How to Track Hepatitis B and Titer

If you haven't already done so, please read How to Set Up A Visit Category Protocol,Medical Activity and Result Codes Overview, Immunizations and Surveillance Overview before continuing!

Summary

This topic explains how to document:

  • Three doses of the HBV vaccine

  • The blood draw for the titer

  • The titer results

  • A booster shot if needed

  • Re-administration of the HBV three doses, if needed

To complete this procedure properly, it is essential that you understand medical activity and result codes and are clear that all doses of the Hep B vaccine (or any vaccine for that matter) are documented using the same medical activity code, with different result codes. The titer is documented with a separate code, typically HBsAb. You should also be clear about the standard result codes included in the software, and note that the proper result codes for titers must be used or your reports about immunity status (such as needed in the threat of an outbreak) will be inaccurate.

To have the software automatically set up a tickler for the titer, you must set up the Hep B vaccination to have FOUR steps, not three. This is the standard "out of the box" setup in the software. When you enter the third Hep B dose, the software automatically calculates the Next Due Date Date the employee is due for a particular medical activity (tickler) for one month. What is due on that date, however, is the blood draw for the titer. When the employee arrives for the titer draw, you CHANGE the Hep B result code User-definable code that indicates the status of a particular medical activity. For example, a result code of 1 may indicate the first dose of a multi-dose immunzation, or it may indicate a PPD was placed but not yet read. from 3, meaning the third dose has been given, to C, meaning "Complete". (This is a part you must remember, unless you set up a visit protocol for immunizations, which is explained below.) You also add the titer to the record, with a result code of 1, meaning the blood has been drawn.

The benefit of this approach, even though it requires that you remember to change the last Hep B dose, is that you can have a single letter to remind employees of their Hep B or Titer: one letter, written appropriately, will cover both situations.

If you have set up the Hepatitis B Vaccine to include a 4th step for the titer, your reminder letter should include the following sentence or something similar: "If you have received this letter and have already had 3 doses of the Hepatitis B immunization, this is a reminder notice to have the blood draw for the titer." That way, you can run the entire Hep B program with a single letter and you won't need to remember to send letters for the titer -- they will come out with the letters for regular doses.

The following example demonstrates how to record a 3-dose hepatitis B vaccine series and a follow-up titer. When completed, you will create four different software visits: three for the HBV and one for the titer blood draw.

What Do You Want To Do?

Set up the Hep B vaccination

Document the Hepatitis B Vaccine

  1. Log the visit as usual.
  2. On the [Enter Visit] window, be sure to enter the Clinician who is administering the HBV.
  3. Mark the appropriate Status field for the visit. (e.g. Completed)
  4. Click the Charges button.
  5. Click the Add button.
  6. Select the RESULTS tab.
  7. In the Activity Code field, enter "HBV" or whatever your code is for the Hepatitis B vaccine. Press the TAB key twice.
  8. Type in one of the following codes, as appropriate:
    • 1 Dose 1 (Day 0)
    • 2 Dose 2 (Month 1)
    • 3 Dose 3 (Month 6)
  9. Click the DOSE tab and enter the dosage information

You can set up the dosage information one time, then just add the Lot number and Expiration date. See Medical Activity Drug Dosage Tab.

  1. Optionally, include a brief summary in the Summary field (20 characters)

To override the next due date, if needed to get the employee on the proper schedule after a late dose, enter the new date in the Next Due Date field. the program will automatically check the Override? box to indicate the calculated date has been overridden manually.

  1. Click the Charting button to add notes if needed.

  2. Click OK. At this point, the program will calculate the Next Due Date the employee is due for a particular medical activity automatically. If you re-open the HBV record, you will see it.

If you entered 3, the Next Due Date that the software calculates will be the date the employee needs to return for the titer draw.

  1. Click Close, then OK.

Document the Titer Draw

  1. From the Home Nav Bar click Check-In. (If you have the Appointment Calendar, drag and drop the Appointment record and skip to step 7).
  2. Using the Select Employee Dialog Box or the Select Employee Lookup List, find the employee for whom you are documenting an incident. (If the Employee is not already in the database, see Adding an Employee Manually.)
  3. If visit is not scheduled: Click Log A New Walk In Visit. OR If the visit is scheduled:
    • Click Search the Schedule then
    • Locate and double click the correct Schedule record.
  4. Verify the visit date, the Start time and, if you are tracking, the Completion Time are correct, typing over incorrect entries, pressing the TAB key to move among the fields.
  5. In the Category field, type the code of the visit category you want, OR using the table icon to the right of the Category field, search for and select the desired visit category.
  6. Enter the Clinician who is doing the blood draw.
  7. Mark the appropriate Status field for the visit. (e.g. Completed)
  8. Click the Charges button.
  9. Click the Add button.
  10. In the Activity Code field, enter "HBsAb" or whatever your code is for the titer. (Just enter the letters and don't worry about the caps. The field is not case-sensitive). Press the TAB key twice.
  11. Select the RESULTS tab.
  12. Click the down arrow to the right of the Result Code field and select the choice for "Draw".

If this choice is not available, the titer is not set up properly. To set it up properly, see medical activity result code setup. Do not change any other result codes that have been set up, as it may mess up your history if you have been using the software a while.

  1. Optionally, include a brief summary in the Summary field (20 characters)

  2. Click the Charting button to add notes if needed.

  3. Click OK.

Document the Titer Result

  1. On the Home Nav Bar, click View Chart button.
  2. Enter the Last and First Name or SSN and click OK.
  3. On the [View Employee Chart] window,click the CLINICAL RESULTS tab, then the ALL ACTIVITY HISTORY tab.
  4. You will see all medical activities entered on all visits, in reverse date order (most recent at the top.)
  5. Find and highlight the recent titer draw.
  6. Click Change, to open the activity results record.
  7. Click the down arrow to the right of the Result Code field.
  8. Select the appropriate titer result
  9. If desired, write the result (immune, susceptible, etc.) OR the titer value in the Summary field.
  10. Click OK then Close to return to the Home Nav Bar.

Document a Booster Dose

Follow all instructions for documenting the Hep B. Vaccine. However, instead of choosing a Result Code of 1, 2 or 3, select B for Booster dose. The Booster dose will not calculate a Next Due Date.

Document Re-Administering the Hepatitis B Vaccine

Simply follow the instructions for documenting the Hepatitis B. Enter a Result Code of 1 on the first dose, and the program will calculate the Next Due Date appropriately.

Be sure to read about How to Set Up A Visit Category Protocol, particularly the section on setting up a visit protocol for your Immunizations or Routine Surveillance Visit Category. The notes on the Encounter Form can remind you when drawing the titer, to change the Hep B final dose result code toC.

COMMON MISTAKES

The most common mistake made with hepatitis B tracking is creating separate medical activities in the software for each dose. Each step should be documented using the same activity with different Result Codes. If you create separate activity codes for each step, the program will NOT be able to accurately track patient status and the Next Due Date.