Standing Order for Staff Nurse Clinical Breast Examinations
Upon completion of training and evaluation by the CommunityHealth Medical Director,
CommunityHealth staff nurses may: 1. Perform clinical breast examinations and 2. Order referrals for mammograms to outside hospitals and clinics for patients attending
CommunityHealth with the intention of providing preventative screening.
Clinical Breast Examination privileges include and are limited to:
1.
Performing clinical breast examinations:

Breast inspection

Breast palpitation
2.
Documenting physical findings of the clinical breast examination in the EMR.
3.
Completing and signing referrals for mammogram screening at outside facilities:

In the absence of any concerning or abnormal finding, the nurse is permitted to complete and sign the screening mammogram referral.

In the case that a concerning abnormality is found on exam, the nurse will consult with an onsite MD or NP before completing a referral for a diagnostic mammogram.
4.
Providing patient education:

Educating patients on the U.S Preventive Services Task Force (USPSTF) recommendations for breast cancer screening for women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation

USPSTF recommends biennial screening mammography for women aged 50 to 74 years.

The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits

and harms.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
If at any step during the clinical breast exam, the nurse does not feel she can correctly and safely perform the exam, the nurse will consult an onsite MD or NP.
Signature of Medical Director Date