Guidance Towards Best Practice in Travel Medicine
Introduction
As the practice of travel medicine evolves and more nurses and physicians are delivering travel medicine services, it is important to develop guidelines to practice. ISTM has developed and is offering a certificate exam (CTH) that has helped to set a standard for knowledge in travel health. Many practitioners in travel medicine have also begun to request and/or develop guidelines and standards for practice to help ensure quality and consistent practice.
The Nurse Professional Group (NPG) Officers (and previous committee members of the Practice and Nursing Issues group) have brought together some of the guidelines and standards already developed (Section A) and their collective opinion on the provision of a travel health service (Section B).
Please note, the International Society of Travel Medicine (ISTM) does not officially endorse these standards and opinions - they are provided for information purposes only.
Top of page
Section A
The following information forms a reference for those who wish to review guidelines, standards and recommendations from various countries and specialty groups. They represent important resource for those new to the field and for more experienced practitioners wishing to expand their practice. They can help provide a framework for practice and training of new staff members. These guidelines are not exhaustive and they reflect the practice standards of the professional group or country in which they were developed so there will be variation according to specific national guidance.
United Kingdom (UK)
United States (US)
- Infectious Disease Society of America www.idsociety.org Go to Practice Guidelines and Standards: Other guidelines: Travel Medicine - or found directly on www.idsociety.org/content.aspx?id=4434#tm
- American Travel Health Nursing Association ATHNA www.athna.org Go to Scope and Standards for practice and professional standards consistent with ANA guidelines. Site also includes select policies and procedures. Go to Resources / Links.
Canada (CA)
NPG would welcome information on any other guidelines that may exist so that this resource may be expanded.
Additional links to travel medicine, vaccination and other important information may be found on the "Non ISTM Links" tab from the ISTM web-site home page.
Top of page
Section B
The following recommendations are the consensus of the Nurses Professional Group only. They are offered as useful information and a resource for travel health clinicians who seek to develop guidelines for professional performance. These recommendations are offered in two categories of practice: the generalist and the specialist levels.
What is involved in providing travel health service?
Travel medicine is an evolving specialty, which has developed in response to the needs of travelers and those practicing in the field. The type of services available varies from general to highly specialist.
A general travel health service should include the following:
- Comprehensive travel health risk assessments to allow for the planning of services such as health advice, immunizations and malaria prevention
- Provision of general travel health advice on numerous topics such as prevention and treatment of travelers’ diarrhea, prevention of mosquito bites, HIV and blood borne virus awareness in the travel context
- Information and education on the prescription, provision and administration of "routine" travel vaccines including those recommended specifically for travel purposes (e.g. typhoid and hepatitis A) and updates of national schedule vaccines
- Information and education on, together with the prescription and provision of, malaria chemoprophylaxis.
A more specialist travel health service should include all of the above with the addition of some (or all) of the following:
- provision of more specialist advice such as use of emergency standby malaria medication, post-exposure prophylaxis following blood-borne virus exposure (e.g. for medical electives)
- specialist advice for travelers with underlying medical conditions or who are travelling during pregnancy. This will include the prescription, provision and administration of vaccines to individuals with special needs (for example those with underlying medical conditions, the immune-compromised, pregnant women and children)
- Provision of specialist advice for travelers with complicated itineraries which may also require the prescription, provision and administration of more "unusual" travel vaccines such as Japanese B encephalitis, rabies, tick-borne encephalitis vaccine, BCG
- The prescription, provision and administration of yellow fever vaccine
- The provision and vending of travel health related equipment such as water purification filters, mosquito repellents and nets etc.
- Clinical education for health care professionals who wish to expand their own travel health services.
What should be included in Practice Guidelines
- Practitioner education
- Recommendations of essential and other resources
- Recommendations on the basic elements of best practice (quality indicators) with which one can measure best practice.
- Practitioner Education
It is essential that practitioners stay updated and ensure that they are following best practice.
Those providing a general travel health service should:
- Join the ISTM and appropriate regional/national travel medicine/health groups
- Regularly (i.e. at least once per year) attend a local, national or international study day or conference
- Obtain a travel medicine qualification e.g. "the ISTM Certificate of Knowledge" or a "foundation" course in travel medicine
- Use recommended resources to keep up to date with changes such as disease outbreaks and world events
- Monitor national and international (WHO) web-sites devoted to travelers health for timely updates on outbreaks and recommendations
Those providing a more specialist travel health service are recommended to also:
- Obtain a postgraduate qualification in travel medicine and/or allied field of practice
- Contribute to the growing body of knowledge of travel medicine e.g. participate in study days and seminars, discussion fora, and online surveillance systems (such as "Listserve" etc.).
- Be Involved in research where an opportunity arises
- Be active in a travel health professional organization.
- Utilization of Essential and Other Resources
Travel Medicine is a rapidly evolving specialty and as such it is essential that practitioners utilize recognized, reliable and up to date resources. Use of an authoritative online travel health website is considered necessary for this (e.g. a national site such as that from the Centers for Disease Control and Prevention (CDC) or an international site such as that from the World Health Organization (WHO).
- Recommendations for and measuring of best practice
General recommendations for best practice:
- Always follow your national professional code of conduct and be familiar with relevant medico-legal practice standards
- Be aware of and keep up to date with relevant issues
- Apply evidence based research to clinical practice and work to establish policies and procedures and/or protocols
- Be able to make clinical judgments and decisions as appropriate
- Work effectively as a team member
- Maintain authentic records of advice and procedures
- Provide accurate and consistent advice
- Know where and when to access information or seek further advice
- Know when to admit an inability to cope or lack of knowledge or skills
- Know when and how to refer to a more specialist service.
Recommendations specific to travel health:
- Understand the concept of risk assessment and know how to carry out risk assessment effectively
- Learn about common travel related illness, disease and other hazards
- Learn about geography especially for popular destinations
- Be flexible and be able to prioritize in situations where patients’ time or finances do not allow the optimum recommendations
- Have a thorough understanding of the principles of vaccine storage, administration and theory
- Have an excellent vaccine administration technique
- Allow for sufficient time to provide adequate services to travelers. It is suggested that a minimum of a 20 - 30 minute consultation appointment per person is necessary to exercise best practice. Travelers with more complex needs, for example, backpackers, will require a longer appointment time.
Measuring best practice through:
- Formal appraisal in the workplace by clinical manager, team leader or peers
- Undertaking regular practice audits - using best practice standards/quality indicators to benchmark own practice
- Customer satisfaction surveys