Connecticut State Department of Public Health

Discharge Planning for Tuberculosis Patients

 

Discharge planning for TB patients begins on the first day that the patient is seen in a hospital. Public Act 95-138 requires that a written discharge or treatment plan be approved by the Local Health Director. A TB patient discharge and treatment plan (Plan) must be completed and developed with the collaboration of the Hospital staff, the patient, and Local Health Department staff. The physician and patient must both sign a Plan prior to submitting to the Local Health Director for approval.

Discharge Planning Roles and Responsibilities

1. Hospital Physicians, Infection Control/Prevention, Hospitalists, Discharge Planners

Tuberculosis is a Category 1 disease and must be reported by phone immediately upon recognition or strong suspicion of disease to the TB Control Program at 860-509-7722, and a TB Surveillance Report Form  must be faxed within 24 hours to the TB Control Program at 860-730-8271. Further information about TB reporting and reporting forms is available online.

 

  • Establish a point person to communicate with the Local Health Department and the TB Control Program.
  • Collect specimen(s):
    • Ensure proper method of sputum collection (phlegm brought up from the lungs after a productive cough is what is desired, not nasopharyngeal discharge or saliva).
    • Three consecutive negative acid-fast bacilli (AFB) smears from sputum specimens must be completed.
      • NOTE: Sputum specimens for AFB smears must be collected at least eight hours apart:  At least one specimen MUST be an early morning specimen.
    • Nucleic acid amplification testing (NAAT) requests must be made to the State Public Health Laboratory.
      • NOTE: Prior to the patient being on medications for three days, NAAT requests must be made on at least TWO (2) specimens (morning specimen and another best specimen).
  • Begin treatment with an anti-TB regimen to which organisms are known or likely to be susceptible.
    • Identify and address any adverse effects prior to discharge.
  • Ensure that appropriate anti-TB regimen has been devised, initiated, and tolerated by the patient for at least 14 days.
  • Ensure patient has clinically improved, even if sputum AFB smear positive (i.e., symptoms are resolving).
  • Ensure patient is medically and mentally stable.
  • Send prescriptions to TB Control Program and/or local health and to patient’s preferred pharmacy.
  • Initiate and develop the Plan with the Local Health Department where the patient resides/is being discharged.
  • Provide TB medications:
    • Ensure patient is supplied with enough medications to last until the first scheduled out-patient appointment (Note: Providing prescriptions does not ensure that the patient can or will fill them).
  • Confirm follow-up appointment date and time for TB care.
  • Identify patient needs and make any necessary referrals.
  • Complete the Plan.
  • Ensure that Hospital Physician and the patient have signed the Plan.
  • Send the completed and signed Plan to the Local Health Director for review and final approval. 

2. Patient

  • Participate in interviews with TB Case Manager and/or Local Health Department staff.
  • Be willing to follow up with outpatient care with Directly Observed Therapy (DOT).
  • Be willing and able to observe risk-reduction behaviors until physician determines patient is no longer infectious.
  • Sign the Plan, after collaborating with Hospital Physician and Local Health Department staff. 

3. Local Health Department Director and Staff

  • Conduct Patient Interview(s).
    • Discuss household composition and ability to self-isolate.
    • Elicit contacts for testing.
    • Schedule time/days for DOT services.
  • Contact established Hospital point person to exchange information for ongoing communications.
  • Ensure prescriptions are at the TB Control Program and/or patient’s preferred pharmacy.
  • Assess patient for potential obstacles/barriers that could interfere with treatment.
    • These may include: Access to care, unstable housing, language barriers, cultural beliefs, substance abuse, and/or medical conditions.
  • Verify/validate patient address and phone number.
  • Verify if patient is returning to the same household where he/she resided prior to hospitalization, or if alternative residence has been determined to be appropriate by the Local Health Director.
    • Verify that patient will not be discharged to a congregate setting (i.e., shelter, nursing home, etc.) unless patient has been on anti-TB treatment regimen for at least two weeks, is clinically improving, and demonstrates sputum AFB smear and culture conversion.
    • Verify that patient will not have significant contact with or live with immunosuppressed persons.
    • Verify that patient will not be living with children < 5 years old.
    • Verify that if there are any immunosuppressed persons and/or children < 5 years of age in the home, a plan must be in place by next business day for TB evaluation for window period prophylaxis or LTBI.
  • Educate patient about discharge plan, outpatient treatment and infection control measures.
  • Discuss with patient the anticipated length of therapy, medication side effects, importance of treatment adherence, follow-up appointments, consequences of untreated TB, and home assessment/isolation.
  • Emphasize to patient the benefits of DOT as an effective way to quickly complete TB therapy and prevent drug resistance. DOT is strongly recommended for all suspected/confirmed TB cases.
  • Begin to arrange and conduct follow-up evaluation and contact testing.
  • Ensure that all aspects of the Plan have been completed and signed by the Hospital Physician and by Patient.
  • Local Health Director or designee: Approves and signs Plan.­­­­­­­­­­­­­­­­­­­­

Instructions for Completing the Connecticut Tuberculosis Patient Discharge and Treatment Plan

The Connecticut Tuberculosis Patient Discharge and Treatment Plan is a template that may assist with the discharge planning process. It is a collaborative effort between hospital/facility staff, the TB patient, and Local Health Department staff. The purpose of the Connecticut Tuberculosis Patient Discharge and Treatment Plan is to ensure a safe transition for the patient back to a community setting while considering the public’s health. It also ensures continuity of care, with the goal of successful treatment outcome.

Public Act 95-138 requires that a written discharge or treatment plan be approved by the Local Health Director. It is agreed that this plan provides the best medical and public health care available for this patient. 

A TB patient discharge and treatment plan must be faxed to the TB Control Program at 860-730-8271 after all signatures have been obtained.

Please complete all fields.

 Section A. Patient Contact Information  

  • Enter Patient information, Hospital Admit and Discharge Dates, and Patient Emergency Contact information. 

Section B. Discharge and Treatment Plan

  1. Enter the name of the Hospital staff person who completed and faxed the TB Surveillance Report Form to both the TB Control Program and the Local Health Department.
    1. Note: This person is usually a Hospital staff member.
    2. Fill out the date the TB Surveillance Report Form was faxed to both the TB Control Program and the Local Health Department. 
  2. Enter the name and contact information of the Outpatient TB Care Physician who will be providing the outpatient follow-up care to the patient after hospital discharge.
    1. Enter the date and time of the patient’s follow-up appointment.
      1. Note: The initial follow-up appointment must be made prior to discharge.
      2. The Outpatient TB Care Physician is most appropriately determined by both the patient and the Hospital staff. 
  3. Enter the names of medications and dosages prescribed of all anti-tuberculosis drugs.
    1. Note: This information should usually be found in the TB patient’s Hospital medical record. 
  4. Enter the frequency of administering TB medications at discharge.
    1. Note: This information should be determined by the Discharging Physician. 
  5. Enter the type of supervision of medication ingestion.
    1. Name and phone number of DOT Provider.
    2. Note: All TB patients should be discharged on Directly Observed Therapy (DOT).
    3. Note: The DOT Provider is usually determined by the Local Health Department and may be a Public Health Nurse or clinic staff member. 
  6. Enter location and time when DOT will be conducted.
    1. Note: This must be a planned collaboration between the patient and the DOT Provider, generally at the patient’s convenience, Monday-Friday. 
  7. Enter Name and phone number of the Local Public Health Case Manager.
    1. Note: This is the person at the Local Health Department designated as the primary point person for communications related to the Patient’s completion of TB therapy. 
  8. Enter name of person providing TB-specific Education and Counseling, and the date such Education/Counseling was provided.
    1. Note: TB-specific Education and Counseling includes discussion of TB disease, TB medications, and infection prevention in the home and community. This is most appropriately a function of Hospital Physician or Nurse and reinforced by Local Health Department staff.
    2. Note: TB patients being discharged while still infectious must be advised that home isolation is required. 
  9. Check all that apply.
    1. If Obstacles are identified, describe planned Interventions.
      1. Note: Continuity of care and TB medication regimen completion depends on mitigating these obstacles.
      2. Note: This is usually done by Hospital staff but may also involve collaboration with the Local Health Department.
      3. Fill in names and phone numbers of all Agencies/Persons to whom the Patient was referred for medical management of other diseases and/or social service needs. 

Section C. Signatures

  • All three signature lines (Physician, Patient, and Local Health Director or Designee) must be signed and dated. The Plan is only considered complete when ALL parties have collaborated on, signed, and dated the Plan. 
  • A TB patient discharge and treatment plan must be faxed to the TB Control Program at 860-730-8271 after all signatures have been obtained.

 

 

 

This page last updated 8/03/2021.