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UTI Diagnosis

  • 1.  UTI Diagnosis

    Posted 02-20-2023 11:22

    Does anyone work in an organization that has a standing order or protocol in place for nurses ordering urinalysis or urine cultures for symptomatic patients?



    ------------------------------
    Quiere Robinson MSN, RN, AMB-BC
    Ambulatory Nurse Clinician
    VCU Health
    Henrico VA
    (804)773-9273
    ------------------------------


  • 2.  RE: UTI Diagnosis

    Posted 02-21-2023 07:02

    Hello Quiere, 

    My organization does have a policy in place that allows nurses, both RNs and LPNs to order a urinalysis on a patient based on certain criteria. If the patient meets certain criteria, then the nurse may order the urine through a smartset of orders and certain tests are ran like UA and GCT. If there are any abnormal results from this, then the cosigning provider is notified and then a urine culture is ordered. Hope this information helps. If you have further questions about our process, please feel free to reach out. 

    Quiana 



    ------------------------------
    Quiana Simmons MSN, RN, AMB-BC
    Metrohealth Medical Center
    Cleveland, Ohio
    [216-509-5654
    ------------------------------

    Original Message


  • 3.  RE: UTI Diagnosis

    Posted 02-21-2023 08:39

    Hi Quiana,

    I would love to see you all's policy. Would you mind sharing with me? 



    ------------------------------
    Quiere Robinson MSN, RN, AMB-BC
    Ambulatory Nurse Clinician
    VCU Health
    Henrico VA
    (804)773-9273
    ------------------------------

    Original Message


  • 4.  RE: UTI Diagnosis

    Posted 02-21-2023 08:27

    Good morning, 

    We have a collaborative practice order that allows RNs and LPNs to order a urinalysis w/ reflex if a patient calls with at least two of the following: dysuria, hematuria, frequency, new onset incontinence, urgency, fever, or new lower back or flank pain. 



    ------------------------------
    Katharine Weeks
    Director of Clinical Operations
    Wentworth Douglass Hospital
    ------------------------------

    Original Message


  • 5.  RE: UTI Diagnosis

    Posted 02-21-2023 08:39

    Thank you! I would love to see the set up of you all's order. Would you mind sharing with me? 



    ------------------------------
    Quiere Robinson MSN, RN, AMB-BC
    Ambulatory Nurse Clinician
    VCU Health
    Henrico VA
    (804)773-9273
    ------------------------------

    Original Message


  • 6.  RE: UTI Diagnosis

    Posted 02-21-2023 11:26

    Here are a few examples I found:

     

    Another important consideration is reviewing the Nursing Practice Act to ensure operating under protocol is supported by the state's board of nursing.  

     

    Very respectfully,

    Andrea Kossoudji, MS, MBA, RN, AMB-BC 

    Nurse Educator (detailed)

    NJ War Related Illness and Injury Study Center (WRIISC)

    Field based San Diego, CA

    Mobile: 858-209-0914

     

    Visit WRIISC SharePoint for information on military

    exposures and the Toxic Exposure Screening.

     

    See the source image

     




    Original Message


  • 7.  RE: UTI Diagnosis

    Posted 02-21-2023 13:31

    This is what our P&P states.

    Hope it is what you are looking for.

    Standing Order: Urine POCT or Urine Dipstick Testing

    Purpose:

    To provide guidance for caregivers regarding initiation of screening for urine POC or Urine Dipstick Testing

    Definitions:

    N/A

    Policy:

    1. A patient who presents with complaints of:

    a.     Blood in urine

    b.     Frequent urination

    c.     Abdominal pain

    d.     Difficulty urinating

    e.     Painful urination

    Will have:

                                                                              i.          Urostat POCT (if clinic has Urostat POCT available)
    OR

                                                                            ii.          Urine dipstick (if Urostat POCT is unavailable)

    1. This standing order pertains to:

    a.     Established patients – having been seen in previous year

    b.     Walk-in patients

    c.     Patients calling in with the below symptoms IF they have been seen by a provider in the last 12 months.

    Equipment/Supplies:

    N/A

    Procedure:

    Order Statement
    For patients with a complaint listed in the "Complaint/Diagnosis" column" order the following test

    Epic Procedure Code / Name

    Complaint/Diagnosis (mark all conditions that apply)

    DX Code

    Epic DX ID / Name

    CPT Code
    (Use both CPT Codes)

    POCT

    Urine Collection

    Urostat POCT
    (if clinic has Urostat POCT)

    POC17 -UA Dipstick - Automated

    Frequent urination

    R35.0

    223524 Frequency of micturition

    81000

    99000

    Urine dipstick
    (if Urostat POCT is unavailable)

    POC5 - POCT Urinalysis Dipstick (aka POC Urine - Non-automated

    Painful urination

    R30.9

    1337901 Painful micturition unspecified

    81000

    99000

     

    Hematuria (blood in urine)

    R31.9

    599.70.ICD-9-CM Hematuria, unspecified

    Difficulty urinating

    R39.19

    1387737 Other difficulties with micturition

    Abdominal Pain

    R10.9

    1346885 Unspecified Abdominal pain
    1. If POCT or Dipstick is positive, do not dispose of the urine.
    2. The provider must review results/assess patient and place an order for further testing.
    3. Should the provider order urine to be sent to the lab; below are the orders that will be used.
    4. Dispose of the urine specimen in toilet.

    a.     Do not dispose in a sink.

    1. Dispose of empty urine specimen in regular garbage.

    a.     If empty specimen container contains visible blood, dispose in biohazard waste.

    Lab Test

    Epic Procedure ID / Name

    Use DX codes in above chart for purpose of lab order

    Urinalysis

    POC117 - POC UA w/microscopic (aka urine)

    Urinalysis with reflex to culture

    LAB23323 - Urinalysis, Culture Reflex (aka UA)

    References:

     

     

    Ingrid El Idrissi, RN, BSN, PHN

    Clinical Operations Nursing Manager

    Providence Medical Group

    2725 Myrtle Ave, Suite B

    Eureka, CA 95501

    O 707-269-0644 x 214  C  707-499-2350  F 707-269-9589

     

    A picture containing text, sign Description automatically generated

     

    Graphical user interface, text Description automatically generated

     



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    Original Message


  • 8.  RE: UTI Diagnosis

    Posted 02-21-2023 13:56

    Hi there! We have a standing order for Adult Female Urinary Tract Infection Symptoms (Age 18 years and older).

     

    There are inclusion/exclusion criteria in the standing order.

     

    It was developed through an approval workflow from a variety of SMEs including frontline and system level leadership.

     

    Here are the references utilized in the development:

     

     

     

     

     

     

    Thank you,

     

    LaVetta A. Cummings, BSN, RN

    Director of Nursing and Clinical Practice

    OSF Medical Group & Home Care Services

    124 SW Adams St. | Peoria, IL | 61602

    c: (309) 251-2590 o: (309) 308-6183

    http://www.osfhealthcare.org/

     

    "Serving with the greatest care and love."

     

     

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  • 9.  RE: UTI Diagnosis

    Posted 02-21-2023 15:55

    Hi Lavetta,

    Are you able to share a copy of the standing order, is it for urine cultures, urinalysis, POCT?



    ------------------------------
    Quiere Robinson MSN, RN, AMB-BC
    Ambulatory Nurse Clinician
    VCU Health
    Henrico VA
    (804)773-9273
    ------------------------------

    Original Message


  • 10.  RE: UTI Diagnosis

    Posted 02-22-2023 22:28
    Yes we have a standing order for non pregnant women. 



    Original Message


  • 11.  RE: UTI Diagnosis

    Posted 02-23-2023 09:51

    We also have one in place! 



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    Alison Isabelle BSN, MS, RN
    Manager of Clinical Operations
    UT Southwestern Medical Center
    Dallas TX
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    Original Message


  • 12.  RE: UTI Diagnosis

    Posted 02-23-2023 10:19

    Would love to see what you have developed for non-pregnant women. Are you able to share a copy with me? Thank you.



    ------------------------------
    Quiere Robinson MSN, RN, AMB-BC
    Ambulatory Nurse Clinician
    VCU Health
    Richmond VA
    (804)773-9273
    ------------------------------

    Original Message


  • 13.  RE: UTI Diagnosis

    Posted 02-24-2023 08:25

    We are currently creating standing orders now in the primary care division.  I am happy to share when it is completed.  If anyone has one to share now, it would be appreciated.

     

    Felicia Menefee, RN, MSN, BC, ANP, ACNS,

    Chief Nursing Officer

    Ambulatory Nursing & Advanced Practice Providers

    816-932-1560 (0)

    816-932-2979 (f)

    fmenefee@saint-lukes.org

    _________________________________________

    901 E. 104th Street, Mailstop 300S

    Kansas City, MO 64131

     

     

     

    Saint Luke's Health System Confidentiality Notice

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    Original Message


  • 14.  RE: UTI Diagnosis

    Posted 02-23-2023 10:19

    Would love to see what you have developed for non-pregnant women. Are you able to share a copy with me? Thank you.



    ------------------------------
    Quiere Robinson MSN, RN, AMB-BC
    Ambulatory Nurse Clinician
    VCU Health
    Richmond VA
    (804)773-9273
    ------------------------------

    Original Message


  • 15.  RE: UTI Diagnosis

    Posted 02-24-2023 07:59

    Hi Quiere,

    I work in primary care and do nurse visits regularly for female patients with UTI symptoms. Here is a snip of our standing order. 

    The nurse visit follows our standing rooming process. We review medications, allergies, safety questions, and review their symptoms and vital signs. The nurse will instruct that patient how to collect a clean catch and will order a urinalysis. If the specimen looks like a UTI is present, the provider will treat and order a culture. If negative, the nurse will triage and likely schedule a provider appointment to see why they are having those symptoms.

    Thanks,

    Katie Denslow, RN, AMB-BC



    ------------------------------
    Kathleen Denslow RN
    Maine Medical Partners
    Windham ME
    (207)714-0175
    ------------------------------

    Original Message


  • 16.  RE: UTI Diagnosis

    Posted 02-25-2023 14:30
    Our policy is very similar: 
    image.png

    --
    Lorraine



    Original Message


  • 17.  RE: UTI Diagnosis

    Posted 03-06-2023 18:07

    We have a Clinical Guideline Policy that allows our nurses and MA's to place orders.

    Clinical staff will evaluate and place a power order in Cerner per clinical guidelines for any item listed below. Items that are discussed during the morning structured team meeting should be entered as a verbal communication type.

    1. Lab Tests to include:
      1. COVID-19 Swab when and if patient meets current testing criteria using Olathe Health testing guidelines for PUI.
        • If patient has any high risk symptoms or suspected for higher level of care the nursing staff will NOT place an order for testing and wait for provider to assess the patient.
          NOTE: Nursing staff can still swab the patient but should not proceed with an order until verbal okay from provider.
        • High risk symptoms include, but not limited to:
          • Fever greater than 102
          • O2 saturation less than 94%
          • Elevated heart rate
          • Pleuritic chest pain
      2. Influenza Swab with high fever, cough, runny nose, body aches – if they are less than 3 days duration.
      3. Rapid Strep screen with sore throat, fever, chills, difficulty swallowing, no prominent coughing.
      4. Urinalysis for urinary burning, frequency, urgency and voiding in small quantities.
      5. UCG for confirmation of pregnancy if expected menses has been missed.
      6. UCG for patients who are past due on getting their DepoProvera.
      7. UA Dip for established OB patients.


    ------------------------------
    Shelly Hall RN, CMSRN
    Ambulatory Clinical Practice Development Manager

    Clinical Nursing Education
    Olathe Health Physicians
    13045 South Mur-Len Road| Olathe, KS|66062
    P: 913-355-3665

    Shelly.hall@olathehealth.org
    www.olathehealth.org
    ------------------------------

    Original Message


  • 18.  RE: UTI Diagnosis

    Posted 03-11-2023 00:34

    Yes, we have a standing order protocol. In line with the BRN both RNs and LVNS can initiate an order in our EMR system by using "per protocol, cosign required" based on the criteria in our policy. The order is sent to the provider listed and co-signed, then the results are routed to the provider. MAs can pend the order for the MD to sign as well.



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    Lorraine Macierz, MSN, BSN, RN
    CN lll
    Santa Clara Valley Health & Hospital System
    Gilroy, CA
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    Original Message


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