TB Testing

[coughdrop.2.go, BSN, RN]

Hello all! I'm a RN working a School-based Health Center and we do TB skin testing as well as vaccines. A frequent concern that comes up is students coming to me to get their TB test read after they had it placed some where else (i.e. Public Health Dept. or PCP). Even if they have their paperwork with them, I will refuse to read a skin test placed elsewhere.

I came here because my boss (who is a non-medical provider) does not appreciate that I turn away students because the previous nurse had no problem reading them from wherever; with or without paperwork. I politely let them know that they need to return to where they got it from or they can always get it done here for free. I cannot find any documentation on whether or not it's okay to read skin tests that a facility has placed themselves.

Does anyone else have a clinic policy where you do not read TB skin tests from other providers and a rationale?

[SiwanRN]

There isn't a formal policy, but we don't do TB skin test reads for tests placed by other clinics or agencies. Mostly I think it is common sense. You have to rely on your patient's word of where it was placed, and they may not remember accurately. I've had many patients extend the incorrect arm to me for a reading when I placed the test 2 days ago on the opposite arm. This certainly affects the validity of the test. Additionally, they may be lying about getting the test done, particularly if they do not have documentation of test placement. Finally, sorry to say, but there is plenty of bad technique in giving TB skin tests, and I don't know the training level of staff at another clinic or agency. If a nurse in my health department placed it, I know they've gone through specific training from a local TB clinic for correct technique. I think you are right to refuse.

[coughdrop.2.go, BSN, RN]

There isn't a formal policy, but we don't do TB skin test reads for tests placed by other clinics or agencies. Mostly I think it is common sense. You have to rely on your patient's word of where it was placed, and they may not remember accurately. I've had many patients extend the incorrect arm to me for a reading when I placed the test 2 days ago on the opposite arm. This certainly affects the validity of the test. Additionally, they may be lying about getting the test done, particularly if they do not have documentation of test placement. Finally, sorry to say, but there is plenty of bad technique in giving TB skin tests, and I don't know the training level of staff at another clinic or agency. If a nurse in my health department placed it, I know they've gone through specific training from a local TB clinic for correct technique. I think you are right to refuse.

Thank you so much and you're totally right that I can't account for the other facilities technique. The only exception I have made is if it's placed at our Public Health Clinic because I know that nurse and I will fill-in for her if we're closed for break. Plus I can easily look up the information in our EHR to confirm time and where placed.