# Presentation: 047911

## Update and Overview of Health Care Guidelines TAG

**Johnetta Davis, Field Liaison**
**Humanitas, Inc.**
- Region I Health and Wellness Conference
- San Juan, Puerto Rico
- May 15, 2004

## OVERVIEW

- Background
- Organization of New Technical Assistance Guide (TAG)
- Release Schedule

## BACKGROUND

- Standing Orders TAG was first developed in 1978 and revised in 1991
- November 2003—brainstorming session held in Silver Spring, MD, to outline changes to the Standing Orders TAG

## BACKGROUND(continued)

**Proposed Changes**
- Revise content to include current standards of care
- Organize the TAG in a format that is useful to the health and non-health staff
- Determine a method of delivery of new TAG to center
- Develop a training plan to educate Job Corps Center staff on the new TAG

## BACKGROUND(continued)

**Result**
- Standing Orders TAG renamed Health Care Guidelines TAG

## ORGANIZATION OF TAG

**TAG is divided into five sections:**
- Authorizations
- Health and Non-health
- Professional Standards of Care (PSOC)
- Treatment Guidelines (TG)
- Symptomatic Management Guidelines (SMG)
- Medications

## ORGANIZATION OF TAG (continued)

**Authorizations**
- Three types of authorizations
- Center nurse
- Advanced Practice Clinicians
- (Nurse Practitioner and Physician Assistant)
- Non-health staff

## ORGANIZATION OF TAG (continued)

**PSOC**
- Includes examples of PSOCs
- Discusses the need for health education, follow up, and documentation by health staff

## ORGANIZATION OF TAG (continued)

**PSOC**
- Topics include:
- Medical, mental health, and oral health emergencies
- Immunization protocols
- Medication protocols
- Standard laboratories

## ORGANIZATION OF TAG (continued)

**PSOC**** **(continued)
- Topics include (continued)
- Promotion of health lifestyles
- Physical and cursory examinations
- Biochemical testing (on-entry/on-suspicion)
- After hours care
- Reporting of actions taken
- Referral of students off-center

## ORGANIZATION OF TAG (continued)

**TGs**
- Approximately 60 new TGs
- No longer contain algorithms
- Individual guidelines no longer require signature
- Contain a “When to Refer” section
- Alphabetized for easy access

## TREATMENT GUIDELINES FOR HEALTH STAFF

** **
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**CHLAMYDIA INFECTION**
** **
** **
- Authorized health and wellness center staff may treat laboratory-confirmed chlamydia infection as follows:
** **
- 1.      Administer azithromycin 1 gram po once as a single dose directly observed therapy with fluids or snack.
- 2.      An alternative treatment, or if allergic to azithromycin but not pregnant, administer doxycycline 100 mg p twice daily for 7 days.
- 3.      Instruct student to return for re-treatment if vomiting occurs within 4 hours of treatment.
- 4.      Discuss contact(s) treatment, screening for other STDs as appropriate, health department reporting requirements, and prevention of STDs and pregnancy (offer condoms and contraceptives as appropriate).
- 5.      Instruct student to abstain from sexual intercourse for 7 days and until all sex partners have been treated.
- 6.      Schedule chlamydia retesting in one month.
**WHEN TO REFER TO THE CENTER PHYSICIAN**
** **
-           If the student has rectal pain suggestive of proctitis
-           If the female student has pelvic pain suggestive of pelvic inflammatory disease
-           If the male student has scrotal pain suggestive of epididymitis or lower back pain suggestive of prostatitis

## ORGANIZATION OF TAG (continued)

**SMGs**
**	**28 new SMGs
- 	No longer contain algorithms
- 	Contain a “When to Contact The On-	Call Health and Wellness Staff” section
- 	Alphabetized for easy access

## SYMPTOMATIC MANAGEMENT GUIDELINES FOR NON-HEALTH STAFF

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**ALCOHOL OR DRUG USE BEHAVIOR**
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** **
- Authorized non-health staff may manage possible alcohol or drug use behavior as follows:
** **
** **
- 1.      Bring the student to a private area for evaluation.
- 2.      Document observed behavior.
- 3.      Determine if the student has allegedly ingested alcohol or drugs by questioning staff, student, and peers.
- 4.      If authorized to do so, conduct an alcohol-screening test and urine drug screen on suspicion according to the center operating procedure (COP).
- 5.      Any student under the influence of alcohol or drugs must be observed in the dormitory or the health and wellness center to ensure safety until symptoms have resolved.
- 6.      All documentation of observed behavior should be sent to the health and wellness center for follow-up and inclusion in the student’s medical record.  All alcohol test results, both positive and negative, should be sent to the health and wellness center for follow-up and inclusion in the student’s medical record.  All urine drug screens should be processed by health and wellness center staff while maintaining chain-of-custody according to COP.
**WHEN TO CONTACT THE ON-CALL HEALTH AND WELLNESS STAFF**
-           If the student is incoherent, vomiting, or losing consciousness
-           If student has ingested unknown drugs, unknown quantity, or multiple drugs

## ORGANIZATION OF TAG (continued)

**Job Corps Medication List**
- Comprised of three lists
- Preferred prescription medications
- Preferred psychotropic medications
- Over-the-counter medications

## RELEASE SCHEDULE

- TAG will be posted on the Job Corps Health and Wellness website (_[www.jobcorpshealth.com](http://www.jobcorpshealth.com/)__) at the end of May_
- Available for download in PDF and Microsoft Word format
- Staff training PowerPoint presentation available beginning of June