TB-201_TB_Case_Suspect_Management_Plan_02_2018v2.doc
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- Electronic Health Records
- Solicitation number
- 2024-280
- Issued by
- Collin County, Texas
About this file
The document is a Tuberculosis (TB) Case & Suspect Management Plan from the Texas Department of State Health Services, detailing a comprehensive protocol for managing TB cases and suspects. The plan provides a detailed roadmap for nurse case managers, outlining specific responsibilities and required documentation across multiple months of patient care, including initial medical evaluations, treatment protocols, consent procedures, clinical assessments, adherence tracking, contact investigations, and reporting requirements.
The management plan encompasses a systematic approach to TB patient care, emphasizing direct observation of treatment (DOT), regular clinical assessments, toxicity monitoring, and comprehensive contact tracing. Key components include obtaining informed consent, conducting medical and social history reviews, performing required medical tests (TST/IGRA, chest X-rays, HIV testing), implementing drug regimens, monitoring potential adverse reactions, providing patient education, conducting contact investigations, and ensuring quality assurance through clinical supervisor reviews. The document includes multiple standardized forms (TB-202, TB-205, TB-206, TB-340, TB-400A) to track patient progress, treatment, and public health reporting requirements throughout the patient's treatment period.
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Text version
Texas Department of State Health Services (continued) TB Case & Suspect Management Plan: RN Case Management Group Review
Nurse Case Manager:
Date:
Patient’s Name:
Patient’s DOB:
| Directions: Boxes (to right) indicate when TB service is to be provided. Document date at top of each column. Place initials of provider/staff in appropriate box when task is completed &/or reviewed. Document any comments in progress notes. |
| 1st visit / Mo 1 |
| Wk 2 |
| Mo |
Mo Mo Mo Mo Mo Mo Mo
Date(s)
| Responsibility |
| Assign nurse case manager, establish team; document in client’s record |
| Consents |
| General Consent (L-36), Consents to release/receive, HIPAA, TB-209, TB-409, TB-410/410a/410b, TB-411/411a |
Obtain Informed Consent form TB-411 (TB-411A, if only Spanish speaking) initially & for any drugs added to regimen
| Medical Evaluation |
| Obtain medical & social history; document on TB-202 |
Request previous medical records
Physician evaluation/review; document on intake form or progress notes
RN evaluation; document in progress notes
TST/IGRA (record in “mm”/if IGRA “positive” or “negative”) & record date on TB-400
Chest X-ray w/ date(s) & result(s) documented
Collect observed sputum for AFB smear/culture per protocol
If evaluation & treatment for patient is by private TB physician, please indicate. Document monthly vital signs, weight, labs & eye checks from private physician
HIV tested & document. (unless patient has knowledge of HIV+ status or has documented negative HIV test result within 14 days of TB diagnosis.) If HIV+, document CD4 on TB-400A
Nutritional assessment & document on TB-202
HBV/HCV screening & note on TB-202 & chart
Population & medical risk factor(s), note on TB-400A
Nurses & physician(s) must sign ALL labs, TST/IGRA, imaging & previous records
| Treatment |
| Drug regimen according to protocol or specific order |
Initiate DOT on all cases/suspects; document on TB 206
Drug susceptibility/resistance testing performed on culture positive isolates; document on TB-231
( susceptibility
If DOT not provided, physician’s note must document reason
PZA x2 months; Ethambutol x2 months (or until susceptibilities are reported and organism is known to be pan sensitive)
| Consultation |
| Obtain expert consult for drug resistant cases, complicated adult/pediatric cases, or client who remains symptomatic or sputum smear positive after 2 months of therapy; written consult in client record. Physician documents in chart. |
Toxicity/
Clinical
Assessment Clinical assessment for responses & symptoms of adverse reactions according to protocol. Document on TB-205 & progress notes, as appropriate.
Visual acuity (Snellen) & color discrimination (Ishihara Plates) initially & monthly; document on TB-205
Hearing sweep check initially & monthly if on amikacin, capreomycin, kanamycin or streptomycin; document on TB-205
Nurse Case Manager:
Date:
Patient’s Name:
Patient’s DOB:
| Directions: Boxes (to right) indicate when TB service is to be provided. Document date at top of each column. Place initials of provider/staff in appropriate box when task is completed &/or reviewed. Document any comments in progress notes. |
| 1st visit / Mo 1 |
| Wk 2 |
| Mo |
Mo Mo Mo Mo Mo Mo Mo
Date(s)
| Adherence |
| Issue Order to Implement Measures for a Client With Tuberculosis form TB-410 (TB-410a, if Spanish speaking) on all cases on 1st visit (even private Rx) |
Follow-up missed appointments within 1 working day; initiate court-ordered management according to DSHS policy & notify Regional/Central offices
Evaluate barriers to treatment; document in chart
Isolation
Conduct site visit in 3 business days of report date to assess living situation & aid contact investigation. Document on 340.
Institute isolation in congregate living situation or home & exclude from work or school, if infectious
Discontinue congregate setting isolation or allow to return to work/school following at least 2 wks appropriate therapy (unless otherwise indicated, see SDO’s for release from isolation), 3 consecutive (-) smears on different days & improvement of clinical symptoms. Document in physician orders.
Education
Appropriate client education provided initially & monthly per protocol; written instructions & monthly review of medication side effects, note on TB-203
Public Health/ Contact Investigation Reporting Interview case/suspect & contacts; plan contact investigation using “Concentric Circle” approach & high, medium, low prioritization. Note in CI section
Initiate contact investigation within 3 working days; interview & evaluate within 7 days (TST/IGRA, CXR, medical evaluation) Note on TB-340/341. Make referrals for contacts as needed.
Expand contact investigation according to CDC guidelines, TX TB Work Plan, & local criteria.
Provide 2nd TST/IGRA 8-10 weeks after break in contact with case to all contacts with (-) TST/IGRA on 1st test; document on TB-340
Provide education & counseling for contacts
| Reporting |
| Initial report suspect/case within 1 working day of notification, reclassification of suspect within 90 days. |
Document on TB-400A & TB-400B (all data fields complete) within 7 working days of diagnosis; submit RVCT if case; see TX TB Work Plan for reporting deadlines
Submit TB-340/341 or equivalent (such as mass contact spreadsheet) after 2nd testing of initial negative contacts is complete. See TX TB Work Plan for reporting deadlines
| Quality Assurance Review |
| Clinical supervisor or TB Program Manager reviews & evaluates contact investigation |
Team review of client record
Social Services Referrals
Assist patient in obtaining drug/alcohol treatment program services, nutritional support programs, HIV services, or Medicaid services, as appropriate. Document.
If patient moves out of jurisdiction, appropriate & timely referrals documented
NURESE/CASE MGR OR
TB PROGRAM MGR NAME: _________________ SIGNATURE:
INITIALS:
PRINTED NAME: _______________________ __ SIGNATURE:
PRINTED NAME: _________________________________ ______ SIGNATURE:
TB-201 TB Case & Suspect Management Plan – 08/2017; Amended by CCHCS 02/2018
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