Category: Control of Infectious Diseases
Subject: Directly Observed Therapy (DOT) Weekly Report to the TB Clinic
Policy Number: CA.82.01.209
Effective Date: July 24, 2013
To ensure the successful treatment of active tuberculosis (TB), the Ontario Public Health Standard (OPHS), published by the Minister of Health and Long-Term Care under the authority of the Health Protection and Promotion Act (HPPA), requires boards of health to provide management of active cases of TB to minimize the public health risk in accordance with the Tuberculosis Prevention and Control Protocol (2008, or as current). The successful management of a TB case includes having a mechanism in place to provide directly observed therapy (DOT) and to utilize DOT assessment tools to identify compliance or tolerance issues.
Active cases ofTB identified in Wellington-Dufferin-Guelph will have directly observed therapy for a minimum of eight weeks on treatment. Issues with drug tolerance or non-compliance will be reported to the Manager. If the case is being seen at the Public Health Tuberculosis Clinic, the Most Responsible Nurse at the TB Clinic must be advised of compliance or tolerance concerns in advance of the clinic using the Directly Observed Therapy (DOT) Weekly Report Form (HPDTB(F)5).
The Medical Officer of Health (MOH) may modify DOT for clients on a case by case basis based on their individual needs, ability and history of compliance.
Directly observed therapy is considered a gold standard of care for active TB and supports treatment adherence and completion.
This policy and the related procedure apply to all Wellington-Dufferin-Guelph Public Health (WDGPH) employees that provide directly observed therapy and/or TB Clinic support for the Control oflnfectious Diseases (CID) team.
- Orientate new staff to this policy CA.82.01.209 and procedure CA.82.02.209 Directly Observed Therapy (DOT) Weekly Report to the TB Clinic Staff; and
- Ensure the Directly Observed Therapy (DOT) Weekly Report Form (HPDTB(F)5) is used for all clients receiving DOT in Wellington and Dufferin Counties who are being monitored by the Guelph TB Clinic.
- Review the DOT policy CA.82.01.209 and procedure CA.82.02.209 Directly Observed Therapy (DOT) Weekly Report to the TB Clinic Staff;
- Report DOT observations to the Guelph TB Clinic on a weekly basis using the appropriate program form: Directly Observed Therapy (DOT) Weekly Report Form (HPDTB(F)5);
- Review the signs and symptoms of adverse reactions (toxicity and hypersensitivity) to TB
- Report any/all adverse reactions promptly to Manager or Supervisor; and
- Report all noncompliance concerns or drug intolerance to Manager/Supervisor.
Directly Observed Therapy (DOT) -DOT is the process used by WDGPH to observe the patient diagnosed with active TB, swallow each dose of medication/daily. Standard DOT refers to DOT provided through the initial and continuation stage. DOT can be modified for part of the treatment period at the discretion of the MOHand/or Respirologist based on weekly DOT reports which indicate a client’s ability, history of compliance and drug tolerance.
REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES
Corresponding Procedure: CA.82.02.209 Directly Observed Therapy (DOT) Weekly Report to the TB Clinic Staff
CA. 82.01.201 and CA.82.02.201 TB Clinic
CA. 82.01.206 and CA.82.02 206 TB Active Case Investigation
CA. 82.01.207 and CA.82.02.207 Tuberculosis Directly Observed Therapy
CA.86.01.103 and CA.86.02.103 Notebook Documentation
CA.86.01.105 and CA.86.02.105 Documentation
Health Protection and Promotion Act
Canadian Tuberculosis Standards (as current)