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Travel Medicine Orders for International Travel - Adult/Pediatric - Ambulatory [66]

Travel Medicine Orders for International Travel - Adult/Pediatric - Ambulatory [66] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols



Delegation Protocol Number: 66

Delegation Protocol Title:
Travel Medicine Orders for International Travel - Adult/Pediatric - Ambulatory

Delegation Protocol Applies To:
UW Health Travel Medicine Clinic, General Pediatric and Adolescent Clinic

Target Patient Population:
Any UW Health adult or pediatric patient who is being seen in preparation for international travel.

Delegation Protocol Champions:
David Andes, MD – Department of Medicine – Infectious Disease
Greg Landry, MD – Department of Pediatrics

Delegation Protocol Workgroup:
CNS - Infectious Disease & Immunology
RN - General Pediatric and Adolescent, University Station
RN - Infectious Disease & Immunology

Responsible Departments:
Department of Medicine, Division of Infectious Disease
Department of Pediatrics

Purpose Statement:
To delegate authority from the covering Infectious Disease provider to registered nurses (RNs) in the Travel
Medicine Clinic or to delegate authority from the patients Primary Care Provider to registered nurses (RNs) in
the General Pediatric and Adolescent Clinic to order prophylactic medications and immunizations indicated for
international travel.

Who May Carry Out This Delegation Protocol:
Registered nurses (RNs) in the UW Health Travel Medicine Clinic and the UWHC General Pediatric and
Adolescent Clinic who have been trained and demonstrate proficiency with the delegated activities and have
been trained in the use of this delegation protocol.

Guidelines for Implementation:
1. This protocol is activated when patient presents to the Travel Clinic or UWHC General Pediatric and
Adolescent Clinic in preparation for international travel.
2. RN will obtain information from patient regarding travel destination(s) (country/countries, length of stay,
rural versus urban), and information regarding the patient’s health history, previous immunizations, and
current medications.
3. RN will review patient information, including medication reconciliation and allergies, before administering
any immunizations or ordering any medications for patients. If there are any questions about medication
compatibility, allergies, or patient’s ability to tolerate recommended immunizations or prophylactic
medications, travel medicine provider will be contacted before administering any immunizations or entering
medication orders.
4. RN will follow recommendations made according to commercial travel clinic advice database chosen by
UWHC. Recommendations are based on travel itinerary, patient age, and health status. This database
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

compiles information from CDC and WHO regarding current travel recommendations for preparatory
immunizations, prophylactic medications and health risks.
5. RN will identify immunization needs, order and administer vaccines according to Vaccine Information
Statement, guidelines and following UWHC Ambulatory Protocol #56, Ambulatory Immunization Procedures.
Patient may decline any recommended immunizations. Refusal should be documented in the patient’s
clinical record.
5.1. Usual immunizations include routine (MMR, Tdap, polio) and influenza, hepatitis A and B, typhoid (both
live and inactivated), meningitis and yellow fever. Some patients may require Japanese encephalitis
depending on destination and duration of stay, and rabies immunization may also be considered when
traveling to an area where exposure to animals which carry rabies is likely. Infants under 1 year of age
and pregnant women may require hep A immunoglobulin.
6. RN will recommend and order prophylactic medications based on travel clinic database recommendations
based on patient risk. Patient may decline any prophylactic medications. Refusal should be documented in
the patient’s clinical record.
6.1. Malaria prophylaxis includes atovaquone/proguanil, chloroquine (there is significant resistance in many
parts of the world), doxycycline, and mefloquine.
6.2. Other prophylactic medications and supplies that may be ordered include antibiotics for the prevention
of traveler’s diarrhea, including ciprofloxacin (if greater than 18 years of age) or azithromycin
depending on area of travel (advice per travel clinic advice database), and rifaxamin (if greater than 12
years of age). Loperamide and/or bismuth subsalicylate will also be ordered when antibiotics are
prescribed.
6.3. If patient is traveling to an area where HIV is prevalent and has concern for exposure (health care work,
etc.), PrEP (Pre Exposure Prophylaxis) or PEP (Post Exposure Prophylaxis) the staff will review the travel
clinic advice database and CDC guidelines and consult with the physician prior to ordering prescriptions.
6.4. Additional medications and supplies that may be ordered, depending on location of travel and patient’s
health history, may include scopolomine transdermal patch, acetazolamide, or dexamethasone for
acute mountain sickness, and thromboembolic deterrent stockings.
7. RN will also provide teaching based on patient’s risks while traveling, according to software
recommendations.
8. Immunocompromised patients (e.g. post transplant, HIV/AIDS) and patients who have serious underlying
medical conditions or contraindications to recommendations will be reviewed with travel medicine provider
before administering any immunizations and or entering any medication orders. Patients who are pregnant,
planning to become pregnant or nursing are advised according to travel clinic advice database
recommendations.
9. Patient will be given an International Certificate of Vaccine or Medical Contraindication as required for
travel, completed with appropriate documentation if yellow fever vaccine is given. All other patients receive
a copy of their updated Wisconsin Immunization Registry.
10. Antibody testing for hepatitis A and B, rubeola, rubella, mumps, and rabies, and urine pregnancy may be
performed prior to ordering of vaccines, based on recommendations in travel clinic advice database. Orders
for these labs will be sent for provider cosignature.

References:
1. Shoreland Travax®. Travax.com, 2014. Accessed April 25, 2014
2. Centers for Disease Control and Prevention. Travelers’ Health. http://wwwnc.cdc.gov/travel/. Accessed
April 25, 2014.
3. World Health Organization. www.who.int. Accessed April 25, 2014
4. International Society of Travel Medicine: www.istm.org. Accessed April 25, 2014
5. U.S. Department of State: www.travel.state.gov. Accessed April 25, 2014

Collateral Documents/Tools: NA
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Approved By:
UW Health Ambulatory Protocol Committee: January 2012, *February 2014
UWHC Antimicrobial Use Subcommittee: January 2012, *September 2014
UWHC Pharmacy and Therapeutics Committee: January 2012, *September 2014
UWHC Medical Board: February 2012, *September 2014
UW Health Chief Ambulatory Medical Officer: February 2012, *September 2014

Effective Date: September 2014

Scheduled for Review: September 2016
* Expedited Approval Process
141105 – Updated delegating provider for Infectious Disease Clinic reflecting changes to workflow.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org