Principles of TB Nurse Case Management: Why are We Here? Catalina Navarro, RN, BSN March 17, 2015 TB Nurse Case Management March 17 19, 2015 San Antonio, Texas EXCELLENCE EXPERTISE INNOVATION Catalina Navarro, RN, BSN has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity
The Reason Why We Are Here Principles of TB Nurse Case Management San Antonio, Texas March 17, 2015 Catalina Navarro RN, BSN Heartland National TB Center The Reason Why We Are Here According to CDC The responsibility for successful (TB) treatment is clearly assigned to the public health program or the private provider, not to the patient It s strongly recommended that the initial treatment strategy utilize patient-center case management... MMWR June 20, 2003 52:RR-11 Treatment of Tuberculosis
NEWS Worldwide tuberculosis cases decline for first time: WHO TB Latest News! Deaths from tuberculosis fell globally to the lowest level in a decade, to 1.4 million in 2010, after peaking at 1.8 million in 2003. Reuters Oct 11, 2011 10:24 AM ET Last Updated: Oct 11, 2011 10:28 AM ET By Alina Selyukh The number of people getting sick with tuberculosis
TB Cases in Texas by County AMARILLO (10) GREGG (14) VALVERDE (7) HARDIN FORT BEND (23)
TB Cases in Texas by County 2012 2013 Harris 267 287 Dallas 178 191 Bexar 71 75 Tarrant 72 70 Hidalgo 72 64 Cameron 72 70 El Paso 37 49 Travis 37 41 Webb 30 35 Collin 22 30 Diabetes and TB: A growing threat By Dr. Susan Fisher-Hoch, Special to CNN updated 12:38 PM EDT, Mon March 24, 2014 Editor's note: Dr. Susan Fisher-Hoch is a professor in the Department of Epidemiology at the University of Texas Houston School of Public Health in Brownsville, Texas. She is also on the board of Stop TB USA. Monday is World Tuberculosis Day
Objectives Define the role of the TB NCM Define Goals of Case Management Describe the Elements of Case Management Process Role of the TB Nurse Case Manager Management services for a TB patient or a TB suspect from initiation to completion of treatment. Management of individuals with Latent TB Infection.
Goals of TB Case Management Treat TB patient according with CDC Guidelines Complete treatment in appropriate time frames Prevent progression of TB and drug resistant Prevent transmission of TB with effective Contact Investigation (CI) Educate patient, family and community about TB How?
TB Nurse Case Management Process Case Finding Assessment Identify Problems Plan Implementation Evaluation
Case - Call from AZ 26 y/o Philippine male admitted last month due to weakness, weight loss and some fever Asking for recommendations on treatment Lymph node enlarged AFB smear (+) NAAT confirmed MTB Patient D/C from hospital with a appointment to a TB clinic TB Nurse Case Management Process Case Finding Assessment Identify Problems Plan Implementation Evaluation
Case- Call from AZ 26 y/o Philippine male admitted due to weakness, weight loss and some fever Lymph node enlarged (Sample grew MTB) Case Finding Information needed: Gather Relevant data Chest X-ray? Is also a Pulmonary TB case? Were sputums taken? Other comorbiditis? Diabetes? HIV? Suceptibilities? Weight? Medication list? History of TB: LTBI? Contact to a TB case? Social History: Habits? Life style? Incarceration? Homeless? Alcohol? Drugs? Work? Identify Problems HIV (+) Chest X-ray abnormal MRI Tuberculomas Disseminated TB Including: Clinical (H & P, D/C summaries, referrals) Gather & analyze Relevant data Psychosocial and behavioral health Chest X-ray Labs, Microbiology results Nutritional status Past medical history and current condition Concomitant diseases, Infectiousness etc. Case Finding Assessment Identify Problems Plan Implementation Documentation Including: Asses existing and/or potential health problems Coordinate team meetings to discuss patient s assessment Monitor outcomes and identify new problems Including: DOT administration (Adherence to treatment) Initiation of Treatment Monitoring (Clinical assessment for toxicity) Referrals Patient education Evaluation Was TB treatment implemented in a timely manner? Were expected outcomes achieved? Was patient satisfied with services? Were the TB staff satisfied with plan and outcome?
Documentation Summary Role of the TB Nurse Case Manager Management services for a TB patient or a TB suspect from initiation to completion of treatment. Management of individuals with Latent TB Infection Goals of Case Management: Each TB patient receive treatment according with CDC Guidelines Treatment is completed in appropriate time frames Prevent progression of TB and drug resistant Transmission of TB is prevented with effective CI Patient, family and community is educated about TB