GEN-2014-007 Medical Directive Title: Ordering of Chest X-Rays within Occupational Health and Safety Services Lead Contact Person: Rhodora Laylo, Coordinator Infection Safety Physician Lead: Dr. Elaine Thurgood Program: Occupational Health and Safety Services Approval By: Medical Advisory Committee Original Effective Date: Revised Date: June 27, 2012 August 21, 2014 This Medical Directive Applies to the following sites: All SJH sites SJH PKWD Southwest Centre Reviewed Date: August 21, 2016 RMHC L MT HOPE This Medical Directive Applies to the following patient population: In-Patients Out-Patients Order: This medical directive provides authority to communicate an order to the Occupational Health Nurse (OHN) to order screening Chest PA and lateral X-Ray for staff members of St. Joseph’s Health Care, London (St. Joseph’s) when indications for a Chest X-Ray (CXR) are present and there are no contraindications to do so Background All employees, persons with practicing privileges, contract workers, students and volunteers who carry on activities within St. Joseph’s will have access to a Chest X-Ray for the purposes of TB screening (when deemed appropriate) through Occupational Health and Safety Services (OHSS). For the purpose of this medical directive, these groups will be collectively referred to as staff members. Appendix Attached? Yes No Recipient Patients: Any Staff members that is deemed to benefit from and have no contraindications to receiving a Chest XRay. NOTE: Any costs incurred to meet the requirements related to health review/clearance are the responsibility of the staff member. Authorized Implementers:  Identify individuals or groups of individuals by position and qualifications who will be involved in implementing the medical directive Position / Title Qualifications / Certifications Occupational Health Nurses (OHNs) Knowledge of internal OHSS Protocol working within Occupational Health and Safety Services refers to the RN and RPN role. Page 1 of 5 GEN-2014-007 Indications & Contraindications: Indications for Chest x-ray: After assessment it is determined that the staff member has:     Positive TST (TB skin test) with induration: 10 mm or more History of previous active TB History of Latent TB or, Positive skin test with no proof of current CXR (within the past 12 months) Contraindications:  Pregnancy  Lack of staff member consent Medication / Drug Table: Please identify all medications/drugs, using the chart below, which are included under this medical directive by listing the AHFS classification and then identifying which drugs are EXCLUDED. Note: medical directives for medication orders excludes: non-formulary medications, special access program medications/investigational drugs, off-label use medications, and narcotics, controlled drugs, and benzodiazepines (definition of practitioner as defined under CDSA and Narcotic Regs restricts prescribers). It is not necessary to list these exclusions. For any off-label use of a specific medication to be included, the actual drug and indication must be listed individually and not in the AHFS classification section (e.g. Gabapentin for pain). Check off the boxes for which formulary medications will be applied to this medical directive: Admission Medication Orders – reorder or continue Initiate Changes to existing orders (e.g. discontinue, adjust dosages, schedules, or routes) Initiate new orders for the following medications Drug Name (GENERIC) by AHFS category LIST EXCLUSIONS Route of Administration Special Consideration (e.g. monitoring, lab tests) N/A (for formulary listings see - http://intra.sjhc.london.on.ca/depts/pharmacy/formulary/formulary.php) Consent The OHN is to obtain verbal consent from the staff member prior to sending for CXR. Educational Requirements The educational components are review of:  Consent Practice Guideline (link: http://www.cno.org/Global/docs/policy/41020_consent.pdf)  TB Surveillance Protocol for Ontario Hospitals (link: http://www.oha.com/Services/HealthSafety/Documents/TB%20Protocol%20Reviewed%20and% 20Revised%20May%202012.pdf)  Tuberculosis (TB) Surveillance and Exposure Management Program for Staff (link: http://intra.sjhc.london.on.ca/policy/search_res.php?polid=STF013&live=1)  Internal OHSS Process Appendix attached? Yes No Page 2 of 5 GEN-2014-007 Documentation & Communication The OHN will make a notation in the staff members electronic chart regarding clinical findings, positive TST and result of Chest X-Ray. Review and Quality Monitoring Guideline: Any questions regarding the implementation of this Medical Directive and/or anticipated outcomes will be raised to and discussed with the Occupational Health Physician. It is the accountability of the Physician authorizing this Medical Directive to communicate any new information. Professional Staff Approvals (Physician, Dentist, Midwife):  Identify all Professional Staff members (less than 10 list by individual name, greater than 10 list by title & program) responsible for patients who may receive an order or procedure under this medical directive. NAME DEPARTMENT / PROGRAM Dr. Elaine Thurgood Occupational Health and Safety Services Page 3 of 5 GEN-2014-007 Administrative Authorization Approval Form Please note: signature pages are not to be signed until the medical directive has been approved. Name of Directive: Ordering of Chest X-Rays within Occupational Health and Safety Services Lead Contact Person (s): Wendy Reed, Director of Occupational Health and Infection Control IMPORTANT: This template is a general document that may need modification based on the needs of the directive. Please modify appropriately.  Identify all administrative bodies, including individuals (PPL’s, managers, directors, chiefs) and other approving bodies (i.e. Medical Advisory Committee, Pharmacy & Therapeutics Committee) that must approve the medical directive. Administrative Authorizations (approved by): Chair, St. Joseph’s Medical Advisory Committee – Dr. Sarah Jarmain Signature Date Director of Nursing Practice – St. Joseph’s, Amanda Thibeault Director of Medical Imaging – St. Joseph’s, Anthony Orfanides St. Joseph's - Site Leader, Medical Imaging – Howard Hansford Occupational Health Physician – Dr. Elaine Thurgood Director Occupational Health and Infection Control – Wendy Reed Rhodora Laylo, Coordinator Infection Safety Page 4 of 5 GEN-2014-007 Implemented by: (Person(s) performing initiation or person representing a large group and responsible for notification of that group) Beverley Barrie, RN Signature Date Linda Doan, RN Brenda Foster, RPN Janet Grantham, RN Lelia Haertel, RPN Nadine McConnell, RN Leemala Ragubance, RN Joyce McLean, RN Page 5 of 5