Tuberculosis Case/suspect Review Form (Page 2 of 2) in pdf

BACKGROUND/OBJECTIVE: All TB suspects/cases whether public or private are case managed by the local health department,

usually by a PHN. Monitoring various patient parameters is essential to this public health case management. Use of this form is

intended to organize this management process. DTC asks that the case manager use this form for the two and eight month patient/

record reviews, to help organize and document the presentation process. Further it will allow for educational discussion. Feedback

and/or use of this form by nursing supervision may be helpful if used in conducting patient management/record audits. Improved

patient and program outcomes are the objective.

INSTRUCTIONS FOR USE:

Number spacing is intended for Division of TB Control (DTC), Central Office.

At two months following the patient’s report to the LHD the case manager has completed much of the information, providing a comment

for each field as possible.

At the eight-month conference the patient will likely have completed therapy, therefore the case manager will likely have the form

completed allowing for a thorough case review.

SPUTUM INFORMATION: Always use collection dates!

Smear Conversion: Many patients are initially sputum smear positive, then as specimens are reported smear negative, consecutively, and

following the initiation of anti-tuberculous medication.

Smear Conversion date: The collection date of the first consecutively negative sputum smears in a previously sputum smear positive

patient and following the initiation of anti-tuberculous medication.

Weeks to smear conversion: Count the number of weeks for a sputum smear positive patient to convert to sputum smear negative,

following the initiation of anti-tuberculous medications.

*** First smear positive sputum collection date MINUS first consecutively smear negative sputum collection date

(following start of anti-tuberculous therapy) = TIME TO CONVERSION (document in number of weeks). ***

*** Do not report a smear as positive if the associated culture is negative***

Culture Conversion: Same as smear but pertains to culture.

Provide name of laboratory used for bacteriology. It is helpful to provide phone number and contact person as well.

ALL TB suspects/cases in Virginia will initially be started on IRPE (report as “RIPE”). The standard of care is directly observed therapy

(DOT). Adherence for any period should not be below 80%. Obtain patient’s weight at initiation of therapy and assess if dose

appropriate.

All initial isolates of M. tuberculosis should be tested for antibiotic susceptibility. Drug regimen is usually modified once these results are

available. If the isolate is fully susceptible, Ethambutol can usually discontinued.

Repeat susceptibility testing in patients who fail to respond to treatment or in whom cultures fail to convert to negative after 2 months of

therapy. If resistance to one or more components of the regimen is present and particularly if resistant to both INH and Rifampin

consultation with DTC’s medical director is advised.

Provide initial patient subjective and objective information, i.e. patient symptoms, chest x-ray, initial treatment plan, and infection control

issues. Then at time of two month case review, having reviewed the patient’s clinical progress, be prepared to provide follow up clinical

information and note any changes in treatment plan.

Management Plan: The plan will be discussed at the central office case review.

Contacts: Only appropriate contacts identified are reported during the case review. This those contacts to smear positive cases.

Note if any contacts are age 4 or younger, and/or those persons who are immunosuppressed.

Report outcomes of contact evaluation and TST testing.

Case closures: Medication completion date or patient disposition is necessary at the eight-month conference. 1) If a patient moves to

another Virginia locality, the case manager transfers the patient information to that district and notifies DTC by e-mail of the transfer

along with a forwarding address. DTC will make changes to database registry. 2) If a patient moves to another state or country, the case

manager notifies DTC as soon as possible so an interstate notification can be sent to the next jurisdiction. The district provides the

forwarding address along with complete and appropriate patient information required for adequate patient follow-up. 3) Only if a patient

moves with an unknown address is the case is closed as “lost”.

Tuberculosis Case/suspect Review Form Page 2

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