PDF Standard Nurse Protocols for Registered Professional Nurses ...

STANDARD NURSE PROTOCOLS FOR

REGISTERED PROFESSIONAL NURSES IN PUBLIC HEALTH

2018

Office of Nursing

Revised January 2019

Georgia Department of Public Health Nurse Protocols for Registered Professional Nurses

2018

TABLE OF CONTENTS UPDATES TO 2018 NURSE PROTOCOLS ....................................... 9 INTRODUCTION TO NURSE PROTOCOLS ................................... 13 THE NURSE PROTOCOL PROCESS.............................................. 17

A. MECHANISM FOR NURSE PROTOCOL DEVELOPMENT, REVIEW AND REVISION .................................. 17 B. General TimeLine for BIAnnual Review and Update of Nurse Protocols (ODD-NUMBERED YEARS) ... 19 C. TOOL FOR REVIEWING NEW NURSE PROTOCOLS ................................................................................. 21 D. STANDARD FORMAT FOR NURSE PROTOCOLS ..................................................................................... 21 E. WORD PROCESSING FOR NURSE PROTOCOLS ...................................................................................... 22 F. CERTIFIED NURSE PROTOCOL REVIEW FORM....................................................................................... 25 G. ACKNOWLEDGMENTS ........................................................................................................................... 26

GUIDELINES FOR NURSE PROTOCOLS ...................................... 32

A. Purpose ................................................................................................................................................. 32 B. Definitions ............................................................................................................................................. 32 C. Drugs to be Covered by Nurse Protocol................................................................................................ 33 D. Drugs covered by NURSE PROTOCOL Or Other Policy or procedure .................................................... 34 E. REQUIREMENTS FOR A REGISTERED PROFESSIONAL NURSE WHO USES A NURSE PROTOCOL ........... 35 F. LICENSED PRACTICAL NURSES............................................................................................................... 36 G. Requirements for Nurse Protocols........................................................................................................ 36 H. Delegated Authority for Ordering Dangerous Drugs ............................................................................ 36 I. DISPENSING DANGEROUS DRUGS......................................................................................................... 37 J. Accountability........................................................................................................................................ 38 K. Signing Nurse Protocol Agreements ..................................................................................................... 38 L. EXAMPLE nurse protocol signature page .............................................................................................. 40 M. EXAMPLE Nurse protocol for administering vaccines ....................................................................... 41 N. EXAMPLE emergency nurse protocol agreement ................................................................................. 42 O. Retention of Nurse Protocols ................................................................................................................ 44 P. NURSE Protocol agreement formats for APRNS ................................................................................... 44 Q. GENERAL TEMPLATE for aprn nurse protocol agreement .................................................................... 46 R. TEMPLATE for Women's Health nurse protocol agreement................................................................. 48 S. TEMPLATE for HIV nurse protocol agreement ...................................................................................... 50 T. EXAMPLE Drug Formulary for advanced practice registered nurses .................................................... 53

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Georgia Department of Public Health Nurse Protocols for Registered Professional Nurses

2018

U. TEXTS/REFERENCES USED/RECOMMENDED FOR APRNS ..................................................................... 56

DRUG DISPENSING PROCEDURE................................................. 61

A. Definitions ............................................................................................................................................. 62 B. General Requirements .......................................................................................................................... 63 C. Drug Storage and Record Keeping ........................................................................................................ 64 D. Outdated, Deteriorated, Returned and Recalled Drugs........................................................................ 67 E. Inventory ............................................................................................................................................... 68 F. Labeling and Appropriate Containers ................................................................................................... 68 G. Patient Counseling Components ........................................................................................................... 69 H. Drug Programs/Contracts ..................................................................................................................... 71 I. Dispensing/Administering of 340B and 340B PVP Products ................................................................. 72 J. ADDITIONAL INFORMATION ................................................................................................................. 73

TRANSPORTING DANGEROUS DRUGS ....................................... 78

A. PURPOSE ............................................................................................................................................... 78 B. ACCOUNTABILITY STANDARDS.............................................................................................................. 79 C. TRANSPORTING DANGEROUS DRUGS TRAINING COMPONENTS ......................................................... 79 D. Example of acknowledgement of completion of transporting dangerous drugs training components81

ORIENTATION, TRAINING, AND QUALITY ASSURANCE............ 84

A. Initial Orientation and Training ............................................................................................................. 84 B. Continuing Education/Training ............................................................................................................. 84 C. Documentation of Training ................................................................................................................... 85

CHILD HEALTH NURSE PROTOCOLS .......................................... 89

STANDARD NURSE PROTOCOL FOR MILD ACNE ....................................................................................... 90 STANDARD NURSE PROTOCOL FOR PEDIATRIC ALLERGIC RHINITIS ......................................................... 95 STANDARD NURSE PROTOCOL FOR IMPACTED CERUMEN/EARWAX..................................................... 105 STANDARD NURSE PROTOCOL FOR CONJUNCTIVITIS............................................................................. 109 STANDARD NURSE PROTOCOL FOR CONSTIPATION............................................................................... 117 STANDARD NURSE PROTOCOL FOR CRADLE CAP ................................................................................... 126 STANDARD NURSE PROTOCOL FOR ATOPIC DERMATITIS (ECZEMA)...................................................... 129 STANDARD NURSE PROTOCOL FOR MILD CONTACT DERMATITIS ......................................................... 136 STANDARD NURSE PROTOCOL FOR DIAPER DERMATITIS (DIAPER RASH).............................................. 142 STANDARD NURSE PROTOCOL FOR DYSLIPIDEMIA SCREENING............................................................. 146

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Georgia Department of Public Health Nurse Protocols for Registered Professional Nurses

2018

STANDARD NURSE PROTOCOL FOR FEVER ............................................................................................. 152 ACETAMINOPHEN ................................................................................................................................... 154 IBUPROFEN CHILDREN'S SUSPENSION & CHEWABLE TABLETS .............................................................. 155 STANDARD NURSE PROTOCOL FOR IMPETIGO ....................................................................................... 160 STANDARD NURSE PROTOCOL FOR TREATMENT OF IRON DEFICIENCY ANEMIA .................................. 167 STANDARD NURSE PROTOCOL FOR OTITIS EXTERNA ............................................................................. 177 STANDARD NURSE PROTOCOL FOR PEDICULOSIS CAPITIS (HEAD LICE) ................................................. 182 STANDARD NURSE PROTOCOL FOR PINWORMS .................................................................................... 193 STANDARD NURSE PROTOCOL FOR RINGWORM: .................................................................................. 198 STANDARD NURSE PROTOCOL FOR RUBRAL/HEAT RASH....................................................................... 202 STANDARD NURSE PROTOCOL FOR SCABIES .......................................................................................... 206 STANDARD NURSE PROTOCOL FOR TEETHING ....................................................................................... 213 STANDARD NURSE PROTOCOL FOR THRUSH (ORAL CANDIDIASIS) ........................................................ 219 STANDARD NURSE PROTOCOL FOR TINEA PEDIS ................................................................................... 224 STANDARD NURSE PROTOCOL FOR UPPER RESPIRATORY INFECTION ................................................... 228

DIABETES MELLITUS IN ADULTS NURSE PROTOCOLS.......... 236

STANDARD NURSE PROTOCOL FOR DIABETES MELLITUS IN ADULTS..................................................... 238 APPENDIX A Clinical Tasks in the Care of Patients with Diabetes ........................................................... 265 APPENDIX B Clinical Tasks in the Follow-up Care of Patients with Diabetes .......................................... 267 APPENDIX C Treatment Algorithm of Type 2 Diabetes ........................................................................... 269 APPENDIX D Summary of Recommendations for Adults with Diabetes ................................................. 271 APPENDIX E Correlation between A1C level and mean plasma glucose levels on multiple testing over 2? 3 months ................................................................................................................................................. 273 APPENDIX F Management of Lipids in Patients with Diabetes ............................................................... 276 APPENDIX G Referral Sources for DSME/T and DPP/Lifestyle Change Programs ................................... 280

EMERGENCY GUIDELINES, POLICIES, PROCEDURES AND PROTOCOLS.................................................................................. 286

GUIDELINES FOR EMERGENCY KITS/CARTS IN PUBLIC HEALTH CLINIC SITES ......................................... 287 STANDARD NURSE PROTOCOL FOR ALTERED LEVEL OF CONSCIOUSNESS, SYNCOPE AND/OR SEIZURE ACTIVITY .................................................................................................................................................. 291 GUIDELINES FOR ALLERGIC REACTIONS, INCLUDING ACUTE ANAPHYLAXIS IN ADULTS, INFANTS AND CHILDREN ................................................................................................................................................ 294 POLICY FOR REVIEWING EMERGENCY PROTOCOLS/PROCEDURES IN PUBLIC HEALTH CLINIC SITES..... 307 EMERGENCY CHECKLIST FOR PUBLIC HEALTH CLINIC SITES ................................................................... 308

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Georgia Department of Public Health Nurse Protocols for Registered Professional Nurses

2018

EVALUATION TOOL FOR PRACTICE DRILL................................................................................................ 310 STANDARD NURSE PROTOCOL FOR SHOCK/HEMORRHAGE................................................................... 312 GUIDELINES FOR SUSPECTED OPIOID OVERDOSE................................................................................... 316

HIV .................................................................................................. 325

RECOMMENDATIONS FOR USE OF THE HIV/AIDS-RELATED STANDARD NURSE PROTOCOLS ............... 326 STANDARD NURSE PROTOCOL FOR CONTINUATION OF ANTIRETROVIRAL THERAPY IN HIV-INFECTED ADULT...................................................................................................................................................... 327 STANDARD NURSE PROTOCOL FOR DISSEMINATED MYCOBACTERIUM AVIUM COMPLEX PROPHYLAXIS IN HIV-INFECTED ADULT.......................................................................................................................... 334 STANDARD NURSE PROTOCOL FOR HERPES ZOSTER (SHINGLES) IN HIV-INFECTED ADULT................... 343 STANDARD NURSE PROTOCOL FOR NEW ONSET (ACUTE) DIARRHEA IN HIV-INFECTED ADULT............ 352 STANDARD NURSE PROTOCOL FOR ORAL CANDIDIASIS IN HIV-INFECTED ADULT ................................. 361 STANDARD NURSE PROTOCOL FOR OROLABIAL HERPES SIMPLEX IN HIV-INFECTED ADULT................. 368 STANDARD NURSE PROTOCOL FOR PCP PROPHYLAXIS IN HIV-INFECTED ADULT .................................. 375 STANDARD NURSE PROTOCOL FOR PERSISTENT (CHRONIC) DIARRHEA IN HIV-INFECTED ADULT ........ 383 STANDARD NURSE PROTOCOL FOR PRE-EXPOSURE PROPHYLAXIS (PrEP) USE IN THE PREVENTION OF HIV ........................................................................................................................................................... 394 Appendix A: Clinician Determination of HIV Status for PrEP Provision .................................................. 407 Appendix B Risk Behavior Assessment Tables ........................................................................................ 408 Appendix C: Paying for PrEP Patient Insurance....................................................................................... 410 STANDARD NURSE PROTOCOL FOR SEBORRHEIC DERMATITIS IN HIV-INFECTED ADULT ...................... 412 STANDARD NURSE PROTOCOL FOR TOXOPLASMOSIS PROPHYLAXIS IN HIV-INFECTED ADULT ............ 420

IMMUNIZATION .............................................................................. 429

Childhood and Adult Immunization Program ......................................................................................... 430

OTHER INFECTIOUS DISEASES .................................................. 433

STANDARD NURSE PROTOCOL FOR AMEBIASIS, UNCOMPLICATED (Amebic Colitis)............................. 434 STANDARD NURSE PROTOCOL FOR PREVENTIVE TREATMENT OF HAEMOPHILUS INFLUENZAE TYPE b (Hib) DISEASE CONTACTS ........................................................................................................................ 440 STANDARD NURSE PROTOCOL FOR PREVENTIVE TREATMENT OF INVASIVE MENINGOCOCCAL DISEASE CONTACTS, INCLUDING MENINGITIS ...................................................................................................... 447 STANDARD NURSE PROTOCOL FOR PREVENTATIVE TREATMENT OF PERTUSSIS CONTACTS ................ 456 STANDARD NURSE PROTOCOL FOR IDENTIFICATION AND TREATMENT OF PROBABLE PERTUSSIS CASES ................................................................................................................................................................. 462 STANDARD NURSE PROTOCOL FOR RHEUMATIC FEVER - PROPHYLACTIC ANTIBIOTIC THERAPY.......... 470

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