TRAVEL CLINIC APPOINTMENTS - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Sat, 08/27/2011
Revised: 
Wed, 07/26/2017

UCSC Student Health Center works with the UCSC Division of Global Engagement (DGE), the UC Education Abroad Program (EAP), and with students traveling abroad outside of campus sponsored programs to prepare students for safe, healthy travel experiences. This procedure delineates the standard elements of an EAP and a non-EAP Travel Consult, both locally coordinated by UCSC DGE. It also provides the process for obtaining UC-wide EAP  and DGE coordinated travel program clearance for participation in one of these programs.

A Travel Consultation allows for reviewing and providing necessary immunizations and educating the student on appropriate health and safety concerns prior to travel abroad. Standing orders are provided which allow the nurse to send students abroad with any necessary prophylactic medications they may need. These orders include medications for malaria prophylaxis, for treatment of diarrhea or altitude sickness and the medications needed to stock a Remote Location Syringe Kit and Emergency Contraception.
 

Procedure
 

Obtaining  Clearance for EAP and Non-EAP programs coordinated by DGE

  • Students entering one of these programs are directed to complete an on-line form: the Travel Health History form specific to their program
  • The Travel Health History form is completed on-line by the student and reviewed by a UCSC Travel Nurse. All students complete the on-line Travel Health History form. The forms for EAP and non-EAP travel programs are similar with each form including a release allowing Student Health to discuss patient specific concerns with UCSC CAPs and the program manager of the specific program.  
  • Travel RN reviews the Clearance Form, comparing the form to the information available in the EMR about the student. The following sections of the student’s chart are reviewed: Diagnosis, Problem List, Appointments, Allergies, Medications, Visit notes, Lab result, Vital signs, Scanned Documents, Referrals and Immunizations. Discrepancies between the student’s Health History form and the student’s EMR must be addressed before clearance can be given.
  • For EAP Program clearance, the Travel Nurse checks the country-specific information in the current UCEAP manual for unique requirements for specific programs. These may require additional information beyond the text macros and should be included in the secure messaging system. 
  • After reviewing the Travel Clearance Form, the country specific information and the EAP program specific information, the RN generates a secure message to the student using one of the prepared responses listed in the Text macro section for travel. The RN may add appropriate open text to the text macros as needed: for example, a statement about the physical demands of the specific program or unique immunization requirements for a specific country. A variety of text macro letters are available.
  • The text macro may be a general “you are cleared” message or may be country or program specific.
  • A text macro option can be used to request that the student obtain specific clearance from a physician or psychiatrist. If a student requires specific clearance from a physician or psychiatrist the text macro informs them to pick-up the necessary clearance form(s) in the Student Health Center (SHC) Medical Records Department.  The RN must leave these forms in the patient pick-up area, in Medical Records.
  • Students requiring any off campus specialist clearance must have their PCP clinician review and sign the clearance after the specialist signs.  For students with the University Insurance plan (UCSHIP) the PCP is a primary care provider at the UCSC SHC.  
  • Students requiring a specialist clearance only from a UCSC CAPs provider and are cleared by CAPs, may have the "General Practitioner" section of the clearance signed by a UCSC Travel Nurse and do not need to see a UCSC primary care clinician for sign off.  Travel Nurses at thier discretion can require a clincian visit if indicated.
  • Text macro options allow the RN to request that the student come in for immunizations, a travel clinic consult and/or a required physical exam with or without lab work.
  • The nurse completes a Travel non-appointment chart note in the EMR which documents the review of health history, any required labs, and a plan of care. This note generates the charges for this work.
  • If the Travel clearance process is not complete at this point the RN generates a “reminder” for the “Travel Clinician” as a way to keep track of those student’s still in the process of obtaining clearance.
  • When all requirements for clearance have been met it is important to remove the “reminder” from the Travel Clinician reminder list to indicate that the student has completed their clearance.
  • Some students must also obtain a Travel Health Education Certificate. They obtain this certificate when they have completed the UCEAP on-line Travel Health Education program. Their EAP materials direct them to the site to complete this program. After successful completion they must print and present their Travel Health Education Certificate. A copy of this certificate is made and scanned into the student’s EMR. The original Certificate of Completion is submitted to the University Wide EAP office. Students traveling with DGE sponsored programs are also required to complete this on-line program 
  • On completion and review of the Travel Clearance Form, some students have met the requirements for travel abroad. The RN completes the Travel Clearance form, leaves the original at patient-pick-up and scans a copy for the EMR. Particular attention should be paid to question 1D on this form (allergies and medications). It is the student’s responsibility to submit the Travel Clearance form to the University Wide EAP office or UCSC DGE, depending on their program.
  • On completion and review of the Travel Clearance Form, some students will need a Travel Consult appointment. These students receive a secure message instructing them to make an appointment.
     

Travel Consult Visit (EAP or Non-EAP)
 Students scheduled for Travel Consult should be instructed to bring a copy of their immunization records and to complete the Travel Clinic Questionnaire which inquires about immunization and current health status. Failure to bring immunization records may be a reason to reschedule the Travel Consult appointment. A Travel Consult visit starts with a review of any program specific requirements for the student’s specific travel abroad experience.
 Using the recommended on-line travel health reference and the student’s completed Travel Clinic Questionnaire, the RN generates a Country Specific Travel Consult handout which includes a country specific comprehensive risk assessment.
 RN reviews and discusses any needed immunizations. The student receives a VIS for each required immunization. Obtain signature of consent for immunizations. Provide immunization per standing order. The RN Standardized Procedure Medication List includes oral typhoid vaccine prescriptions.
 Discuss malaria risk. If there is a risk of malaria, discuss whether mosquito avoidance is adequate or if an anti-malarial prophylactic regimen is advised. Review whether the area is at risk for quinine resistant malaria. Discuss the costs and the burdens of the various anti-malarial options. Provide a script for the appropriate malaria prophylaxis program using the RN Standardized Procedure Medication List.
 Review the specifics of mosquito avoidance: mosquito nets, DEET, clothing.
 Yellow Fever: students traveling into and out of a country which has Yellow Fever may be required  to carry an official CDC/WHO Vaccine certificate. Emphasize that this certificate is as important as their passport and should be cared for in a similar manner: keep a copy in a separate location and take extra precautions to avoid losing the certificate.
 Review and discuss the risk of altitude sickness. For altitudes of 10,000 feet or more, consider providing altitude sickness medication per the RN Standardized Procedure Medication List.
 Review the recommended on-line travel health reference,  handouts for any additional risks the student may need to be aware of. Use the handouts provided to address the specific identified risks such as food and water concerns or travel to high altitudes. For locations with a moderate or high risk of traveler’s diarrhea  provide anti-diarrhea antibiotic medications if indicated using the RN Standardized Procedure Medication List.
 For very remote locations, consider supplying a Remote Location Syringe Set per the RN Standardized Procedure Medication List.
 

Experience, Training and/or Education
 Current California RN License
 Completion of UCSC Student Health Center orientation specific to this procedure
 

Evaluation of Competency
Initial Competency:  On-line Clearances

  • Observes experienced RN implementing this procedure
  • Demonstrates correct application of this procedure under direct RN supervision for a minimum of 5 clearances
  • Submits a minimum of 10 additional chart notes demonstrating correct use of the procedure to the Clinic Director for review

Initial Competency:  In-person Travel Visits

  • Observes experienced RN implementing this procedure.
  • Demonstrates correct application of this procedure under direct RN supervision for a minimum of 9 visits
  • Submits a minimum of 10 additional chart notes demonstrating correct 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 supervision required.
Clinician available as needed for questions or clarifications.
 

Criteria for Provider Consultation and Referral
 Students with severe physical or mental health problems require a clinician consult around travel planning and preparation.
 Students who are going to an area where malaria prophylaxis would require use of a medication not in the RN Standardized Procedure List.
 Any situation in which the RN assesses the student’s health or travel plans would benefit from a clinician consultation.
 

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