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Tuberculin (TB) Skin Test Ordering – Adult/Pediatric – Ambulatory [92]

Tuberculin (TB) Skin Test Ordering – Adult/Pediatric – Ambulatory [92] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols




Delegation Protocol Number: 92

Delegation Protocol Title:
Tuberculin (TB) Skin Test Ordering - Adult/Pediatric - Ambulatory

Delegation Protocol Applies To:
UW Health Clinics

Target Patient Population:
Adult and pediatric patients

Delegation Protocol Champions:
Sandra Kamnetz, MD - Department of Family Medicine
Gail Allen - MD, Department of Pediatrics
Elizabeth Trowbridge, MD, Department of Medicine
Nasia Safdar, MD – Department of Medicine, Infectious Disease

Delegation Protocol Reviewers:
Kimberly Zielke, MSN, RN – Interim Manager, Clinical Staff Education
Eve Christoffersen, RN – Clinical Staff Education

Responsible Department:
Clinical Staff Education

Purpose Statement:
To delegate authority from the provider managing the patient’s care in the ordering department to Registered
Nurses (RNs), Licensed Practical Nurses (LPNs) or Medical Assistants (MAs) to verify patient status regarding the
need for tuberculin bacillus (TB) testing and to enter an order for the purified protein derivative (PPD) skin test.

Who May Carry Out This Delegation Protocol:
RNs, LPNs, and MAs who have successfully completed training in the use of this delegation protocol.

Guidelines for Implementation:
1. This protocol is initiated by a scheduled office visit or Allied Health/Nurse visit where the patient requests
tuberculin (TB) screening for school, work, camp, residential placement or volunteer work.
2. The RN, MA, or LPN will review the patient’s medical record and interview the patient to determine if the
patient has ever had a positive TB test, received a live virus vaccine within the last 30 days or has current
prescriptions for TB medications. If the patient is positive for any of these items the protocol will no longer
apply and RN, MA, or LPN will consult with the provider prior to placing any orders. If the patient answers
“No” to all screening questions the RN, LPN or MA may order the PPD using the TB Screening Smart Set to
place the order and document the screening.
3. RN, LPN or MA will place and read the PPD in accordance with the appropriate TB skin test placement and
reading policy.

Order Mode:
Medications: Protocol/Policy, Without Cosign
Non-Medications: Cosign Required, Protocol/Policy
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org


References:
1. Centers for Disease Control and Prevention. Tuberculin Skin Testing. Updated September 1, 2012.
http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm. Accessed March 21, 2016.

Collateral Documents/Tools:
1. University of Wisconsin Medical Foundation/Department of Family Medicine. MF TB Skin Test
Placement/Reading Policy. Effective Date: April 2015.
https://uconnect.wisc.edu/servlet/Satellite?cid=1121383634502&pagename=B_EXTRANET_UWHC_POLICIE
S%2FFlexMember%2FShow_Policy&c=FlexMember. Accessed November 6, 2013
2. University of Wisconsin Hospital and Clinics. UWHC Patient Care Policy 12.50 Ambulatory Tuberculin Bacillus
(TB) Skin Testing Procedures. Effective Date September 19, 2012.
https://uconnect.wisc.edu/servlet/Satellite?cid=1126666231980&pagename=B_EXTRANET_UWHC_POLICIE
S%2FFlexMember%2FShow_Policy&c=FlexMember. Accessed November 6, 2013.
3. UW Health. TB Test Health Link Document. March 2013. https://uconnect.wisc.edu/growth/training--
education/health-link/10-minutes/immunization/ . Accessed March 21, 2016.
4. Smart Set: TB SCREENING [205]
5. Smart Text: PPD SCREENING QUESTIONS/PLACEMENT DOCUMENTATION [32938]

Approved By:
UW Health Ambulatory Protocol Committee: November 2013, April 2016 (expedited review)
UWHC Pharmacy & Therapeutics Committee: January 2014, April 2016 (expedited review)
UWHC Medical Board: January 2014, April 2016 (expedited review)
UW Health Chief Medical Officer: January 2014, April 2016 (expedited review)

Effective Date: April 2016

Scheduled for Review: April 2019


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org