COLUMBUS COUNTY HEALTH DEPARTMENTS

SEXUALLY TRANSMITTED DISEASE (STD) PROGRAM POLICY

Policy Title:

/ Sexually Transmitted Disease Program

Program Area:

/

STD CLINIC

/

STD program policy and Staff Responsibilities in the one policy 4/30/13

/

Effective Date:

/

10/2002

Approval Date:

/

10/2002

/

Revision Date(s):

/

6/05/2013, 3/20/2014, 12/04/2014, 1/25/2017, 12/8/2017

Approved by:

/

Kim Smith RN, BSN, MSHCA, Health Director

Approved by:

/

Elizabeth Kinlaw, ERRN, Tammy Stevens ERRN, Emily Lee, ERRN

Purpose:
Columbus County Health Department (CCHD) STD clinic program goals are to:
  • Provide testing for STDs
  • Provide treatment and cure as directed by NC STD Treatment Guidelines and standing orders signed by CCHD Medical Director.
  • Provide education/counseling to reduce future transmission of all STDs and coping with chronic sexually transmitted infections.
  • Provide outreach for care and management to exposed sex partners

Definitions:
The Health Department staff in cooperation with the medical consultant, the regional and State Disease Investigation Specialist, CCHD Medical Director, and private physicians of Columbus County provides sexually transmitted disease control.CCHD staff will adopt and follow the North Carolina Sexually Transmitted Disease Manual online @ .
Responsibilities:
CCHD STD clinic staff, management, community partners
Procedures:
A. Sexually Transmitted Disease (sexually transmitted disease) Control service shall consist of
  1. Medical screening and treatment services will be available every working dayon a walk-in first come first serve basis on Monday, Tuesday, and Thursday from 1 pm to 3:30pm and Wednesday and Friday8:30 am until 11:30 am.
  1. Health History
  1. Personal data
  2. Present complaint
  3. Past medical history
  • Sign/symptoms of venereal disease
  • Sexual history
  • Medication/allergy history
  • Occurrence of past venereal disease
  1. Blood pressure/ Temperature- Optional
  2. HIV counseling
3.Physical assessment for Sexually Transmitted Disease with documentation on state form DHHS 2808. (control click on link).
4.Treatment of Sexually Transmitted Disease (if applicable)
5.Counseling and Anticipatory Guidance.
6.CCHD provided epidemiology service as:
  1. Laboratory Services
  • Syphilis Screen
  • FTA-ABS
  • Gonorrhea culture for males only(G.C.)
  • Gram stain (G.C. smear) males only
  • Herpes culture if indicated
  • Wet mount-female only
  • Penicillin sensitivities on all positive gonorrhea cultures
  • NAAT GC/Chlamydia culturefor females only
  • HIV Screen
  1. Health Education Service
  • The health department willprovide STD education services to persons or groups as needed and as requested.
  • Professional education to update local physicians, nurses, and other professionals in the latest methodologies of STD control as needed and requested.
  • One-on-one client education including, but not limited to counseling at the time of treatment aimed at preventing re-infection or early recognition of signs and symptoms of STD.
  • HIV Risk Reduction Education
  1. Referral Service
1)Promptly reports to the Division of Health Services all cases of publicly treated sexually transmitted disease in accordance with the following schedule:
  • Cases of early syphilis (primary, secondary, and early latent under one year duration) will be reported by phone to The Disease Intervention Specialist by the STD Nurse Coordinator.
  • All cases of STD’s by the health department and private facilities (except HIV, and Syphilis) will be reported via the North Carolina Electronic Disease Surveillance System on a daily basis by the assigned processing assistant after being review by the ERRN STD coordinator.
2)Ensure that confidentiality of the records and clients right to privacy is maintained according to agency policy.
3)The health department encourages private laboratories and private physicians to meet the requirements of G.S. 130A-140 relating to reporting.
  • Encourage private physician to routinely report all cases of STD within twenty-four hours of treatment.
  • Encourage all non-health department laboratories to submit reports of all positive laboratory tests for STDs.
  • Ensure that physicians and laboratories not previously providing services within its area of jurisdiction are informed of proper reporting requirements and procedures
Follow-Up Service
  1. Three attemptsvia phone or letter will be made by the STD Nurse Coordinator to have patients return for treatment when not treated on the day of exam.
  2. Patient education and counseling are done one-on-one and documented.
Recruitment and Outreach Service

A.Clients are recruited for health department sexually transmitted disease services through the health department clinics, hospitals, private physician's offices, and from other health departments.

  1. Outreach is provided by The Disease Intervention Specialist and the public healthnurse, as indicated.
Records
  1. The problem oriented health record shall be used in the sexually transmitted disease program
  1. The STD records are incorporated into the electronic medical record (CureMD) and consist of:
1)Personal Data (DHS 2800)
2)Sexually Transmitted Disease Female/Male (Form DHHS 2808)
3)Note Sheet (DHS2803)
4)Problem List (DHS 2801)
Eligibility
  1. Treatment services are available to all persons in the community who need them. (Drugs used in the treatment of sexually transmitted diseases are provided by the State STD Control Program at no charge to the Health Department or patient).
  2. Private physician referrals and follow-up are encouraged.
  3. Clients presenting for screening on days or times other than those designated by this agency are to:
  1. Return to the health department clinic within one working day or less for evaluation and treatment.
  2. If for some reason the patient cannot be seen within one working day refer him or her to their primary medical doctor.
  3. If the patient does not have a primary physician instruct them to theEmergency Room or Urgent Care.
Charges
  1. Screening and treatment services will be provided to all clients regardless of financial abilities.
  2. Can bill Medicaid and or third party insurance if the patient agrees.
Quality Assurance
  1. There will bequarterly program assessments and evaluation and corrective action plans as indicated.
  2. Clinical record audits will be done according to department policy
Program Procedures
  1. Columbus County Health Department provides screening and treatment services for STD on Monday, Tuesday, and Thursday 1:00pm-3:30pm. Also Wednesday and Friday 8:30am-11:30am.
  2. Columbus County Health Department will assure access to care within one working dayof request for care by clients needing evaluation for symptoms of sexually transmitted infection or for exposure to sexually transmitted infection.
  3. Epidemiology services are provided through STD Control Branch
Routine Clinics
  1. Registration
1.Upon arrival, clients are received at front entrance desk.
2.A registration clerk will obtain record from the files, confirm the client’s name, updates the personal data information, checks record adding forms as needed.
a)Personal Data Sheet
  • Obtain additional information including the number of family members, their names, ages, and relationship to clients.
  • Emergency telephone number(s) will be obtained.
  • Registration staff updates and signs Personal Data Sheet each visit.
Responsibilities STD Clinic Staff
Position Title:
STD Nurse
Position purpose:
Functions in an expanded role providing primary care to patients, who have or are suspected of having, one or more sexually transmitted diseases (STD). The STD program policies and procedures, inclusive of standing orders, are approved by the clinic physician back-up. Coordinates related activities to ensure all common STDs are screened, actively investigated, treated and followed.
Principle Responsibilities:
  1. Provides direct care to patients requesting services including examination, screening and treatment under the STD policies and procedures.
  1. Consults with the medical back-up or the (N.P. or P.A.) according to the clinic guidelines for patients with diagnostic problems or complications, or for any other medical circumstances not covered in the written protocol.
  2. Provides patient education regarding the disease process, treatment, necessary follow-up examinations and the importance of sex partner examination.
  3. Refers patients to other appropriate community resources when findings indicate problems beyond the scope of the STD clinic.
  4. Refers patients for disease intervention follow-up according to established clinic guidelines.
  5. Triage for proper counseling and referral of symptomatic patients who cannot be examined and treated during clinic hours.
  6. Documents all patient records, formsin electronic medical record and reports thoroughly and according to the requirements of each.
  7. Reports deficiencies in charts found through chart reviews to other staff members for correction and review.
  8. ERRN STD nurses coordinate appropriate follow-up examination appointments.
  9. Orders appropriate STD medication from the state office as needed assuring adequate stock.
  10. Reviews all STD clinic pending lab result tests when received for appropriate management and documentation.
  11. Collaborates with regional Disease Intervention Specialist (DIS) in receiving, reporting and follow up of HIV and Syphilis cases.
  12. Participates in staff meetings and continuing education programs sponsored by the clinic or other designated agency.
  13. Assesses available educational resources for utilization with patients and other colleagues.
  14. Maintains adequate and updated inventory of educational materials. Orders supplies (pamphlets, films, videos, etc.) as necessary.
  15. Performs other related duties as assigned.
Reportability:
  1. Director of Nursing
  2. Health Director

Laws and Rules:
10A NCAC 4 1A .0204, 10A NCAC 41 A .0202, 10A NCAC 41 A .0102, 10A NCAC 41 A .0101
Reference(s):
NC Sexually Transmitted Disease Public Health Program Manual
The Pocket Reference Guide for Clinical Evaluation and Treatment of Clients with Sexually Transmitted Infections.

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