Improving TB Assessment and Screening by Nurse Practitioners: A clinic-based quality improvement project

Background The unique pathogenesis of Tuberculosis (TB) necessitates periodic evaluation of TB screening policies and educational opportunities to occur in primary health care settings to ensure quality patient care and... [ view full abstract ]

Background
The unique pathogenesis of Tuberculosis (TB) necessitates periodic evaluation of TB screening policies and educational opportunities to occur in primary health care settings to ensure quality patient care and optimal patient outcomes. TB policy awareness and adherence may assist with identifying patients in high risk TB groups that may benefit from therapy.

Aim
The specific aim of this QI project was to improve nurse practitioner (NP) awareness and adherence to CDC TB screening guidelines in an indigent health care clinic.

Objective
Together, the TB educational session and clinical screening algorithm should increase identification of patients who are in groups at high risk for TB by the NP, ultimately resulting in a potential decrease in the rate of LTBI conversion to TB disease.

Description of innovation
The innovation included: (a) a TB educational session based on CDC screening guidelines, (b) a TB risk questionnaire, to assist the NP with identifying high risk TB groups, and (c) a TB clinical screening algorithm, to assist the NP with adherence to CDC TB screening guidelines.

Impact of innovation
The NP was administered pre- and posttests to assess the knowledge before and after participation in the TB educational session. The scores were 92.9% and 100.0%, respectively, indicating that the TB educational session decreased TB knowledge deficits by the NP.
A review of 10 patient charts preintervention and 20 postintervention charts was conducted. Preintervention data collected, the NP identified variables of high risk TB groups and adherence to CDC TB screening guidelines in 50% of the cases. Postintervention data collected, the NP identified variables of high risk TB groups and adhered to the CDC TB screening guidelines in 100% of the cases.

Conclusions and implications
Health care providers must understand the appropriate use of each diagnostic method to screen patients for TB exposure. Health care providers must be cognizant of current TB screening guidelines for prevention and elimination of TB. Implementation of the TB risk questionnaire, to identify high-risk TB groups, and the TB screening algorithm to ensure use of approved TB screening methods may reduce rates of TB conversion and transmission.