
For cases where the client is distressed, HealthLine is to send an email for immediate follow-up action attention to
Programme personnel:
June Huang ([email protected]);
Susanne Line ([email protected])
HealthLine Nurses are to provide an incident report for such cases.
Title: Voice Message
Scope: HPB - HealthLine
P&P Reference: 4.3
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Health Promotion Board’s (HPB) HealthLine shall ensure regular and timely retrieval of voicemail messages and
return of calls pertaining to the National Colorectal Cancer (CRC) Screening Programme (the Programme).
PROCEDURES
1. The HealthLine nurse will retrieve messages twice a day, at 10am and at 3pm.
2. The HealthLine nurse will return all calls left in the voicemail box by the next working day. A case is not
considered closed until the caller is contacted or 3 attempts at separate times or on separate days have been
made to contact the caller. Call information and status are recorded as per HealthLine Standard Operation
Procedure (SOP).
Screen for Life (National Colorectal Cancer Screening Programme ) Policy
Health Promotion Board
Title:
Screening Workflow
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
Laboratories
Collection points e.g. participating
pharmacies
P&P Reference: 5.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date: March 2016
Collection points for FIT kits
Individuals who wish to join the National Colorectal Cancer (CRC) Screening Programme (the Programme) are
required to register at collection points that provide Faecal Immunochemical Test (FIT) kits for CRC screening under
the Programme.
Refer to the list of collection points in Annex 1.
Outlined below is the workflow for the clinics and collection points.
Collection points - WORKFLOW
Pre-screening preparation at collection points:
Ensure available stock of consent forms
and educational materials e.g. pamphlets.
Ensure adequate stock of FIT kits, correct
storage, and expiry dates checked
regularly. Request supplies from HPB or
distributor if necessary.
Provide relevant training and briefing to staff,
especially when new tenders for FIT kit supply
commence. Ensure accessibility to operating and
instructional manuals. Ensure distribution staff are
familiar with correct use of FIT kit and correct
paperwork required
Eligibility checks and FIT kit distribution:
Client presents Screen for Life invitation
letter to clinic PSA. Check NRIC.
Check eligibility of walk-in clients (i.e. age, due for
screening – no FIT done in past one year or
colonoscopy in past 10 years, asymptomatic)
No
Eligible for CRC
Programme
Yes
Register eligible client:
 Verify client details and subsidy status
 Administer Consent or Opt-Out form
 Complete relevant data fields of Screen for Life
Registration and Lab Referral Forms
 Provide educational materials
Issue FIT kit:
 Check all forms for accuracy and completeness, in
particular the Registration and Lab Referral form
Section A (clinic details); Section B (client details,
including the 10 digit reference number of eligibility
for subsidy); Section C, No. 3 (Colorectal Cancer
Screening); and Consent for participation signed by
client. Refer to sample in Annex 2.
 Advise client on collection procedure and dispatch of
samples along with carbon copies of above
Registration Form.
 Inform client they will receive results within 4 weeks
of sample submission to the lab
End
Title:
Registration and Instructions for Clients
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
P&P Reference: 5.2
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), Clinics are responsible for:
 Administering the relevant pre-screening forms
 Giving the client pre-screening instructions
 Advising the client on how to collect their stool sample
 Informing clients on when to expect screening results
PROCEDURES
1. Registration
When a client arrives with their Screen for Life Invitation letter, proceed with registration.
Walk-in clients are to be provided with the Screen for Life Programme booklet (‘What you need to know about health
screening’).
2. Consent
Clinic staff should administer the Consent Form (Refer to Annex 2) and explain the Terms and Conditions of the
Consent. If the Client consents to join the Programme, staff must obtain the Client’s signature on the consent form.
The staff administering the consent will be required to write his/her name and sign as a witness on the Consent
Form. The Consent Form should be filed in the Client’s case notes.
If the Client does not consent, staff to explain to the Client that he/she will not be part of the Programme.
If the Client requires translation, staff to explain using the translations provided by Health Promotion Board (HPB).
3. Post-screening Results
Nurses are to advise the Client that they will be informed of their results within 4 weeks of submitting the sample to
the lab for testing.
If the Client has not received their results after 4 weeks, inform them to call the clinic they attended to check on the
results.
Title:
Follow Up
Scope: HPB - CRC Staff
HPB – HL Staff
Clinics
Laboratories
P&P Reference: 5.3
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Clinics supporting the National Colorectal Cancer (CRC) Screening Programme (the Programme) under Screen for
Life are responsible for:
 Extending to Clients the relevant educational materials after screening
 Following up in the event that the Client is found to have an abnormal Faecal Immunochemical Test (FIT) result
i.e. FIT positive
PROCEDURES
Results Notification
Clinics are to follow up with the laboratories if the Client’s result has not been received within 4 weeks of the Client’s
screening date.

Normal results (FIT negative)
The normal result letter should be posted within 21 days of the Client’s screening date, to both the referring GP and to
the Client.
The Client should be encouraged by the Clinic and GP to re-screen with FIT in one year’s time.

Inconclusive Results e.g. only one test submitted for testing, or test unsuitable for processing
Clinics are to ensure the following:
I.
Record the lab result notification received by the referring GP and acknowledge the inconclusive result;
II.
Contact the Client and explain that the laboratory has only processed one stool sample;
III.
Request the Client to complete and submit the second test if they have only performed it once;
IV.

Instruct the Client on correct collection technique if the original submission was deemed unsuitable e.g. too
much sample collected so kit leaked and was unable to be processed by the lab; or if stool was submitted
instead of the sampling kit.
Abnormal results (FIT positive)
Clinics are to ensure the following:
I.
If the Client is FIT positive, call the Client to return to the clinic for follow-up
II.
If Client is not contactable after 2 weeks following 3 attempts to contact Client on different days and at different
times, send the abnormal result notification letter by mail and include the pamphlet on “Guide to Further
Assessment for Colorectal Cancer”
III.
When the Client returns to the clinic, GP is to ensure the following will be done:
a. Advise on the results and follow-up tests
b. Give Client the abnormal result letter and the pamphlet “Guide to Further Assessment for Colorectal
Cancer”
IV.
Refer the Client for further investigation at the Specialist Outpatient Centre (SOC). A CRC Nurse Coordinator
based in the nearest Restructured Hospital (RH) will contact the client to:
a. Make an appointment for the Client at the preferred RH
b. Complete the referral form for the Client
c. Inform the Client of the appointment date and time. Remind Client to bring the referral form and
NRIC when they attend the follow-up appointment at the RH.
Billing
Clinics are to charge $32/- for non-subsidised participants and $0/- for subsidised clients of the Programme for FIT
Kits excluding doctors’ consultation fees. Laboratories will invoice clinics on a monthly basis for processing of FIT Kits
of the non-subsidised patients at $32/- (for 2 FIT Kits). HPB will pay the laboratories’ the processing fees for subsidised
clients’ FIT Kits.
Title:
Defaulter Tracking
Scope: HPB - CRC Staff
HPB – HL Staff
Restructured Hospitals (Nurse Coordinators)
Clinics
Laboratories
P&P Reference: 5.4
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), Nurse Coordinators (NCs)
based in the Restructured Hospitals (RHs) are to follow-up on first-time defaulters from their Specialist Outpatient
Clinic (SOC) appointments.
PROCEDURES
1. NCs are to contact all Clients who do not present for assessment at the RH as scheduled.
2. NCs are to log onto the Health Promotion Board’s (HPB) Enhanced Integrated Screening System (EISS)
and update the status of the attempt to contact the client i.e. Client forgot appointment, refused
assessment, etc. within 2 weeks of the defaulted appointment.
3. After three attempts to contact the client during different times of the day, the NC will close the case and
update EISS.
Screen for Life (National Colorectal Cancer Screening Programme) Policy
Health Promotion Board
Title:
Client FIT results letters
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Appointed Vendors
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 6.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Appointed Vendors participating in the National Colorectal Cancer (CRC) Screening Programme (the Programme)
are responsible for processing the client’s submitted Faecal Immunochemical Test (FIT) and reporting the results to
the client and to the registered clinic.
PROCEDURES
1. The Appointed Laboratories processing FIT under the Programme are required to notify the client of the results
of each FIT kit submitted for processing, by sending a hard copy of the results letter:
a. Clients with normal results (FIT negative <100ng/ml) are advised to be screened again in one year.
b. Clients with abnormal results (FIT positive >100ng/ml) are advised to discuss with their doctor about
follow-up investigation of the source of the bleeding.
2. The Appointed Vendor is required to notify the GP clinic of the results of each FIT kit submitted for processing,
by sending a hard copy of the results letter:
a. Clients with normal results (FIT negative <100ng/ml) are advised to be screened again in one year.
b. Clients with abnormal results (FIT positive >100ng/ml) are advised to discuss with their doctor about
follow-up investigation of the source of the bleeding.
3. Each results letter will contain a report showing:
 type of test;
 date of screening;
 concentration of blood found in the sample;
 reference range; and
 indication of positive or negative result.
4. Summary of the results letter (refer to example below):
 1 out of the 2 tests is positive = positive result requiring follow-up investigation;
 2 out of the 2 tests are positive = positive result requiring follow-up investigation;


Only 1 kit tested negative (no submission of 2nd kit) = inconclusive result requiring HealthLine to
contact the client and request they submit a second kit for testing;
2 kits tested negative = negative result requiring re-screening in one year.
5. The client and the clinic shall receive the results letter within four weeks of the sample being submitted to the
laboratory for processing.
a) When GPs are notified of the results, they should provide consultation to the client with FIT positive
results.
b) Nurse coordinators (refer to Section 2.13) will access Health Promotion Board’s (HPB) Enhanced
Integrated Screening System (EISS) and contact each FIT positive client to refer them to any of the
participating Restructured Hospitals (RHs) for follow-up assessment.
6. The Appointed Vendors shall submit the data required by the Programme via web service to EISS within 21
days of processing of the results.
Two examples of results summaries in letters to clients and GPs:
Title:
Appointed Vendor notifications to HPB
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Appointed Vendors
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 6.2
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Appointed Vendors participating in the National Colorectal Cancer (CRC) Screening Programme (the Programme)
are responsible for notifying Health Promotion Board (HPB) personnel in the Screening Policy and Planning team of
any discrepancies or issues that arise with any client’s Faecal Immunochemical Test (FIT) processing and /or results.
PROCEDURES
1.
The Appointed Vendors processing FIT under the Programme will follow the rejection criteria Standard
Operation Procedure (SOP) when a client:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
2.
Submits an incomplete registration form with a FIT kit;
Submits a FIT kit with no registration form enclosed;
Submits a FIT kit with unclear or illegible details on the kit or the registration form;
Submits a registration form with no FIT kit;
Submits any un-labelled sample or wrongly labelled sample (e.g. name on request form does not
match name on sample);
Submits insufficient sample volume;
Submits excessive sample volume;
Submits an unsuitable specimen e.g. specimen sent in wrong/ inappropriate container;
Submits a contaminated sample or request form;
Submits a broken, leaking container or spilt sample;
Submits any sample that poses significant risk to client or staff safety.
The Appointed Vendors processing FIT under the Programme are required to notify HPB for samples which
have been rejected, using the Specimen Rejection log (refer to Annex 2). The log is to be submitted to HPB
monthly, by the 7th day of each new month.
Title:
QA Framework for Laboratories
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 6.3
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Appointed Laboratories participating in the National Colorectal Cancer (CRC) Screening Programme (the
Programme) are responsible for ensuring adherence to the recommended Quality Assurance (QA) indicators,
standards and guidelines to enable quality of service and care for the clients.
PROCEDURES
1. The QA framework for Laboratories processing Faecal Immunochemical Tests (FIT) under the Programme
constitutes guidelines and standards for processing from specimen receipt to report generation. Corresponding
QA indicators are tracked based on the relevant datasets submitted by the Laboratories to Health Promotion
Board (HPB).
2. The Appointed Laboratories will be audited based on the work flow as well as the guidelines and recommended
standards as specified in Annex 4: Quality Assurance for Laboratories Processing Faecal Immunochemcial
Test.
3. The QA requirements are:
a. Organisation and Quality Management
b. Procedure Manual
c. Premises and Environment
d. Equipment, Information Systems and Materials
e. Personnel
f. Specimen Receipt, Storage and Processing
g. Interpretation and Reporting of Results
4. Laboratories outside of the Programme are also encouraged to adopt the Programme’s QA framework on a
voluntary basis.
5. The Laboratories which meet the guidelines and recommended standards will be placed on the Programme’s
approved list of FIT processing services for two years. An audit will be conducted every two years.
Title:
Data Collection and Submission Policy
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Appointed Vendors
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 6.4
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Appointed Vendors participating in the National Colorectal Cancer (CRC) Screening Programme (the Programme)
shall be responsible for ensuring that all Data submitted to Health Promotion Board (HPB) is correct and complete,
and according to the timeline stipulated by HPB.
PROCEDURE
Appointed Vendors:
1.
The Appointed Vendors are required to submit Faecal Immunochemical Test (FIT) screening results (the Data)
to HPB by uploading the Data to the Enhanced Integrated Screening System (EISS) within 21 days of the FIT
being processed.
2.
In the event of Data submission failure to HPB, the Vendor shall forward the Data on an MSExcel spreadsheet
to HPB to upload into the system. In the event of system or connection failure, HPB will notify the Vendor once
system connectivity is resumed.
3.
The Appointed Vendors are required to generate a laboratory result letter for the GP clinic, within 2 weeks upon
receipt of completed FIT kits.
4.
The Appointed Vendors are required to submit a log sheet which tracks any FIT kits discarded by the appointed
laboratory to HPB on a monthly basis using the standard MSExcel template provided by HPB (refer to Annex 2
– Specimen Rejection Log).
Appointed Laboratories:
1.
The Appointed Laboratories are required to check that the specimens are labeled correctly and verify against the
personal particulars of clients as indicated on the request form on receipt of the completed FIT kits from the
participants.
2.
The Appointed Laboratories are required to check that the client information is indicated on the request form.
3.
The Appointed Laboratories are required to process the completed FIT kits and provide FIT results which meet
the minimum standards of the Programme.
4.
The Appointed Laboratories are required to send a hard copy of the client’s screening results to the client within
2 weeks upon receipt of completed FIT kits.
Title:
Downtime Procedure
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Appointed Vendors
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 6.5
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY and PROCEDURES
1. Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), clients’ data recorded
on hardcopy MSExcel spreadsheet during system downtime, shall be emailed to HPB personnel. HPB shall
upload the data into the Enhanced Integrated Screening System (EISS).
2. Each Appointed Vendor shall have written protocol as a component of the Workflow on handling of downtime
data and management of data once the system is up. This should be made known to all staff involved.
Screen for Life (National Colorectal Cancer Screening Programme) Policy
Health Promotion Board
Title:
Hospital Workflow – Referral for
Assessment
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 7.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
Version/Revision : 1.1
POLICY
The Restructured Hospitals (RHs) / Centres under the National Colorectal Cancer (CRC) Screening Programme (the
Programme) are responsible for adhering to the workflow below. Clients who require further investigation for a positive
Faecal Immunochemical Test (FIT) result should have a diagnostic colonoscopy within 5 weeks of referral.
RHs are required to inform HPB in writing if the timeline of 5weeks of referral for a diagnostic colonoscopy is not able
to be met.
Abnormal Outcome (Positive FIT results)
Nurse Coordinators
(NCs) will make
appointment with
RH/Centre for specialist
consultation for all FIT +
clients)
Referred to RHs for
Specialist Consultation
Specialist Consult at SOC
Colonoscopy Appointment
Re-invite
after 5 yrs
for FIT
Client
without
polyps
Client
with
polyps
Negative for CRC
Re-screen in CRC
Programme after 2, 3 or 5
years upon specialist advice
Colorectal Cancer (CRC)
Exit CRC Programme.
Client undergoes appropriate
treatment by RH/Centre
Title:
Appointment Booking for Specialist P&P Reference:
Consultation
Scope: HPB - CRC Staff
Prepared By:
HPB - HealthLine
Clinics
Restructured Hospitals (RHs)
Revised By:
7.2
Ms Koh Jing Yun
Manager, Integrated Screening
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Clients who are tested positive for Faecal Immunochemical Test (FIT) under the National Colorectal Cancer (CRC)
Screening Programme (the Programme) must be assessed by a specialist at the Restructured Hospital (RH)/Centre
for consultation prior to their colonoscopy appointment to ensure that all necessary pre-procedure assessments are
carried out in the interest of patient safety.
All FIT-positive Clients shall be referred for a specialist consultation at one of the participating RHs under the
Programme.
PROCEDURES
1. For screening follow-up of Clients from either the GP Model or the Outreach Model, the Nurse Coordinator (NC)
shall assist the FIT-positive Client to make the first appointment with a specialist at the participating RH. The NC
will be notified electronically by the Enhanced Integrated Screening System (EISS) on receipt of the positive FIT
results from the laboratories. The NC will then call the Client and make an appointment to see the specialist.
2. If a client chooses to attend a different RH than the one they were referred to through EISS, the NC will make the
transfer via EISS after liaising with the NC at the new RH. The NC at the new RH will proceed to make the
appointment for the client.
3. For clients who return to their GP for referral, the appointment details shall be noted on the Screen for Life
Colorectal Cancer Referral Form for Further Assessment (refer to Annex 2) and handed to the Client.
4. Once an appointment has been made:
a. A client under the GP Model shall be reminded by the GP to bring the following on the day of specialist
consultation:
 NRIC
 Lab reports of FIT result
 Referral Form for Further Assessment
b. A client under the Outreach Model shall have a copy of the referral from EISS printed out by the NCs in
the RHs and filed in the client notes.
5. The Client shall be encouraged to have their spouse or family member accompany them on the day of specialist
consultation, to listen to instructions (e.g. regarding effective bowel preparation), ask further questions, and be
able to support the Client.
Title:
Opt-out
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Restructured Hospitals (RHs)
P&P Reference: 7.3
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
A Client who wishes to withdraw from the National Colorectal Cancer (CRC) Screening Programme (the Programme)
is required to sign the Opt-Out form (refer to Annex 2).
In a situation whereby the client chooses to opt out from the Programme by telephoning a centre or clinic, the
personnel taking the call can assist to complete the Opt-Out form with the client’s details and submit it to HPB. HPB
will contact the client to verify their consent before amending the details on the system.
PROCEDURES
1. Upon withdrawal from the Programme, the Client shall no longer be invited under Screen for Life for re-screening.
2. However, all information concerning the Client’s previous tests and results will be retained by the Programme for
statistical and research purposes only. Under no circumstances will any personal or identifying details be released
or used for other purposes.
Title:
Entry of final assessment outcomes
Scope: HPB - CRC Staff
Restructured Hospitals (RHs)
P&P Reference: 7.4
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), the Nurse Coordinator (NC)
based in the Restructured Hospital (RH) / Centre is responsible for entering the finalised assessment outcomes of
the Client into the Enhanced Integrated Screening System (EISS).
The NC is to ensure that each case is closed.
Title:
Clients who require colonoscopy
Scope: HPB - CRC Staff
Restructured Hospitals (RHs)
P&P Reference: 7.5
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), institutional consent specific
to the colonoscopy procedure must be obtained in writing from the Client who requires colonoscopy.
All colonoscopy procedures shall be performed by trained and qualified colonoscopists, under the appropriate
environment as indicated in the Quality Assurance (QA) Guidelines.
See Annex 4 for the QA Guidelines.
PROCEDURES
1. There shall be a pre-assessment process prior to the colonoscopy procedure.
2. The Restructured Hospital (RH) / Centre shall provide all Clients with adequate information prior to the procedure.
The information may include the possible risks, benefits and alternatives.
3. The Client’s signature shall be obtained on the consent form prior to the colonoscopy procedure. For a Client who
cannot sign, appropriate procedures (e.g. name and signature of interpreter or caregiver who obtained oral consent,
including written confirmation of the consent; thumbprint or ‘X’ by the client) should be in place to obtain consent.
The RH / Centre shall also provide the option for a Client to withdraw consent at any stage.
Title:
Clients with normal results or benign
findings
Scope: HPB - CRC Staff
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 7.6
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.0
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), a Client found to have normal
Faecal Immunochemical Test (FIT) results, i.e. FIT Negative, will be discharged to the routine re-screening cycle (i.e.
screening with FIT once every year).
A Client under the Programme (either GP or Outreach Model) who is found to have normal or benign results after a
diagnostic colonoscopy will be discharged to the routine re-screening cycle (i.e. screening once every five years with
screening colonoscopy). The specialist is required to inform the client of their individual screening pathway i.e.
annual FIT test is neither required nor recommended between the five-yearly colonoscopy.
A Client found to be negative for colorectal cancer after a diagnostic colonoscopy, but found with diverticular lesions,
adenomatous carcinomas, and other conditions, will be treated by the specialist as appropriate for the condition.
Such Clients should then be encouraged to resume regular consultation with their usual General Practitioner (GP)
within the healthcare system.
The responsibility for tracking when such Client’s next colonoscopy is due should be positioned with the GP and/ or
the patients themselves.
PROCEDURES
1. The Laboratories shall inform the Client with normal FIT results in writing that they are discharged for routine rescreen with FIT (once every year).
2. Under each respective Restructured Hospital’s (RH’s) protocol (usual SOP), all Restructured Hospitals (RHs) /
Centres shall inform clients with normal colonoscopy results and benign findings in writing that they are
discharged for routine re-screen with screening colonoscopy (once every five years).
Title:
Clients Diagnosed with Colorectal
Cancer
Scope: HPB - CRC Staff
Restructured Hospitals (RHs)
P&P Reference: 7.7
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), a Client diagnosed with
colorectal cancer shall be informed of the diagnosis by the doctor-in-charge at the Restructured Hospital (RH), and
should be counseled on the treatment options available. All Clients requiring treatment shall be followed-up by the RH
to ensure that appropriate treatment has been provided.
Communication and guidance about the processes and procedures, including information about financial assistance if
required, will be offered to the Client when seeking treatment.
PROCEDURE
Under each respective RH’s protocol (usual SOP), the doctor and/or the nurse will discuss treatment options during
a counselling session with the Client and ensure that the Client has the opportunity to understand all the implications
and procedures likely to follow, including any out-of-pocket costs to the Client.
Title:
Client with interval or missed cancers
Scope: HPB - CRC Staff
Restructured Hospitals (RHs)
P&P Reference: 7.8
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), a Client diagnosed with missed
or interval colorectal cancer shall be informed of the diagnosis by the doctor-in-charge at the Restructured Hospital
(RH) and should be counseled on treatment options available. All Clients requiring treatment shall be followed-up by
the RH to ensure that appropriate treatment has been provided.
PROCEDURES
The Client will be informed of the diagnosis by their doctor-in-charge. Communication and guidance about the
processes and procedures, including information about financial assistance if required, will be offered to the Client
when seeking treatment.
If a fully developed carcinoma is detected within 5 years of an index ‘normal’ colonoscopy, then it will be considered a
missed cancer. The doctor-in-charge would take action by checking on the result of any previous colonoscopy. Followup care would proceed following the RH’s Standard Operating Procedure.
Title:
Clients Who Did Not Attend
Colonoscopy Appointment
Scope: HPB - CRC Staff
Restructured Hospitals (RHs)
P&P Reference: 7.9
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Checked By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Nurse Coordinators (NCs) based in the Restructured Hospitals (RHs are responsible for tracking and following up with
any Client who fails to attend their colonoscopy appointment after it has been made.
PROCEDURES
NCs in the RHs shall track Clients who are required to attend for further assessment at their Centre. Three attempts
must be made to contact the Client who has defaulted his/her appointment.
If there is an opportunity to speak to the Client, the NC shall attempt to counsel and educate the Client on the
importance of the investigative colonoscopy.
The NC is to follow through with the Client until the case is closed.
Title:
Data Collection and Submission Policy
Scope: HPB - CRC Staff
Restructured Hospitals (RHs)
P&P Reference: 7.10
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.0
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Restructured Hospitals(RHs)/ Centres participating in the National Colorectal (CRC) Screening Programme (the
Programme) shall be responsible for ensuring that all Data submitted to Health Promotion Board (HPB), is correct,
complete and adheres to the timeline as requested by HPB.
PROCEDURE
The RHs shall ensure that the required datasets are accurately recorded and submitted to the HPB’s Screening System
via system interface:
a.
During normal activity - within 28 calendar days (4 weeks) from the date of receipt of the information and
results (e.g. for a Client assessment conducted in January 2016, such Client data must be submitted to the HPB
through the system interface by 28 February 2016).
b.
During peak periods i.e. Colorectal Cancer Awareness Campaigns – within 42 calendar days (6 weeks) from
the date of receipt of the information and results (e.g. for a Client assessment conducted in March 2016, such Client
data must be submitted to the HPB through the system interface by 13 May 2016).
If there is any delay in submission of the data, the RHs shall notify HPB of the reason e.g. if a Client attends their
Specialist Outpatient Clinic appointment but chooses to postpone their colonoscopy for several months (e.g. due to
overseas travel). Such cases will be an exception to the timeline for submission as outlined above.
Title:
Downtime Procedures
Scope: HPB - CRC Staff
Restructured Hospitals (RHs)
P&P Reference: 7.11
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Under the National Colorectal Cancer (CRC) Screening Programme (the Programme), Clients’ data recorded on the
MS Excel hardcopy forms during system downtime shall be transferred into the Enhanced Integrated Screening
System (EISS) within three (3) working days from the time the system is up.
PRINCIPLES
1. The Restructured Hospitals (RHs) shall ensure that the data entered into the EISS post-downtime is complete
and accurate.
2. Each RH shall have a written protocol on the handling of downtime data and management of data once the
system is up. This should be made known to all staff involved.
3. Referrals to the RHs will be sent by HPB to the RHs NCs in an MS Excel file with an encrypted password for
security purposes.
4. The NCs will contact Clients based on the referrals in the MS Excel file. Updates of cases will be done through
a MS Excel file (MS Excel dataset). Once the system is back to normal, updates are to be transferred to the
system.
Title:
QA Framework for Restructured
Hospitals
Scope: HPB - CRC Staff
Restructured Hospitals (RHs)
P&P Reference: 7.12
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
The Restructured Hospitals (RHs) / Centres under the National Colorectal (CRC) Screening Programme (the
Programme) are responsible for ensuring adherence to the recommended Quality Assurance (QA) indicators,
standards and guidelines to enable quality of care for the Client.
PROCEDURES
1.
The QA framework for RHs / Centres providing colonoscopy services under the Programme constitutes
guidelines and recommended standards for the assessment process from specialist consultation to discharge
from the RHs / Centres. Corresponding QA indicators are tracked based on the relevant datasets submitted by
the RHs / Centres to Health Promotion Board (HPB).
2.
RHs / Centres participating in the Programme will be audited based on the work flow as well as the guidelines
and recommended standards as specified in ‘Quality Assurance in Colonoscopy for Individuals with Positive
FIT Results’. The QA requirements are:














Organisation
Environment and Facility
Equipment
Guidelines, Polices and Procedures
Appointment Booking and Waiting Time
Documentation and Reporting of Results
Quality Assurance
Pre-assessment and Consent Process
Sedation and Comfort
Aftercare
Specimen Handling
Recommended requirements for Clinical Professionals
Quality Indicators for Colonoscopist
Quality Indicators for Colonoscopy Centre
3.
RHs / Centres which meet the guidelines and recommended standards will be placed on the Programme’s
approved list of diagnostic colonoscopy services providers for three years. An audit will be conducted every
three years.
4.
Refer to QA documents in Annex 4.
Screen for Life (National Colorectal Cancer Screening Programme) Policy
Health Promotion Board
Title:
HPB Data Protection Policy
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 8.1
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
All administrative and clinical staff involved with the National Colorectal Cancer (CRC) Screening Programme (the
Programme) shall read, understand and comply with the rules and regulations set up in Health Promotion Board’s
(HPB) Data Protection Policy (version 1.4) in relation to the collection of Data from the public, processing and
maintenance of such Data, and the release of such Data to other government departments and agencies, Statutory
Boards, the healthcare sector and other third parties.
Refer to document: Data Protection Policy – Annex 2
Title:
Quality Control of Data Collection
Scope: HPB - CRC Staff
HPB - HealthLine
Clinics
Laboratories
Restructured Hospitals (RHs)
P&P Reference: 8.2
Prepared By:
Ms Koh Jing Yun
Manager, Integrated Screening
Revised By:
Mrs Susanne Line
Senior Manager, Screening Policy &
Planning
Approved By:
Version/Revision : 1.1
Dr Shyamala Thilagaratnam
Director, Regional Health and
Community Outreach Division
Date of Original Issue : Jan 2012
Effective Date : March 2016
POLICY
Laboratories and Restructured Hospitals (RHs) / Centres participating in the National Colorectal Cancer (CRC)
Screening Programme (the Programme) shall ensure that quality control procedures are in place to guarantee accurate
and timely submission of data to Health Promotion Board (HPB).
PROCEDURES
1. Adherence to the timeline stipulated is important in order to ensure prompt screening result notification to all
clients; and in particular, to expedite arrangements for clients who are tested positive for Faecal
Immunochemical Test (FIT). It is essential for minimising a client’s anxiety in waiting for the outcome of their
screening result and further assessment when necessary.
2. Please refer to Annex 4 for QA Guidelines and Standards which are applicable to the Laboratories and RHs.
3. These procedures shall be documented in the Laboratories and RHs / Centre’s operating policies and
manuals, indicating, where appropriate, the timing of these checks.