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Preventive TB Procedure PURPOSE: To treat patients with inactive tuberculosis infection in order to prevent the progression to active disease EQUIPMENT: Chart, Family Data Sheet, Pre-TB Clinic Initial Patient Questionnaire, TB Program Monthly Flow Sheet, Periodic Patient Questionnaire, Pamphlets, Care Plan. PROCEDURE: 1. Preventive treatment for inactive tuberculosis infection is done either in accordance with therapy begun elsewhere, or in accordance with a decision made by the Medical Director or his designate at the Doctor’s Tuberculosis Clinic. See the procedure descriptions for the appropriate situation. 2. The public health nurses are empowered to discuss with clients the relative risks and benefits of choosing to take treatment to prevent tuberculosis. Clients who feel they understand the risks and benefits may reach their decision in conjunction with the public health nurse about whether to take preventive treatment for tuberculosis. They will need to sign the informed consent, just as they would have in Doctor’s Tuberculosis Clinic. In these cases, the appropriate paperwork, including the Pre-TB Clinic Initial Patient Questionnaire and any accompanying X-ray and laboratory results, will be presented to the Medical Director or his designate for a consultation regarding preventive treatment for tuberculosis. However, in this case the client does not need to be present in person for the consultation. If the client does not feel like he understands the issues adequately to make a decision, if he/she would prefer to speak to a doctor before making the decision, or if there are any issues which the public health nurse feels are beyond his/her ability to address adequately, then the client will be seen in person at the Doctor’s Tuberculosis Clinic. 2. In either situation, the patient should have a chart made up and completion of the Family Data Sheet, Pre-TB Clinic Initial Patient Questionnaire, TB Program Monthly Flow Sheet, and during the monthly medication visits, completion of the Periodic Patient Questionnaire. 3. Details of exact medications are in accordance with those ordered by the physician. The nurse distributes the medications monthly in accordance with the procedure described for monthly medication pickup. When the patient has questions which are difficult for the nurse to answer, or signs or symptoms suggestive of medication toxicity, treatment failure, or another illness which requires physician attention, the nurse will contact the physician for further instructions. 4. Generally the indications for treatment and the details of the treatment regimen are consistent with those discussed in reference (1) or more current standards. When this is not so, the Medical Director or his designate will confer with an appropriate specialist or resource to assure the treatment given is appropriate. D:\769861655.docPage 1 of 2 REFERENCE (1) American Thoracic Society (and Centers for Disease Control and Prevention), Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children, Am J Respir Crit Care Med, Volume 149, pp 1359-1374, 1994. Rev. 10/8/1999 TB/Manual/PreventiveTBProcedure.doc D:\769861655.docPage 2 of 2