MEDICAL ASSISTANT STANDING ORDERS FOR PLACEMENT OF TUBERCULIN SKIN TEST (TST)

Effective Date: 
Wed, 09/02/2015
Reviewed: 
Mon, 10/03/2016
Revised: 
Wed, 12/21/2016
Policy: 

Purpose:  Expanding access to Tuberculosis skin testing supports the UCSC SHC Communicable Disease Screening Policy.  This includes screening of UCSC SHC staff under the Employee Health Screening criteria, as well as students that present for screening for tuberculosis for a number of reasons.  

Policy:  Under this Standing Order from the medical director, MAs who have successfully completed  the UCSC SHC TST placement training, may place tuberculin skin  tests (TST)  provided the patients and/or staff meet the following criteria:

 1.  Are required to receive this screening under the UCSC SHC Employee Health Communicable Disease Screening policy requirements
 2.  For students:  Meets the guidelines under the UCSC SHC Clinical Guidelines :Tuberculosis Testing

(see attached links).

Under this standing order, the medical director delegates the authority to supervise the MA to place TST to MDs, DOs, registered nurses, pharmacists, physician assistants and nurse practitioners.

TST may be placed by an MA only when there is a physician or advanced practice provider (NP, PA) on the premises of the Student Health Center.

Procedure: 

1.  Employee or student completes the TB Screen and Test form HC:330. (For students this questionnaire can be completed on-line and populates the EHR note using the Health e-Communicator secure messaging system.)
2.  The MA reviews the form to verify no prior positive TST or other active risk factors.  If prior history of positive TST or other positive risk factors, an RN or clinician is consulted for next steps.  If the patient is a UCSC SHC employee, the MA consults the Employee Health Nurse or designee.  No TST is to be placed on anyone with a history of previous positive TST. 
3.  If there are no contraindications the MA draws up 0.1cc of Tubersol.  In every instance the MA, prior to administration of the tuberculin skin test, must present the vial of Tubersol to a Registered Nurse, pharmacist, physician, physician assistant or nurse practitioner to verify the correct medication and dosage. 

4.  After verification, the MA cleans inner aspect of the patient's forearm, and injects intradermally, needle bevel up, creating a small wheal. Procedure is repeated in another location if no wheal is noted.
5.  Safety mechanism is activated, syringe is discarded in sharps container.
6.  The patient is notified that the test results need to be read in 48 to 72 hours by a SHC nurse.
7.  The MA documents test placement in the medical record per protocol