Routine Tuberculosis Skin Testing (TST)

  1. Add an appropriate order for TB testing; open the linked Tuberculosis data-entry screen or PDF form and complete the fields related to injecting the antigen. If a pre-placement screen, check 2-step box. For Reason, use FUEXP if the patient has been exposed to active TB, PREPLAC1 or 2 for 2-step pre-placement testing, or SURV for routine surveillance. If the reason is FUEXP, indicate Exposure Date and Method of Exposure. If the patient previously had a BCG vaccine, check that box, Save.
  2. Schedule a return appointment within 48-72 hours to read test. If your clinic prefers not to schedule the reading visit, create an order on the original visit for reading test and entering the results, or simply have a step in the work flow sequence of the original order to ensure that the read step is not omitted.
  3. Scheduling return visits:
    • If you schedule return visits, screen for patients who don’t show up by printing the Patient Stat Scheduling report with Appointment Status = A, C, N, Date = yesterday, and Patient Names = Yes.
    • If you do not schedule return visits, use the Patient Orders Tracking report with Date = yesterday, Outstanding Task Type = D, and Task Section = TB. If you are using PDF forms and work flow sequences, the original order will be in the responsible person’s Chart Box in the Clinical Work Area.
  4. When the patient returns, measure the induration (raised area, not redness). Retrieve the Tuberculosis record/form started in Step 1. If the induration is round, enter diameter in Induration Max Dimension field. If not round, enter the larger dimension in the Induration Max Dimension field and optionally enter the smaller dimension in the Addl Measurement field.
    1. If the induration measures > 15mm, the result is positive. If the induration measures between 5mm and 15mm, check the patient’s Medical History for TBFACTOR. If any are listed, or if questioning the patient reveals risk factor(s), evaluate factor(s) to determine if the result is positive.
    2. If the test is part of a 2-step series (pre-placement), and:
      • First test is positive, uncheck Part of 2-Step Series—a second test will not be done.
      • First test is negative, schedule a second step within 1-3 weeks and enter the date in Next Visit field.
    3. If the test is negative, save the record and create a recall record for the next appropriate monitoring or follow-up activity. If this was the first test following an exposure, the recall visit should be in three months.
    4. If the test is positive, save the record and follow the steps under Positive Follow-up.
  5. If clinic policy is to add TB records to Immunizations so they display in a patient’s Medical History, click on the Make Immunization Record button (Alt+M).
  6. Create a recall record for the next appropriate monitoring or follow-up activity.