nursing-case-protocols.pdf

nursing-case-protocols.pdf - Massachusetts Tuberculosis...

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Massachusetts Tuberculosis Nursing Case Management Protocols T uberculosis E limination A chieved through M anagement
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TABLE OF CONTENTS I. Introduction Theoretical Framework Goal of Case Management Treatment Standard of Care Legal Authority A. Nursing Case Management Model 1. Indirect Case Management 2. Direct Case Management B. The Case Management Process Nursing Case Management Model (Diagram) II. Case Management Standards of Care Suspected/Confirmed Cases of Tuberculosis Contacts Source Case Investigations III. Tuberculosis Nursing Case Management Protocols Case Reporting Nursing Case Management Model A. Initial Patient Assessment 1. Initial Case Investigation 2. Contact Investigation B. Nursing Care Plan 1. Treatment Plan 2. Discharge Plan C. Implementation 1. Outreach Involvement Page 5 5 5 5 5 5 5 6 7 9 11 11 12 12 13 13 13 13 13 14 16 16 17 18 18 Priorities for Outreach Staff Assignments 19 2. Referrals for Other Community Resources 19 D. Evaluation 19 1. Monthly Evaluation by Direct Case Manager 20 2. Division Evaluation Plan 20 IV. Treatment Delivery Protocols 21 Treatment Standard of Care 21 Candidates for Directly Observed Therapy 21 A. Guidelines for Self Administered Therapy 21 1. Initiate Treatment 21 2. Educate Patient 22 3. Evaluation 22 B. Guidelines for Directly Observed Therapy (DOT) 23 C. Guidelines for Long-term Hospitalization 24 1. Voluntary Hospitalization 24 October 2001 1
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2. Involuntary (compulsory) Hospitalization 24 Priorities for Treatment of Latent TB Infection D. Guidelines for Treatment of Latent TB Infection 25 25 1. Initiate Treatment of Latent TB Infection 25 2. Educate Patient 25 3. Evaluation 26 Two-month Regimen of Rifampin and Pyrazinamide 26 Figure 1. Care Continuum 27 V. Contact Evaluation and Management 29 Theoretical Framework 29 Legal Authority 29 A. Transmission Risk Assessment 29 1. Person Factors 29 2. Place Factors 30 3. Time Factors 30 4. Evidence of Transmission 30 B. Priorities for Contact Evaluation 30 C. Evaluation and Management of Contacts 31 1. Symptom Review 31 2. Initial Tuberculin Skin Test and Follow-Up 31 3. Repeat Tuberculin Skin Test and Follow-Up 32 4. Patients whose Cultures Convert to Positive 33 D. Special Considerations for Infant and Child Contacts 34 1. Initial Tuberculin Skin Test and Chest X-ray 34 2. Repeat Tuberculin Skin Test and Chest X-ray 35 E. Source Case Investigation 35 Possible Source Patient who is Symptomatic 35 Figure 2. Concentric Circle Analysis 37 VI. Glossary of Terms 39 October 2001 2
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VII. Commonwealth of Massachusetts Regulations 1. 105 CMR 350.000 Determining Active Tuberculosis 2. 105 CMR 360.000 Tuberculosis Treatment Unit Standards for Admission, Treatment, and Discharge 3. 105 CMR 365.000 Standards for Management of Tuberculosis Outside Hospitals 4. Procedure for Compulsory Hospitalization 5. Local Certification Form VIII. Forms Section MDPH-TB03 Epidemiologic Report on a Tuberculosis Case (contact form) Letter to Private Providers for Contact Follow-up MDPH-TB04A Initial Clinical Evaluation Form & Instructions MDPH-TB04B TB History Form & Instructions MDPH-TB05 Case/Suspect Follow Up Form MDPH-TB06
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