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.

Procedure
Students requesting asymptomatic STI testing are directed to the lab for self-directed STI testing. They are encouraged to complete the on-line STI Risk Assessment tool called STI Wizard, available through a link on the front page of the UCSC Student Health Center website, healthcenter.ucsc.edu. Completion of the on-line STI Risk Assessment tool is recommended before testing to assist the patient to order the appropriate tests, from the appropriate body parts, after appropriate waiting times for accurate testing.   Students requesting educaiton on STIs and STI risk reduction should be referred to SHOP.

Students needing a throat culture for gonnorhea can be seen by a nurse for throat swabbing.

Reviewing and Responding to STI Test Results:
 RN reviews STI Test results ordered through  the self-directed testing system daily.
 Positive STI results are referred to the Medical Director or Patient Care Coordinator for notification and treatment.  The RN does not acknowledge these result.  The provider assuming responsibility for notification and treatment is responsible for acknowledging the result and for completing the appropriate CMR.
 A priority secure message is sent to the Medical Director or Patient care Coordinator notifying them of a positive STI result.
 In the absence of both the Medical Director and the Patient Care Coordinator, the DOC is responsible for same day notification of positive STI results.
 Students are notified of negative or normal STI test results using the secure messaging system and standardized text macro messages.
 The RN acknowledges negative or normal STI lab test results in the EMR.
 Students who are getting STI testing more than every six weeks will be encouraged to see a clinician for comprehensive risk evaluation and education.

Experience,Training and/or Education
 Current CA RN license
 Completion of UCSC RN orientation specific to this procedure and on-going training programs.
 Completion of the on-line STI risk assessment tool.

Evaluation of Competency
Initial Competency

 Observes experienced RN implementing this procedure.
 Demonstrates successful use of this procedure under direct RN supervision at least three times.

 Submits a minimum of 5 chart notes demonstrating use of the procedure to the Clinic Director for review.

On-going Competency
Chart reviews of this procedure occur as part of the on-going Quality Assurance program of the UCSC Student Health Center.

Scope of Supervision
No direct clinician supervision.
Clinicians available as needed for consultation and referral.
 

Criteria for Provider Consultation & Referral
 Students with symptoms.
 Students with complex issues.
 Students who are presenting as a known contact of someone with an STI.
 Students who request hepatitis or herpes testing.
 Students who are victims of sexual assault,
 Students who have requested STI testing more than every six weeks should be referred to a provider.

Documentation
RN documents according to the standards delineated in the UCSC Student Health Center Policy on Documentation of Care.