PPD test question

[pretty70]

I work in LTC. I have a question R/T PPD test. When you receive an admission from the hospital you just give the PPD test on admission or wait until you get records showing if the patient had a PPD test recently in another facility. At my facility we are suppose to give a PPD test upon admission. This order worry me because most of the time I only get the discharge document from the hospital and no other previous history for example if the patient had previous positive reaction, etc. I would like to know other protocols in other facilities. thanks.

[aura_of_laura]

We usually administer them on admission to residential. Many times the documentation isn't clear, and patients or their charts will say a previous test was positive when really they just had a localized irritation (it's amazing how many TB tests are misread as false positives, because any old nurse can read them, even if they don't know what they're looking for). And if the patient has a history of a positive TB test, another PPD won't hurt them. Just document the positive, and get a followup chest x-ray. If they have a legitimate allergy to a PPD test, it should be listed in their allergies - plus, anytime you inject anybody with anything, you should have an epi-pen handy.

[cb_rn]

At my last hospital the patient couldn't go to a SNF or LTC facility without a PPD that had been read. It delayed discharges all the time.

And I have read many a PPD. Its not that hard, its well within the scope of "any old nurse" as long as they have been verified competent -- just like any other nursing skill. Its about feeling the induration, not how much *non-raised* red is present.

I would hope that if a patient had a + PPD the nurse notified someone and the appropriate followup such as a CXR was performed. If a nurse is documenting a + that isn't truly a + and the physician is in agreement, sounds like some hospital inservice and education is needed.

[kauainursing]

In most of the SNF/nursing homes that I have worked in, we require a 2 step PPD. Yes, it does delay the admission process, however, it beats exposing the other residents to the disease. As far as acquiring past records, sometimes we are not fortunate enough to have all that information, as previously noted, placing the PPD will not harm the patient. At least, by placing the PPD, you will be one step closer to knowing whether your patient is positive or not.

In my current facility of employment, only RNs are allowed to read PPDs.

[CapeCodMermaid, RN]

We administer the PPD on admission. The hospitals around here don't test for TB. We had a referral which stated the patient had 'under treated TB' and the hospital still did not do testing..but watch out! If you walk into any of them, they'll stick a swab up your nose and up your something else to see if you have MRSA!

[CoffeeRTC, BSN, RN]

Two step is done on all new admits.