How to Document TB Skin Tests and TST+ Questionnaires

If you haven't already done so, please read the Overview of Managing TB Surveillance prior to entering TB skin tests, and review the TB skin test Result Codes.

A single-step TB skin test has two steps in the software: (1) Place and (2) Read; documentation includes two visit records.

A two-step TB skin test has four steps in the software: (1) Place (2) Read (3) Place (4) Read; documentation includes four visit records.

If an employee is hired in positive for TB skin tests, youmustenter a TB skin test with a+result code in their New Hire Physical record. You can make a note in theSummaryfield for the medical activity that the employee wasHired in positive.If you fail to do this, the employee will show on all reports as requiring a TB skin test, since the program is (most often) set up to require TB skin tests.

What Do You Want To Do?

Starting from the Home Nav Bar:

  • Document a Single-Step TB skin test

    Record the placement of a single-step TB skin test

    1. From the Home Nav Bar click Check-In.

    2. Using the Select Employee Dialog Box or the Select Employee Lookup List, find the desired employee. (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.

    1. Verify that the visit date and start time are correct, typing over incorrect entries, then press the TAB key.

    2. In the Category field, type the code of the visit category for TB skin test Place or Read visits, OR using the table icon to the right of the Category field, search for and select the correct visit category.

    3. Complete the Provider or Clinician field(s).

    4. Click the Results button.

    5. Click the Add button. [Visit Results]

    6. Search for and select the TB skin test medical activity and press the TAB key twice.

    7. Enter 1, or click the down arrow to the right of the Result Code field and select 1.

    8. Press the TAB key on your keyboard.

    9. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    10. The program automatically calculates the Next Due Date. To enter a different date, simply type over the existing date, and the program will automatically check the Override? box.

    11. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who placed the TB skin test.

    12. If you are tracking the lot number and other details, click the DOSE tab and enter the required information. (See Medical Activity Drug Dosage Tab to have the software enter the standard dose, unit measurement and drug company automatically. You then just add the lot number, expiration date and injection site.)

    13. Click OK, then Close to return to the [Enter Visit] window.

    14. Mark the visit Completed.

    15. ClickOKto close the visit record and return to the Home Nav Bar.

    Record the reading of a single-step TB skin test

    1. From the Home Nav Bar click Check-In.

    2. Using the Select Employee Dialog Box or the Select Employee Lookup List, find the desired employee. (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.

    1. Verify that the visit date and start time are correct, typing over incorrect entries, then press the TAB key.

    2. In the Category field, type the code of the visit category for TB skin test Place or Read visits, OR using the table icon to the right of the Category field, search for and select the correct visit category.

    3. Complete the Provider or Clinician field(s).

    4. Click the Results button.

    5. Click the Add button. [Visit Results]

    6. Search for and select the TB skin test medical activity and press the TAB key twice.

    7. Enter the appropriate result code ORclick the down arrow to the right of the Result Code field. [ and select the appropriate result code:

      • If the TB skin test is non-reactive

        • Enter or select - and press the TAB key.

        • Record the induration.

        • If the TB skin test is non-reactive, the program will automatically calculate the Next Due Date according to the rules set up for TB skin tests. If a different date is needed, (perhaps to get an employee back on a schedule if he or she was late for their TB skin test this year), simply type it over the existing date.

      • If the TB skin test is reactive

        • Enter or select + and press the TAB key.

        • Record the induration.

        • If the employee converted while working for your hospital, check the box Conversion Occurred? Otherwise, leave the box unchecked.

        • If the TB skin test is reactive, it will not be repeated so no Next Due Date will be displayed in that field.

        • If a conversion occurred, you will need to document an Incident so that the conversion will display on your OSHA log.

    8. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    9. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who read the TB skin test.

    10. Click OK, then Close to return to the [Enter Visit] window.

    11. Mark the visit Completed.

    12. ClickOKto close the visit record and return to the Home Nav Bar.

  • Document A Two-Step TB skin test

    Record the first placement of a two-step TB skin test

    1. From the Home Nav Bar click Check-In.

    2. Using the Select Employee Dialog Box or the Select Employee Lookup List, find the desired employee. (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.

    1. Verify that the visit date and start time are correct, typing over incorrect entries, then press the TAB key.

    2. In the Category field, type the code of the visit category for TB skin test Place or Read visits, OR using the table icon to the right of the Category field, search for and select the correct visit category.

    3. Complete the Provider or Clinician field(s).

    4. Click the Results button.

    5. Click the Add button. [Visit Results]

    6. Search for and select the TST medical activity and press the TAB key twice.

    7. Enter 1, or click the down arrow to the right of the Result Code field and select 1.

    8. Press the TAB key on your keyboard.

    9. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    10. The program automatically calculates the Next Due Date. To enter a different date, simply type over the existing date, and the program will automatically check the Override? box.

    11. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who placed the TB skin test.

    12. If you are tracking the lot number and other details, click the DOSE tab and enter the required information. (See Medical Activity Drug Dosage Tab to have the software enter the standard dose, unit measurement and drug company automatically. You then just add the lot number, expiration date and injection site.)

    13. Click OK, then Close to return to the [Enter Visit] window.

    14. Mark the visit Completed.

    15. ClickOKto close the visit record and return to the Home Nav Bar.

    Record the first reading of a two-step TB skin test

    1. From the Home Nav Bar click Check-In.

    2. Using the Select Employee Dialog Box or the Select Employee Lookup List, find the desired employee. (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.

    1. Verify that the visit date and start time are correct, typing over incorrect entries, then press the TAB key.

    2. In the Category field, type the code of the visit category for TB skin test Place or Read visits, OR using the table icon to the right of the Category field, search for and select the correct visit category.

    3. Complete the Provider or Clinician field(s).

    4. Click the Results button.

    5. Click the Add button. [Visit Results]

    6. Search for and select the TB skin test medical activity and press the TAB key twice.

    7. Enter the appropriate result code OR click the down arrow to the right of the Result Code field, and select the appropriate result code:

      • If the TB skin test is non-reactive

        • Enter or select 2 and press the TAB key.

        • Record the induration, if any

        • the program will automatically calculate the Next Due Date according to the rules set up for TSTs. If a different date is needed, simply type it over the existing date.

      • If the TB skin test is reactive

        • Enter or select + and press the TAB key.

        • Record the induration.

        • If the employee converted while working for your hospital, check the box Conversion Occurred? Otherwise, leave the box unchecked.

        • If the TB skin test is positive, it will not be repeated so no Next Due Date will be displayed in that field.

    8. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    9. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who read the TB skin test.

    10. Click OK, then Close to return to the [Enter Visit] window.

    11. Mark the visit Completed.

    12. ClickOKto close the visit record and return to the Home Nav Bar.

    Record the second placement of a two-step TB skin test

    1. From the Home Nav Bar click Check-In.

    2. Using the Select Employee Dialog Box or the Select Employee Lookup List, find the desired employee. (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.

    1. Verify that the visit date and start time are correct, typing over incorrect entries, then press the TAB key.

    2. In the Category field, type the code of the visit category for TB skin test Place or Read visits, OR using the table icon to the right of the Category field, search for and select the correct visit category.

    3. Complete the Provider or Clinician field(s).

    4. Click the Results button.

    5. Click the Add button. [Visit Results]

    6. Search for and select the TB skin test medical activity and press the TAB key twice.

    7. Enter 3, or click the down arrow to the right of the Result Code field and select 3.

    8. Press the TAB key on your keyboard.

    9. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    10. The program automatically calculates the Next Due Date. To enter a different date, simply type over the existing date, and the program will automatically check the Override? box.

    11. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who placed the TB skin test.

    12. If you are tracking the lot number and other details, click the DOSE tab and enter the required information. (See Medical Activity Drug Dosage Tab to have the software enter the standard dose, unit measurement and drug company automatically. You then just add the lot number, expiration date and injection site.)

    13. Click OK, then Close to return to the [Enter Visit] window.

    14. Mark the visit Completed.

    15. ClickOKto close the visit record and return to the Home Nav Bar.

    Record the second reading of a two-step TB skin test

    1. From the Home Nav Bar click Check-In.

    2. Using the Select Employee Dialog Box or the Select Employee Lookup List, find the desired employee. (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.

    1. Verify that the visit date and start time are correct, typing over incorrect entries, then press the TAB key.

    2. In the Category field, type the code of the visit category for TST Place or Read visits, OR using the table icon to the right of the Category field, search for and select the correct visit category.

    3. Complete the Provider or Clinician field(s).

    4. Click the Results button.

    5. Click the Add button. [Visit Results]

    6. Search for and select the TST medical activity and press the TAB key twice.

    7. Enter the appropriate result code ORclick the down arrow to the right of the Result Code field. [ and select the appropriate result code:

      • If the TST is non-reactive

        • Enter or select - and press the TAB key.

        • Record the induration.

        • If the TST is non-reactive, the program will automatically calculate the Next Due Date according to the rules set up for TSTs. If a different date is needed, (perhaps to get an employee back on a schedule if he or she was late for their TST this year), simply type it over the existing date.

      • If the TST is reactive

        • Enter or select + and press the TAB key.

        • Record the induration.

        • If the employee converted while working for your hospital, check the box Conversion Occurred? Otherwise, leave the box unchecked.

        • If the TST is reactive, it will not be repeated so no Next Due Date will be displayed in that field.

    8. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    9. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who read the TST.

    10. Click OK, then Close to return to the [Enter Visit] window.

    11. Mark the visit Completed.

    12. ClickOKto close the visit record and return to the Home Nav Bar.

Starting from the Appointment Calendar:

  • Document A Single-Step TB skin test

    Record the placement of a single-step TB skin test

    1. Highlight the appointment record for the visit you want to log. You can do this either in the time slot (e.g. 3:20 for Dr. Jones) or in the [Appointment Details] pane.

    2. Drag the appointment record to the Today's Visits button on the calendar. When the cursor changes into an arrow, release the mouse button. the program will open the [Enter Visit] window.

    • Note that the visit details (visit category, provider, start time) are filled in from the schedule record. Be sure to override the Start time of the visit if the patient was late!

    1. Click the Results button.

    2. Click the Add button. [Visit Results]

    3. Search for and select the TB skin test medical activity and press the TAB key twice.

    4. Enter 1, or click the down arrow to the right of the Result Code field and select 1.

    5. Press the TAB key on your keyboard.

    6. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    7. The program automatically calculates the Next Due Date. To enter a different date, simply type over the existing date, and the program will automatically check the Override? box.

    8. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who placed the TB skin test.

    9. If you are tracking the lot number and other details, click the DOSE tab and enter the required information. (See Medical Activity Drug Dosage Tab to have the software enter the standard dose, unit measurement and drug company automatically. You then just add the lot number, expiration date and injection site.)

    10. Click OK, then Close to return to the [Enter Visit] window.

    11. Mark the visit Completed.

    12. ClickOKto close the visit record and return to the Appointment Calendar.

    Record the reading of a single-step TB skin test

    1. Highlight the appointment record for the visit you want to log. You can do this either in the time slot (e.g. 3:20 for Dr. Jones) or in the [Appointment Details] pane.

    2. Drag the appointment record to the Today's Visits button on the calendar. When the cursor changes into an arrow, release the mouse button. the program will open the [Enter Visit] window.

    • Note that the visit details (visit category, provider, start time) are filled in from the schedule record. Be sure to override the Start time of the visit if the patient was late!

    1. Click the Results button.

    2. Click the Add button. [Visit Results]

    3. Search for and select the TB skin test medical activity and press the TAB key twice.

    4. Enter the appropriate result code OR click the down arrow to the right of the Result Code field, and select the appropriate result code:

      • If the TB skin test is non-reactive

        • Enter or select - and press the TAB key.

        • Record the induration, if any

        • the program will automatically calculate the Next Due Date according to the rules set up for TB skin tests. If a different date is needed, simply type it over the existing date.

      • If the TB skin test is reactive

        • Enter or select + and press the TAB key.

        • Record the induration.

        • If the employee converted while working for your hospital, check the box Conversion Occurred? Otherwise, leave the box unchecked.

        • If a conversion occurred, you will need to document an Incident so that the conversion will display on your OSHA log.

        • If the TB skin test is reactive, it will not be repeated so no Next Due Date will be displayed in that field.

    5. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    6. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who read the TB skin test.

    7. Click OK, then Close to return to the [Enter Visit] window.

    8. Mark the visit Completed.

    9. ClickOKto close the visit record and return to the Appointment Calendar.

  • Document A Two-Step TB skin test

    Record the first placement of a two-step TB skin test

    1. Highlight the appointment record for the visit you want to log. You can do this either in the time slot (e.g. 3:20 for Dr. Jones) or in the [Appointment Details] pane.

    2. Drag the appointment record to the Today's Visits button on the calendar. When the cursor changes into an arrow, release the mouse button. the program will open the [Enter Visit] window.

    • Note that the visit details (visit category, provider, start time) are filled in from the schedule record. Be sure to override the Start time of the visit if the patient was late!

    1. Click the Results button.

    2. Click the Add button. [Visit Results]

    3. Search for and select the TB skin test medical activity and press the TAB key twice.

    4. Enter 1, or click the down arrow to the right of the Result Code field and select 1.

    5. Press the TAB key on your keyboard.

    6. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    7. The program automatically calculates the Next Due Date. To enter a different date, simply type over the existing date, and the program will automatically check the Override? box.

    8. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who placed the TB skin test.

    9. If you are tracking the lot number and other details, click the DOSE tab and enter the required information. (See Medical Activity Drug Dosage Tab to have the software enter the standard dose, unit measurement and drug company automatically. You then just add the lot number, expiration date and injection site.)

    10. Click OK, then Close to return to the [Enter Visit] window.

    11. Mark the visit Completed.

    12. ClickOKto close the visit record and return to the Appointment Calendar.

    Record the first reading of a two-step TB skin test

    1. Highlight the appointment record for the visit you want to log. You can do this either in the time slot (e.g. 3:20 for Dr. Jones) or in the [Appointment Details] pane.

    2. Drag the appointment record to the Today's Visits button on the calendar. When the cursor changes into an arrow, release the mouse button. the program will open the [Enter Visit] window.

    • Note that the visit details (visit category, provider, start time) are filled in from the schedule record. Be sure to override the Start time of the visit if the patient was late!

    1. Click the Results button.

    2. Click the Add button. [Visit Results]

    3. Search for and select the TB skin test medical activity and press the TAB key twice.

    4. Enter the appropriate result code OR click the down arrow to the right of the Result Code field, and select the appropriate result code:

      • If the TB skin test is non-reactive

        • Enter or select 2 and press the TAB key.

        • Record the induration, if any

        • the program will automatically calculate the Next Due Date according to the rules set up for TB skin tests. If a different date is needed, simply type it over the existing date.

      • If the TB skin test is reactive

        • Enter or select + and press the TAB key.

        • Record the induration.

        • If the employee converted while working for your hospital, check the box Conversion Occurred? Otherwise, leave the box unchecked.

        • If the TB skin test is reactive, it will not be repeated so no Next Due Date will be displayed in that field.

    5. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    6. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who read the TB skin test.

    7. Click OK, then Close to return to the [Enter Visit] window.

    8. Mark the visit Completed.

    9. ClickOKto close the visit record and return to the Appointment Calendar.

    Record the second placement of a single-step TB skin test

    1. Highlight the appointment record for the visit you want to log. You can do this either in the time slot (e.g. 3:20 for Dr. Jones) or in the [Appointment Details] pane.

    2. Drag the appointment record to the Today's Visits button on the calendar. When the cursor changes into an arrow, release the mouse button. the program will open the [Enter Visit] window.

    • Note that the visit details (visit category, provider, start time) are filled in from the schedule record. Be sure to override the Start time of the visit if the patient was late!

    1. Click the Results button.

    2. Click the Add button. [Visit Results]

    3. Search for and select the TB skin test medical activity and press the TAB key twice.

    4. Enter 3, or click the down arrow to the right of the Result Code field and select 3.

    5. Press the TAB key on your keyboard.

    6. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    7. The program automatically calculates the Next Due Date. To enter a different date, simply type over the existing date, and the program will automatically check the Override? box.

    8. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who placed the TB skin test.

    9. If you are tracking the lot number and other details, click the DOSE tab and enter the required information. (See Medical Activity Drug Dosage Tab to have the software enter the standard dose, unit measurement and drug company automatically. You then just add the lot number, expiration date and injection site.)

    10. Click OK, then Close to return to the [Enter Visit] window.

    11. Mark the visit Completed.

    12. ClickOKto close the visit record and return to the Appointment Calendar.

    Record the final reading of a two-step TB skin test

    1. Highlight the appointment record for the visit you want to log. You can do this either in the time slot (e.g. 3:20 for Dr. Jones) or in the [Appointment Details] pane.

    2. Drag the appointment record to the Today's Visits button on the calendar. When the cursor changes into an arrow, release the mouse button. the program will open the [Enter Visit] window.

    • Note that the visit details (visit category, provider, start time) are filled in from the schedule record. Be sure to override the Start time of the visit if the patient was late!

    1. Click the Results button.

    2. Click the Add button. [Visit Results]

    3. Search for and select the TB skin test medical activity and press the TAB key twice.

    4. Enter the appropriate result code OR click the down arrow to the right of the Result Code field, and select the appropriate result code:

      • If the TB skin test is non-reactive

        • Enter or select - and press the TAB key.

        • Record the induration, if any

        • the program will automatically calculate the Next Due Date according to the rules set up for TB skin tests. If a different date is needed, simply type it over the existing date.

      • If the TB skin test is reactive

        • Enter or select + and press the TAB key.

        • Record the induration.

        • If the employee converted while working for your hospital, check the box Conversion Occurred? Otherwise, leave the box unchecked.

        • If the TB skin test is reactive, it will not be repeated so no Next Due Date will be displayed in that field.

    5. Enter a brief note, if needed, in the Summary field. If a longer note is needed, click the Charting button and enter a charting note.

    6. If different from the Clinician already selected on the [Enter Visit] window, enter in the Clinician field the code (initials) for the Clinician who read the TB skin test.

    7. Click OK, then Close to return to the [Enter Visit] window.

    8. Mark the visit Completed.

    9. ClickOKto close the visit record and return to the Appointment Calendar.

Documenting Reactive TB skin tests

  • Document A TST Questionnaire When reading a reactive TB skin test

    When you give the employee a questionnaire at the time of reading a reactive TB skin test, you can record the questionnaire and, if the employee completes it immediately before leaving your department, you can record the results (Normal or Abnormal). The instructions below are added before Step 7 in any of the TB skin test Reading instructions above, regardless of whether you start from the Home Nav Bar or from the Appointment Calendar:

    1. Click the Add button. [Visit Results]

    2. Enter the Code for the TB skin test Questionnaire [TST+] OR search for and select the TST+ Questionnaire medical activity and press the TAB key.

    3. On the [Enter Medical Activity] window, type C, or click the down arrow to the right of the Result Code field and select C. If assessment questions are defined, these will display for entry of answers.

    4. Click OK and return to Step 7 in the TB skin test Reading instructions above.

  • Send out TST Questionnaires

    You can send out TST+ Questionnaires annually to people who are TB skin test positive. Please see Reminder Letters Setup and Use.

    Your questionnaires should be pre-printed and sent with the letters. You can document that the questionnaires were sent by setting up the medical activity for the questionnaire using a result code of 1 when the questionnaire is sent. Then, you can generate a list of people who haven't returned them by running the Surveillance History Report, selecting for the result code 1.

  • Document Returned TST Questionnaires

    You can document the results of a returned TST+ questionnaire. Follow the instructions for adding clinical results from the Patient Chart. Select the medical activity that you set up for the questionnaire. Enter a result code of N (Normal) if the employee's responses indicate no evidence of disease, or A (Abnormal) to indicate some evidence of disease.

    When you add the medical activity code to the Patient Chart, CLINICAL RESULTS Tab, you will be able to document individual question responses, if desired. Most nurses who do this only document abnormal responses, as it is too time consuming and little value is added to document normal responses.

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