- Standard statement
- Rationale
- Resources
- Professional practice
- Outcome
- References
Each patient is registered appropriately, started on an approved treatment regimen and given practical advice, support and information according to their individual needs and concerns. |
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Identification of appropriate management unit (click to view)
It is essential for all patients who are diagnosed with TB to be registered at an appropriate management unit as soon as possible after diagnosis so that they can receive the care they need and their progress can be monitored. Each patient should be given the option to be followed up at the management unit that is most convenient for them. A patient may attend a large hospital or clinic known to provide services for TB and be unaware that there is a facility closer to her/his home. Referring her/him to a local unit will also alleviate pressure from larger units. If the patient is found to have DR-TB, the patient is given appropriate treatment based on country policy and needs to be managed by a unit approved for the treatment of DR-TB.
It is essential to keep a record at the centre where the diagnosis of TB was made in order provide a means for ensuring that the patient has been registered and started treatment at the management unit s/he has been referred to - this includes specialist DR-TB facilities. It is also the responsibility of the unit that made the diagnosis to report on the eventual treatment outcome.
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Read more: Union 2007 Best Practice Guide, Chapter 4, Starting treatment |
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Registering the patient and starting the correct treatment (click to view)
Clear, accurate and timely documentation (click to view)
Standardised recording and reporting systems help to evaluate patient progress and treatment outcome and give a picture of how the programme is performing overall. All documentation must be completed clearly and accurately as soon as the TB diagnosis is confirmed. This includes : Laboratory register, TB register, Patient treatment card, Quarterly Reports
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Read more: WHO (2006) TB recording and reporting forms and registers |
It is important at an early stage to get details of the patient’s address as well as details of a close friend or relative through whom the patient can be contacted. The earlier this information is documented the better, in case for some reason the patient does not attend and needs to be traced. As some patients may be reluctant to give accurate contact details at first, and may only do so once they have gained trust in the service, it is useful to check regularly if any of the details have changed or are due to change |
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Offering an HIV test (click to view)
As TB is one of the main opportunistic infections associated with HIV, all TB patients should be tested for HIV. The earlier it is found that someone is infected with HIV, the sooner he or she can be offered advice and treatment to prevent opportunistic infections, prolong life, and decrease the possibility of further transmission. It will also present an opportunity to offer diagnostic and care services to the patient’s partner who may be at significant risk from contact with both HIV and TB.
This is covered in more detail in TB and HIV: HIV Testing
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Read more: Union 2007 Best Practice Guide, Chapter 7, HIV testing |
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Assessing the patient’s social and psychological needs (click to view)
Assessing the patient’s knowledge and understanding of TB (click to view)
The successful treatment of the patient requires that the patient understands what is happening. Each patient will have a different level of knowledge and understanding about TB, depending on what they have already heard and whether they have known someone who has had the disease. It is important to find out what they know so that they can be given the information they need, correcting misconceptions and concentrating on the areas they are most concerned about. The patient and, if possible, at least one member of the family or a trusted friend, should clearly understand the answers to the following questions:
What is tuberculosis?
How is it treated?
How does the disease spread?
What measures can be taken to limit its spread?
The use of appropriate visual materials can be helpful, but should never replace one-to-one discussion, and the amount of information covered at any one time will depend on the individual patient’s needs and concerns. |
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Continuing to build a good relationship (click to view)
Being diagnosed with TB can be a very traumatic event in a person's life and presents many challenges that they must cope with. A good relationship can be built by listening carefully to the patient. It is important at the beginning of treatment to create a time to counsel the patient regarding her/his disease, the prescribed treatment, and how the diagnosis and treatment may affect her/his lifestyle. This will encourage her/him to attend for treatment and follow-up visits. If a patient feels that staff are rude or too busy to care, s/he is less likely to want to come back. Spending time with a patient early on can save time in the long run by preventing irregular attendance, default, treatment failure and prolonged treatment.
Pointers
for good communication
• Listen carefully
• Use open questions, e.g., those starting with
“what”, “how”, “why”,
etc., to encourage fuller responses
• Think about it from the patient’s point
of view
• Hear and respect patients’ beliefs,
values, customs and habits
• Work together with the patient as an equal
partner
• Smile and look at the patient when they are
speaking and when you are talking to them
• Check with the patient that you understand
by repeating back a summary of what he or she has
told you
• Take a long term view
• Use touch (e.g., squeezing or shaking the
hand) if appropriate to reassure and show support
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| Audit your practice |
| Action Plan |
| Patients will be accurately registered at an appropriate management unit and all information including results will be correctly entered in the treatment card and TB register. Patients will understand their condition, its treatment and where they can go to if they need help. The initial assessment will provide the basis for a patient-centred plan of care, which will be minimise barriers to treatment, including the selection of the best “TB treatment facility” where DOT will be performed. The success of this standard can be measured by comparing the information in the TB register with the information on the treatment card and laboratory register; default rates in the intensive phase; and direct feedback from patients.
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