MONTANA STATE UNIVERSITY COLLEGE OF NURSING A-20 Procedure

Similar documents
SE WI Nursing Alliance and WI State-wide Health Requirements. for Students/Faculty Starting Clinical Rotations

HOFSTRA UNIVERSITY DEPARTMENT OF PHYSICIAN ASSISTANT STUDIES

Wisconsin State-wide Health Requirements for Students Starting Clinical Rotations

CUSOM Student Health Immunization Requirements

Allied Health STUDENT HEALTH AND SAFETY DOCUMENTATION CHECKLIST

Student Health Requirements Master of Arts, Biomedical Sciences Program

Port Gamble S'Klallam Tribe POLICIES/PROCEDURES. Employee Immunity Assessment and Immunization Policy

Explanation of requirements for clinical experiences HFU

SCHOOL OF MEDICINE IMMUNIZATION COMPLIANCE FORM

UNIVERSITY OF WISCONSIN-MADISON SCHOOL OF PHARMACY. Health Policies

Hospital-based Massage Training Program Admissions Check List

Student and Learner Placement Service Immunization & Infectious Diseases Screening

CUYAHOGA COMMUNITY COLLEGE HEALTLH CAREERS PROGRAMS IMMUNIZATION FORM

Surgical Technology Program Check List

Summary of Immunization Options

Student Health and Immunization Record

Clinical Passport Tutorial

Doctor of Pharmacy Program Required Immunization Form

PRE-CLINICAL HEALTH REQUIREMENTS (PCHR) RANGOS SCHOOL OF HEALTH SCIENCES

Clinical Passport Tutorial

UNDERGRADUATE NURSING MANDATORIES INFORMATION

PRE-CLINICAL HEALTH REQUIREMENTS (PCHR) DUQUESNE UNIVERSITY SCHOOL OF PHARMACY

MUSC Student Pre-Matriculation Requirements Instructions for Completion of Form

Health Careers and Nursing Immunization and Health Requirement Form

Healthcare Requirements for Health Science Students To Be Completed by your Primary Healthcare Provider

Ministry of Health, Screening and Vaccination Requirements from 1 January 2019

Physician Assistant Program Required Immunization Form

Health Careers and Nursing Immunization and Health Requirement Completion Guide

PRE-CLINICAL HEALTH REQUIREMENTS (PCHR) DUQUESNE UNIVERSITY SCHOOL OF PHARMACY

Wisconsin Indianhead Technical College Allied Health and Nursing Divisions Health Form

FULL-TIME ADULT STUDENT Acceptance Package Phase II

Personal Information Name Campus Housing Resident Commuter Student ID Number Date of Birth Sex

MS MEDICAL LABORATORY SCIENCE MANDATORIES INFORMATION

DO NOT SEPARATE THESE FORMS

NOSM Learner Immunization Form

Immunization Policy. "UIC/COD-sponsored graduate education program" is one for which UIC/COD maintains academic responsibility.

THIS FORM IS FOR MEDICAL STUDENTS ONLY IMMUNIZATION RECORD

Compliance Requirements for Physician Assistant Students

Dear Student, Welcome to the University of Chicago!

Madison College School of Health Education. Health Forms & Immunization Requirements

Dear New USC Student,

PRE-CLINICAL HEALTH REQUIREMENTS (PCHR)-Freshman,Transfer, 2nd Degree Nursing

Student Health Services 881 Commonwealth Ave, West / Student Information (To be completed by the student) Student Name Last First Middle

Rutgers School of Nursing Center for Professional Development 65 Bergen Street, Room Newark, New Jersey 07107

New Student Health Form

Vice Chancellor, Health Affairs & Dean, School of Medicine Vice Chancellor & Dean s Office Origination Date: 05/20/2013 Date of Revision: Scope:

Student Health Record

RUTGERS POLICY. Errors or changes? Contact: Rutgers University Occupational Health Department

Step-by-Step Immunization Compliance Guide STUDENT HEALTH SERVICES

Preadmission Health History and P hysical for NOVA Nursing Programs

IMMUNIZATION AND MEDICAL HISTORY FORM

Dear New USC Health Science Campus Student,

Dear USC Visiting Student,

UNDERGRADUATE NURSING MANDATORIES INFORMATION

Your completed Health Record and any laboratory results must be uploaded to the Student Health Portal at: shac.usciences.edu

SHENANDOAH UNIVERSITY HEALTH FORM

Health Clearance FAQ s

PRE-ENTRANCE MEDICAL RECORD PART I: GENERAL INFORMATION-

COFM Immunization Policy 2016

Dear New USC Health Science Campus Student,

The University of Toledo Medical Center and its Medical Staff, Residents, Fellows, Salaried and Hourly employees

IMMUNIZATION REQUIREMENTS FORM

POLICY TITLE: HEALTH CARE PERSONNEL IMMUNIZATION Former Policy Title: DOCUMENT NAME: Health Care Personnel Immunization Policy-LG Health

Student Health Services 100 East Brown Street (Phone)

Vulnerable Sector Police

Vulnerable Sector Police

Clinical Preparedness Permit (Revised June 2018)

Fax MUSC Student. standards is done. to protect the. 1. and both. may. is non immune

DO NOT SEPARATE THESE FORMS

Washtenaw County Community Mental Health HEALTH CARE PERSONNEL (HCP) VACCINES (RECOMMENDED EMPLOYEE IMMUNIZATIONS)

Dear New WUSM Student:

How to Submit Your Preregistration Requirements

Signature of student Date Signature of parent or guardian (if student is a minor) Date

IMMUNIZATION & PHYSICAL FORM

Nursing and Midwifery students only. Section 1: Information

Student Immunisation Record Faculty of Medicine. Section 1: Information. Notes

Health Card #: Expiry date: Province: Address (during academic program): Apt. #: City: Province: Country: Postal/Zip Code: Address: Apt.

HOW TO COMPLETE YOUR STUDENT IMMUNISATION RECORD FORM

EMT-Intermediate Certification Class Requirements

COFM Immunization Policy

Penn State New Kensington Radiological Sciences Program Physical Examination

CNHP IMMUNIZATION RECORD (7 TOTAL PAGES) MENINGOCOCCAL FORM

How to obtain vaccination records

IMMUNIZATION & PHYSICAL FORM

Congratulations on your admission to Samuel Merritt University. Welcome to the SHAC! (Student Health and Counseling)

Michael G. DeGroote School of Medicine Visiting Student Electives Program Health Screening Record

N E W Y O R K M E D I C A L C O L L E G E A M E M B E R O F T H E T O U R O C O L L E G E A N D U N I V E R I S T Y S Y S T E M

PLACEMENT OPERATIONS - FREQUENTLY ASKED QUESTIONS

EL CENTRO COLLEGE CENTER FOR ALLIED HEALTH AND NURSING HEALTH OCCUPATIONS ADMISSIONS

Examples COMPLETED. Immunization Forms

Student Health Record

HUMBER COLLEGE & UNIVERSITY OF GUELPH-HUMBER

Policies and Procedures SECTION:

RED RIVER COLLEGE IMMUNIZATION/TESTING INFORMATION SHEET

Radford University School of Nursing GRADUATE HEALTH RECORD FORM

IMMUNIZATION & PHYSICAL FORM

Prior to starting at the University of the Pacific, there are several health clearance requirements that need to be completed.

3. State any instructions or limitations with which the student has been advised to comply. Please mark N/A if not applicable.

Name: RUID: Last, First MI This section is to be completed by the students' licensed healthcare provider. VACCINE Dose #1 Date

Transcription:

MONTANA STATE UNIVERSITY COLLEGE OF NURSING A-20 Procedure PROCEDURE: The MSU College of Nursing follows the procedures recommended by the Centers for Disease Control and Prevention and outlined by the Immunization Action Coalition at http://www.immunize.org/catg.d/p2017.pdf or Attachment A. In addition to the CDC procedures for MMR, Hepatitis B, Tdap, Varicella, and Influenza, all students and faculty are required to sign and submit the HBV Seroimmunity Status/Documentation form (Attachment C). All students and faculty without seroimmunity are required to meet with the appropriate Campus Director for counseling. Tuberculosis Students and faculty must provide a negative screening result for Tuberculosis to establish a baseline prior to clinical coursework. This will include one of the following: 1) evidence of serial Tuberculosis Skin Tests (TST) with no more than 12 months between series, 2) a two-step TST, or 3) a negative interferon gamma release assay (IGRA). Documentation of TSTs must include the dates the test was placed and read as well as the results of the test in millimeters. Students and faculty with a positive TST (depending on risk may be an induration greater than or equal to 5 mm, 10 mm, or 15 mm) will be assessed for risk and appropriately referred to their private health care provider for follow-up. Written clearance from their private health care provider will be required to participate in clinical courses. Standard Precautions All health care workers should routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood and other body fluids of any patient/client is anticipated. For a full description of the procedures students and faculty are expected to use see the World Health Organization s Standard Precautions in Health Care (October 2007) at www.who.int/csr/resources/publications/epr_am2_e7.pdf or facility policy. All students and faculty will complete an annual training on Standard Precautions on each campus.

Attachment A Immunization Recommendations

TABLE #1-MSU CON Immunization Requirements- Policy #A-20 REQUIREMENT PROCEDURE COMPLETION DEADLINES Tuberculosis: All nursing students are screened annually for tuberculosis (TB)* Measles Mumps Rubella (MMR): All students must provide evidence of adequate immunity via proof of prior vaccination for MMR. *If the student has had no test, or no recent test (within 2 years), a two-step skin test must be done to provide a baseline. NEW APPLICANT OR NO EVIDENCE OF ANNUAL TB TESTS past 2 years*: 1. If the student has had no test, or no recent test (within 2 years), a twostep skin test must be done to provide a baseline. STEP 1: A skin test is administered using Purified Protein Derivative (PPD) and must be read within 48-72 hours. STEP 2: If the first skin test is negative, a second PPD skin test is administered within 1-3 weeks after the first one and read within 48-72 hours. Students who interrupt the program of study and who are not able to produce evidence of annual testing while out ot the program, must submit the 2 STEP TESTING. CONTINUING STUDENT: The Student has provided evidence annually of TB tests while in program. 1. One PPD skin test is administered and read within 48-72 hours. If the skin test is positive or converts to positive, a medical evaluation is required. This test must be completed within 10-12 months of the previous annual test. STUDENTS with history of exposure to TB/BCG immunization/sensitivity to PPD Testing: 1. QuantiFERON Gold blood test (lab report required) OR T-Spot blood test (lab report required) POSITIVE TEST RESULTS TO ANY TESTING: If positive results to any of the above, the student MUST submit provider clearance documented on provider letterhead. 1. Applicants born in 1957 or later can be considered immune to Measles Mumps and Rubella (MMR) only if they have one of the following: a. Documentation of laboratory confirmation of disease b. Proof of appropriate vaccination against MMR: i. 2 doses of live measles and mumps vaccines given on or after the first birthday and separated by 28 days or more and at least one does of live rubella vaccine. NEW APPLICANTS: Upon application as a 2 step test process unless able to provide evidence of annual testing CONTINUING STUDENTS: Annually thereafter And Upon return from travel outside the US regardless of when the next annual TB test is due *Students who have interrupted their placement for any reason must either show annual tests results while out of the program, or must submit to a new two-step testing process upon return. Upon application

Hepatitis B (HBV): Students entering undergraduate clinical nursing course work are required to present documentation of serologic evidence of immunity (either by vaccination or previous infection, demonstrated by positive titer) to HBV. A series of three vaccinations is given over 6 months to provide immunization. A titer level is drawn 6 weeks after the last injection to document immunity. If the previously vaccinated student does not have evidence of a responsive post vaccination titer: 1. Complete a booster or challenge dose and obtain a titer post booster 2. If the student does not respond to the challenge dose, complete the series and obtain a final titer. If the student has never been immunized or exposed to Hepatitis B: 1. Complete the Hep B series and provide evidence of a positive antibody titer post vaccination (lab report required) 2. If your series is in process, provide evidence of where you are in the series to CastleBranch. Upon application Varicella: Tetanus, Diphtheria, Acellular Pertussis (Tdap) Note: If the student declines these Hep B requirements, the student must sign the Declination Waiver form. The Declination Waiver is available to download on Castle Branch from this requirement. Students are required to provide one of the following: 1. Documentation of adequate immunity through a positive varicella titer OR 2. Proof of 2 vaccinations OR 3. Medically documented history of disease (date of disease required) 4. If a student s varicella titer level is negative, the student must receive 2 doses of vaccine at an interval of 4-8 weeks between doses. 5. Post vaccination titer after 2 doses of vaccine is not necessary or recommended. One of the following is required: 1. Documentation of a Tetanus, Diphtheria & Pertussis (TDaP) vaccination from anytime AND a Td booster administered within the past 10 years OR 2. Documentation of a Tetanus, Diphtheria & Pertussis (TDaP) vaccination, administered within the past 10 years. FLU vaccine 1. Students should receive annual flu vaccination 2. If a student wishes to decline, he/she must sign a declination waiver and must comply with all clinical agency requirements during flu season as an unvaccinated person. Upon Application Upon Application Annually during flu season Students without valid documentation will not be permitted to attend clinical (will be denied access to clients).

Procedure #A-20 Time Lines Traditional BSN option Fall Applicant (August 1 st ) I. Fall applicants: a. Application is due by August 1 st each year b. Start Upper Division (J1) the following Fall c. Start Sophomore NRSG courses Spring semester before J1 1. Initial Immunization evidence is completed and uploaded by August 1 st when the application is due and isused to begin NRSG 225 clinicals the next Spring semester. a. The College of Nursing utilizes CastleBranch for all background checks, urine drug screens, immunization tracking, CPR verification, and E-learning compliance training b. Students must create a CastleBranch Account before turning in their applications. c. Background checks, urine drug screens, CPR verification, and E-learning must be completed at application deadline d. All Immunization status must be uploaded at application deadline Hepatitis B may be in process TB 2 step may be in process 2. 2nd Back Ground Check is completed by August 1 st and is used to begin J1 clinicals in the Fall. 3. 3rd Back Ground Check is completed by August 1 st and is used to begin S1 clinicals in the Fall. Traditional BSN option Spring Applicant (January 2 nd ) II. Spring applicants: a. Application is due by January 2 nd each year b. Start Upper Division (J1) the following Spring c. Start Sophomore NRSG courses Fall semester before J1 1. Initial Immunization evidence is completed and uploaded by January 2 nd, when the application is due and isused to begin NRSG 225 clinicals the next Fall semester. a. The College of Nursing utilizes CastleBranch for all background checks, urine drug screens, immunization tracking, CPR verification, and E-learning compliance training b. Students must create a CastleBranch Account before turning in their applications. c. Background checks, urine drug screens, CPR verification, and E-learning must be completed at application deadline d. All Immunization status must be uploaded at application deadline Hepatitis B may be in process TB 2 step may be in process 1. 2nd Back Ground Check is completed by January 2 nd and is used to begin J1 clinicals in the Spring. 2. 3rd Back Ground Check is completed by January 2 nd and is used to begin S1 clinicals in the Spring.

ACCELERATED OPTION BSN (ABSN) III. Annual (Fall) Application: a. Application is due by October 15 th each year b. Start the Sophomore Nursing courses the following May c. Start Upper Division in the Fall following the first block of summer course work 1. Initial Immunization evidence is to be completed and uploaded to CastleBranch by October 15 th when the application is due and is used to begin clinical and lab the next May at program start a. The College of Nursing utilizes CastleBranch for all background checks, urine drug screens, immunization tracking, CPR verification, and E-learning compliance training b. Students must create a CastleBranch Account before turning in their applications. c. Background Check, urine drug screens, CPR verification, E-learning must be completed at application deadline d. All immunization status must be uploaded at application deadline Hepatitis B may be in process TB 2 step may be in process 2. 2nd Background Check is completed by October 15 th and is used for continuing clinical compliance through graduation the following August.

GRADUATE STUDENTS 1. Initial Immunization verification is due by August 1 st of the first fall semester of the program of study a. The College of Nursing utilizes CastleBranch for all background checks, urine drug screens, immunization tracking, E-learning compliance training, and CPR and RNlicensure tracking b. Students must create a CastleBranch Account in order to begin the compliance screening process c. All Immunization status must be uploaded by program start Hepatitis B may be in process TB 2 step may be in process 2. Continuing graduate students will receive direction from the graduate program coordinator regarding annual compliance due dates.

Hepatitis B Declination Waiver STUDENT: PHONE: PLEASE INIAL THE CORRECT STATUS OF YOUR HBV TO DATE: 1) I have completed the required HBV vaccination series/final titer (according to Montana State University College of Nursing Policy A-20). Attached is documentation of my seroimmunity status. (Skip to the bottom to sign and date) 2) I have not started the required HBV vaccination series / final titer (according to Montana State University College of Nursing Policy A-20) for the following reasons: [NOTE: If for health reasons, documentation from primary care provider must be attached]. (Initial and complete #4) 3) I have not completed the HBV vaccination series / final titer (according to Montana State University College of Nursing Policy A-20) for the following reasons: [NOTE: If for health reasons, documentation from primary care provider must be attached]. (Initial and complete #4) 4) I have made the following plan to begin / complete the required HBV vaccination series / final titer to determine sero-conversion: (Initial and complete #5) 5) I understand that since I have not started/completed the required HBV vaccination series/final titer (according to Montana State University College of Nursing Policy A-20) and am unable to provide documentation of seroimmunity at this time, I am at increased risk if exposed to the Hepatitis B virus. I hereby agree to personally assume the risks involved and hereby release the college of nursing, Montana State University, its employees and agents, and any agency in which i have clinical experience of any liability should i become infected. Student Signature Date

Flu Declination Waiver MSU College of Nursing and affiliated clinical agencies have recommended I receive influenza vaccination to protect the patients I come into contact with during the course of my clinical rotations. I acknowledge that I am aware of the following facts: Influenza is a serious respiratory disease that kills thousands of people in the United States each year. Influenza vaccination is recommended for me and all other healthcare workers to protect this facility s patients from influenza, its complications, and death. If I contract influenza, I can shed the virus for 24 hours before influenza symptoms appear. My shedding the virus can spread influenza to patients in this facility. If I become infected with influenza, even if my symptoms are mild or non-existent, I can spread it to others and they can become seriously ill. I understand that the strains of virus that cause influenza infection change almost every year and, even if they don t change, my immunity declines over time. This is why vaccination against influenza is recommended each year. I understand that I cannot get influenza from the influenza vaccine. I understand I am required to accept responsibility for compliance with any/all clinical agencies, to which I am assigned, requirements applicable to the prevention or spread of influenza to their patient population. The consequences of my refusing to be vaccinated could have life-threatening consequences to my health and the health of those with whom I have contact, including all patients in the healthcare facility at which I engage in clinical experiences my coworkers/fellow students/faculty my family my community Despite these facts, I am choosing to decline influenza vaccination right now for the following reasons: I understand that I can change my mind at any time and accept influenza vaccination, if vaccine is still available. I have read and fully understand the information on this declination form. Signature: Date: Name (print): Upload this form to CASTLEBRANCH after signing.