LVNs in California - reading PPDs?

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    Hi guys, new to the forum. New LVN in California. I was trying to think of a good first post and I have something that has been back and forth in my mind. I of course know that as an LVN in California it is well within my scope to read a PPD/feel for induration. However where I get confused is, is there a point where we can or cannot sign it off? Obviously if a very large induration an MD would review and order a CXR. But is there a point where depending on the patient and their risk, we can just sign it off (Ex: low risk patient with say, 5mm of induration)? Or does it depend on the facility you work in? I feel so stupid for asking this like I should know but I can't get a clear answer and am hoping to get one here. Thanks in advance!
  2. 4 Comments so far...

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    I guess it depends on the protocol of the facility. Some say >5mm induration
    might warrant further workup.

    Here in NYS, an LPN cannot ''assess'' a PPD, it has to be done by an RN, although
    in LPN school we were taught to ''read and interpret them'' - which IMHO is very
    nonsensical.
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    I am an LVN working in a County hospital & we are taught to measure PPD induration results. As a safety measure though, I would definitely seek a 2nd nurses opinion if I questioned a result or I saw something out of the ordinary. Most PPD induration results that I have seen, have been "normal" so nothing that ever warranted questioning.
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    Sorry....I should've added in So Cal.
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    Quote from LVNmommy29
    Hi guys, new to the forum. New LVN in California. I was trying to think of a good first post and I have something that has been back and forth in my mind. I of course know that as an LVN in California it is well within my scope to read a PPD/feel for induration. However where I get confused is, is there a point where we can or cannot sign it off? Obviously if a very large induration an MD would review and order a CXR. But is there a point where depending on the patient and their risk, we can just sign it off (Ex: low risk patient with say, 5mm of induration)? Or does it depend on the facility you work in? I feel so stupid for asking this like I should know but I can't get a clear answer and am hoping to get one here. Thanks in advance!
    EXCELLENT QUESTION! You are smart to ask.

    I was an LVN in California for many years.
    This was not taught in your nursing program because the LVN assessment is defined as data collection only. The analysis and synthesis of the data must be done by the registered nurse or physician supervising you. It is not your responsibility to read the result of a PPD. With experience you will probably become expert, however do not assess the result because it is outside your scope of practice. "Signing off" on a result requiring assessment as "normal" will not hold up in court.

    Insist that a physician, NP, or RN assess and sign off on the result.
    I am sorry you were not told this in nursing school.
    Title 16 of the California Code of Regulations states on page 26:
    2518.5. Scope of Vocational Nursing Practice.
    The licensed vocational nurse performs services requiring technical and manual skills which include the following:
    (a) Uses and practices basic assessment (data collection), participates in planning, executes interventions in accordance with the care plan or treatment plan, and contributes to evaluation of individualized interventions related to the care plan or treatment plan.
    (b) Provides direct patient/client care by which the licensee:
    (1) Performs basic nursing services as defined in subdivision (a);
    (2) Administers medications;
    (3) Applies communication skills for the purpose of patient/client care and education; and
    (4) Contributes to the development and implementation of a teaching plan related to self-care for the patient/client.
    Vocational Nursing -- Title 16, California Code of Regulations
    Page four is Title 16 outlines what an LVN may do regarding skin tests and immunizations. While extensive because it allows an LVN to follow standardized procedures in administering tuberculin skin tests it does not include the assessment of test results.
    2860.7. Skin Tests and Immunizations.
    (a) A licensed vocational nurse, acting under the direction of a physician may perform: (1) tuberculin skin tests, coccidioidin skin tests, and histoplasmin skin tests, providing such administration is within the course of a tuberculosis control program, and (2) immunization techniques, providing such administration is upon standing orders of a supervising physician, or pursuant to written guidelines adopted by a hospital or medical group with whom the supervising physician is associated.
    (b) The supervising physician under whose direction the licensed vocational nurse is acting pursuant to subdivision (a) shall require such nurse to:
    (1) Satisfactorily demonstrate competence in the administration of immunizing agents, including knowledge of all indications and contraindications for the administration of such agents, and in the recognition and treatment of any emergency reactions to such agents which constitute a danger to the health or life of the person receiving the immunization; and
    (2) Possess such medications and equipment as required, in the medical judgment of the supervising physician and surgeon, to treat any emergency conditions and reactions caused by the immunizing agents and which constitute a danger to the health or life of the person receiving the immunization, and to demonstrate the ability to administer such medications and to utilize such equipment as necessary.
    (c) Nothing in this section shall be construed to require physical presence of a directing or supervising physician, or the examination by a physician of persons to be tested or immunized.

    Vocational Nursing -- Title 16, California Code of Regulations
    LVN practice standards: www.cphcs.ca.gov/docs/imspp/IMSPP-v05-ch05.pdf


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