Nursing

Self-Directed ASYMPTOMATIC STI TESTING - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/06/2017
Reviewed: 
Wed, 09/06/2017
Revised: 
Wed, 09/06/2017
Policy: 

This Student Health Center policy allows patients to order their own testing for 4 sexually transmitted infections: HIV, Syphillis, Chlamydia and Gonnorhea.  This policy includes permission for patients to order and to self-collect rectal and/or vaginal swabs for Gonnorhea and/or Chlamydia testing.  The policy reviews the RNs role in reviewing self-directed STI results.

Procedure: 

1. Student goes to the lab.

2. Swab It Bulletin Board educates students on what tests to order, when to order them, and what body parts to test.  Swab It Board refers student to SHOP or to the on-line STI Wizard site for additional education and assistance in identifying what tests are indicated.

3. Student completes lab slip indicating the tests they wish to perform.

4. Lab provides urine cup or Aptima test swabs for self-collected urine, vaginal or rectal samples.

5. Lab draws blood for HIV and/or syphillis testing.

6. RNs review Self-Directed STI lab results every morning.

7.  Students with negative test results receive secure email message with results.  Positive test results are forwarded to the Medical Director or Patient Care Coordinator who contacts the student for appropriate treatment.

Key Points: 

CDC Guidelines recommend that all women under age 26 be tested annually for chlamydia and gonnorhea.

Men who have sex with men are recommended to test every 3 to 4 months.

Santa Cruz County has seen a dramatic increase in rates of syphillis and gonnorhea.  Rectal and oropharyngeal gonnorhea rates have been rising more rapidly than genital rates.

Barriers to testing, such as requirements for a clinician visit, reduce access to needed testing.
This procedure minimizes barriers to routine testing.

Rapid diagnosis and treatment of STIs is a public health imperative. Barriers to testing remain a significant source of delayed identification and treatment of STIs, particularly HIV. The implementation of self directed at the the UCSC Student Health Center expedites timely STI Testing.

ANAPHYLAXIS EMERGENCY CARE - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Sat, 08/27/2011
Revised: 
Fri, 02/03/2017

This procedure gives the RN the delegated authority to initiate appropriate care of the patient presenting with an anaphylactic reaction. Anaphylactic reactions are rare but life threatening. The timely use of Epinephrine, Benadryl and oxygen is critical to appropriate care of the patient.
Procedure
RN assesses patient and notes evidence of anaphylaxis. Percentages noted in parenthesis indicate likelihood of having this symptom as an indicator of impending anaphylaxis.
Evidence of developing anaphylaxis includes:

ANKLE AND FOOT X-RAY ORDERS - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Sat, 08/27/2011
Revised: 
Sun, 08/28/2011

This standardized procedure uses the Ottawa Rules for x-ray of the Ankle and the Foot as guidelines to allow the RN to order x-rays prior to clinician appointment when the patient meets the established criteria. In a meta-analysis, the Ottawa Rules for x-ray of the Ankle had a 97.6% sensitivity and reduced the unnecessary use of x-rays by 34%.
Procedure
RN orders x-ray of the ankle if the patient meets the following criteria
 Bone tenderness at posterior edge or tip of the lateral malleolus OR

b.) GENERIC FORMAT FOR STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Fri, 08/19/2011
Revised: 
Thu, 10/06/2016

(developed based on CA Board of Registered Nursing, Title 16, CA Code of Regulations, section 1474)

The introduction to the Specialized Nursing Procedure section of the Nursing Manuel will specify the system by which the procedures are developed and reviewed, the criteria for periodic review, and the standards for continuing education. It will also state that all procedures are done only within the setting of the UCSC Student Health Center.

Procedure
Delineates each step in the procedure
 

a.) INTRODUCTION - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Fri, 08/19/2011
Revised: 
Tue, 05/05/2015

The following standardized procedures outline the specific situations in which a Registered Nurse (RN) at the University of California, Santa Cruz Student Health Center may provide a patient with a prescription for a medication or initiate orders for labs or x-rays. The use of these procedures is limited to the UCSC Student Health Center. These procedures may not be used in any other setting.

ANAPHYLAXIS MEDICATION KITS

Effective Date: 
Wed, 09/15/2004
Reviewed: 
Thu, 08/18/2011
Revised: 
Wed, 05/13/2015
Policy: 

Medication exchange kits are provided by pharmacy to areas outside the pharmacy, per the medical director.

Procedure: 

The pharmacy pre-prepares anaphylaxis medication exchange kits for areas outside the pharmacy.
These kits are sealed by pharmacy with break-away locks.
Once a kit has been opened and used in the Student Health Center, the nursing staff brings the open kit to the pharmacy for immediate exchange for a new kit.
This ensures that medications used in Same Day Clinic treatment are available and fully stocked at all times.
The pharmacy restocks and locks the kit and documents the nearest expiration date on the outside of the box.
Clinical staff will bill for use of Epi-Pen.

KIT LOCATIONS:
West Wing Floor 1:  Treatment Rooms, Nurses Station, Red Cart
West Wing Floor 2:  AIT, Nurse Appointments, Nurses Station, Treatment Room

 

Key Points: 
  • Exchange kits are provided throughout the SHC for urgent treatment of anaphylaxis.
  • Opened kits are returned to pharmacy for immediate replacement.

SPIROMETRY PROCEDURE

Effective Date: 
Thu, 04/01/2004
Reviewed: 
Mon, 08/29/2011
Revised: 
Fri, 10/26/2012

SUBJECT: SPIROMETRY PROCEDURE

PERSONNEL: RN, LVN, MA  currently certified and trained by the NIOSH Approved Spirometry Testing and Respiratory Surveillance Training Program

EQUIPMENT: Renaissance Spirometry System

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