tcfht-md07 uncomplicated urinary tract infection

LastUpdated16-04-2015byShazmahHussein,RN

Title: UncomplicatedUrinaryTractInfection

Number: TCFHT-MD07

ActivationDate: 18-09-2011 DateReviewed: 16-04-2015ReviewDue: 16-04-2016 Sponsoring/ContactPerson(s)(name,position,contactparticulars):

AlissiaValentinis,MD790Bay,Suite522,Toronto,Ontario416-591-1222

Orderand/orDelegatedProcedure: AppendixAttached:XNoYesTitle:

Usingthisdirective,theimplementerisabletoassess,diagnose,andtreatuncomplicatedurinarytractinfectionsduringin-personpatientencounters.RecipientPatients: AppendixAttached:NoXYes

Title:AppendixA–AuthorizerApprovalFormRecipientsmust:• BeactivepatientsofaTCFHTprimarycareproviderwhohasapprovedthisdirectivebysigning

theAuthorizerApprovalForm• Befemale• MeettheconditionsidentifiedinthisdirectiveAuthorizedImplementers:

AppendixAttached:NoXYesTitle:AppendixB–ImplementerApprovalForm

ImplementersmustbeTCFHTemployedRegulatedHealthCareProvidersorPhysicianAssistant(underthesupervisionofaphysician).ImplementersmustcompletethefollowingpreparationandsigntheImplementerApprovalForm:• Assessownknowledge,skill,andjudgmenttocompetentlyassess,diagnose,andtreat

uncomplicatedUrinaryTractInfection• Review“AcuteUncomplicatedCystitisandPyelonephritisinWomen”fromUpToDate,accessible

fromhttp://www.uptodate.com/contents/acute-uncomplicated-cystitis-and-pyelonephritis-in-

MEDICALDIRECTIVE

TCFHT-MD07_UncomplicatedUrinaryTractInfection


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women?source=search_result&search=acute+uncomplicated+cystitis&selectedTitle=1%7E80• Reviewguidelinesforcollectingamidstreamurinespecimen,accessiblefrom

http://www.nursingtimes.net/nursing-practice/clinical-zones/infection-control/specimen-collection-1-obtaining-a-midstream-specimen-of-urine/1295662.article

• Obtainmostrecenteditionof“Anti-infectiveGuidelinesforCommunity-acquiredInfections”(Anti-InfectiveReviewPanel,2013)andreviewAcuteCystitissection.Canbepurchasedfromhttp://www.mumshealth.com/guidelinestools/anti-infective

• Reviewmechanismsofactionofrecommendedantibioticsinpharmacologyreferencetextand/orCPS

• AnauthorizingPrimaryCareProvidermustsupervise3casesIndications: AppendixAttached:XNoYes

Title:• AdultFemalepatientspresentingwith1ormoreofthefollowing:dysuria,frequency,urgency,

cloudyorstrongsmellingurine,suprapubicpainorpressure,and/orlowbackpain.• Midstreamurinespecimenrevealspresenceofleukocytes(morethantraceamount)orpresence

ofnitrites(anypositive,includingtraceamount)ontestingwithchemicalreagentstrip.• Temperature<38.0CwithoutantipyreticsContraindications:• Male,pediatric,pregnant,postmenopausalpatients,orpatientswithdiabetesand/orsevereor

complexmedicalissues.• Temperature>38.0C,vomiting,orpresenceofcostovertebralangletenderness.• Patienthasahistoryofurinarycalculus.• PatienthasahistoryoffrequentUTI’s(>3inthelastyear).Forpatientspresentingwiththeabovecontraindications,theimplementerobtainshistory,performsaphysicalassessment,documentsfindings,andconsultswiththeprimarycareproviderforfurtherdirectiononpatientcareinatimelymanner.Consent: AppendixAttached:XNoYes

Title:• Patient’sconsentisimpliedforimplementertoassessandtreatuncomplicatedUTI,aspatient

haspresentedseekingtreatment,andisaFamilyHealthTeampatient,whereinterprofessionalpracticeisexpected.

• Patientinformedofpurposeoftesting,includingwhenresultswillbeavailable,andfollowuprequirediftestispositiveornegative.

• Patientabletogiveninformedconsentandiscooperativeanddoesnotneedrestraint.• Patientisinformedoftheimportanceofcontactnotificationintheeventofpositiveresults.GuidelinesforImplementingtheOrder/Procedure:

AppendixAttached:NoYesTitle:AppendixC–SampleLabRequisitionAppendixD–SamplePrescription

ForassessmentandtreatmentofpatientswhomeettheIndicationsdescribedabove:



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• Implementerperformsassessmentincluding:o History(presentingsymptoms,urinecharacteristics,confirmptisnotpregnantby

documentingLMP,pasthistoryofUTIandtreatment,allergiestoantibiotics)o Assessmentforbilateralcostovertebralangletendernesstoruleoutpyelonephritiso Temperature

• Implementerobtainsamid-streamurinesample(instructionsshouldbegiventopatienttoensureasepsisisachieved)andappliespatientlabeltospecimenbottle.Urinespecimenshouldthenbetestedwithchemicalreagentstripusingaseptictechnique.

• Assessurinecharacteristicswiththesampleprovided.• Ifmidstreamurinespecimenrevealspresenceofleukocytes(morethantraceamount)or

presenceofnitrites(anypositive,includingtraceamount),implementercommunicateswithpatientthatshelikelyhasUTI.

• ImplementerdocumentstheassessmentintheeMR,usingTCFHT-MD07stamp.• Implementerprepareslabrequisitionforurinalysisandculture&sensitivitiesusingthe

supervisingprimarycareproviderinitialsinPracticeSolutions.• LabRequisitionshouldbesignedasbelow:

o Signatureo ImplementerName/PrimaryCareProviderName(MedicalDirectiveTCFHT-MD07)

• ImplementerpreparesPrescriptionusingthesupervisingprimarycareproviderinitialsinPracticeSolutions.

• Prescriptionshouldbesignedasbelow:o Signatureo ImplementerName/PrimaryCareProviderName(MedicalDirectiveTCFHT-MD07)

• Implementerprovidespatientwitheducationofcommonsideeffectsofantibioticprescribed,whentoexpectresolutionofsymptoms,whentoseekfurthermedicalassistance,andpreventionoffutureUTIs(frequentvoiding,increasingfluidconsumption,perinealhygiene,voidingaftersexualactivity,andpotentialbenefitsofpurecranberryjuice(Jepson&Craig,2008).

• Implementertofollowupwithlabresultspromptlywhenavailableandreviewwiththepatient’sprimarycareprovider.

DocumentationandCommunication: AppendixAttached:NoXYes

Title:AppendixE–TCFHT-MD07Stamp• Documentationinthepatient’seMRneedstoinclude:nameandnumberofthedirective,name

oftheimplementer(includingcredential),andnameofthephysician/nursepractitionerauthorizerresponsibleforthedirectiveandpatient,usingthefollowingPSSStamp:TCFHT-MD07_Uncomplicated_Urinary_Tract_Infection

• Informationregardingimplementationoftheprocedureandthepatient’sresponseshouldbedocumented,inthepatient’seMR,inaccordancewithstandarddocumentationpractice(CollegeofNurses,2008).

• Standarddocumentationisrecommendedforprescriptions,requisitions,andrequestsforconsultation.



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• ImplementerwillsendamessageinPracticeSolutionstopatient’sprimarycareprovider,notifyinghim/herthatpatientwasseen,andtoreviewnoteineMRfordetails.

ReviewandQualityMonitoringGuidelines: AppendixAttached:XNoYes

Title:• Routinereviewwilloccurannuallyontheanniversaryoftheactivationdate.Reviewwillinvolve

acollaborationbetweentheauthorizingprimarycareprovidersandtheauthorizedimplementers.

• Atanysuchtimethatissuesrelatedtotheuseofthisdirectiveareidentified,TCFHTmustactupontheconcernsandimmediatelyundertakeareviewofthedirectivebytheauthorizingprimarycareprovidersandtheauthorizedimplementers.

• Thismedicaldirectivecanbeplacedonholdifroutinereviewprocessesarenotcompleted,orifindicatedforanadhocreview.Duringthehold,implementerscannotperformtheproceduresunderauthorityofthedirectiveandmustobtaindirect,patient-specificordersfortheprocedureuntilitisrenewed.

• Ifnewinformationbecomesavailablebetweenroutinereviews,suchasthepublishingofnew“Anti-infectiveGuidelinesforCommunity-aquiredInfections”,andparticularilyifthisnewinformationhasimplicationsforunexpectedoutcomes,thedirectivewillbereviewedbytheauthorizingphysician/nursepracititionerandamimimumofoneimplementer.

References:Anti-infectiveReviewPanel.(2013).Anti-infectiveGuidelineforCommunity-acquiredInfections.Toronto:MUMSGuidelineClearinghouse.CollegeofNursesofOntario.(2008).PracticeStandard:Documentation.Retrievedfromhttp://www.cno.org/Global/docs/prac/41001_documentation.pdfGuptaetal.(2011).InternationalClinicalPracticeGuidelinesfortheTreatmentofAcuteUncomplicatedCystitisandPyelonephritisinWomen:A2010UpdatebytheInfectiousDiseasesSocietyofAmericaandtheEuropeanSocietyforMicrobiologyandInfectiousDiseases.ClinicalInfectiousDisease,52,e102-120.Higgins,D.(2008).SpecimenCollection1.Obtainingamidstreamspecimenofurine.Retrievedfromhttp://www.nursingtimes.net/nursing-practice/clinical-zones/infection-control/specimen-collection-1-obtaining-a-midstream-specimen-of-urine/1295662.articleHooton,T.,&Gupta,K.(2014).AcuteUncomplicatedCystitisandPyelonephritisinWomen.Retrievedfromhttp://www.uptodate.com/contents/acute-uncomplicated-cystitis-and-pyelonephritis-in-women?source=search_result&search=uti&selectedTitle=2%7E150Jepson,RG.,&,Craig,JC.(2008).Cranberriesforpreventingurinarytractinfections.CochraneDatabaseSystematicReviews,Jan23;(1):CD001321.



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Wagenlehner,F.,Weidner,W.,&Naber,K.(2009).Anupdateonuncomplicatedurinarytractinfectionsinwomen.CurrentOpinioninUrology,2009(19),368-374.NOTE:ThismedicaldirectiveisbasedonTCFHT’spreviousmedicaldirectiveRN-1UTIentitled,“Assessment,Diagnosis,andTreatmentofUncomplicatedUrinaryTractInfections(UTI),”whichrequiredrevisioninformattingtoreflectthegrowthoftheTCFHTorganization.ThemajorityofthecontentofRN-1UTIhasremainedthesamefortherevisedTCFHT-MD07version.Therefore,allapprovedImplementersandAuthorizersformedicaldirectiveRN-1UTI“Assessment,Diagnosis,andTreatmentofUncomplicatedUrinaryTractInfections(UTI)”havegrandfatheredapprovalforTCFHT-MD07“UncomplicatedUrinaryTractInfection.”



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AppendixA:

AuthorizerApprovalForm

NameSignatureDate

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________



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_______________________________________________________________________________

AppendixB:

ImplementerApprovalForm

Tobesignedwhentheimplementerhascompletedtherequiredpreparation,andfeeltheyhavethe

knowledge,skill,andjudgementtocompetentlycarryouttheactionsoutlinedinthisdirective.

NameSignatureDate

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________



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_______________________________________________________________________________

AppendixC:

SampleLabRequisition



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AppendixD:

SamplePrescription

Specimen Collection

x Biochemistry x Hematology x Viral Hepatitis (check one only)Glucose Random Fasting CBC Acute Hepatitis

HbA1C Prothrombin Time (INR) Chronic Hepatitis

Creatinine (eGFR) Immunology Immune Status / Previous ExposureSpecify: Hepatitis A Hepatitis B Hepatitis Cor order individual hepatitis tests in the“Other Tests” section below

Uric Acid Pregnancy Test (Urine)

Sodium Mononucleosis Screen

Potassium Rubella

Chloride Prenatal: ABO, RhD, Antibody Screen(titre and ident. if positive)CK Prostate Specifi c Antigen (PSA)

ALT Repeat Prenatal Antibodies Total PSA Free PSA

Insured – Meets OHIP eligibility criteriaUninsured – Screening: Patient responsible for payment

Alk. Phosphatase Microbiology ID & Sensitivities(if warranted)Bilirubin

Albumin CervicalLipid Assessment (includes Cholesterol, HDL-C, Triglycerides, calculated LDL-C & Chol/HDL-C ratio; individual lipid tests may be ordered in the “Other Tests” section of this form)

Vaginal Vitamin D (25-Hydroxy)Vaginal / Rectal – Group B Strep Insured - Meets OHIP eligibility criteria:

osteopenia; osteoporosis; rickets;renal disease; malabsorption syndromes;medications affecting vitamin D metabolism

Uninsured - Patient responsible for payment

Albumin / Creatinine Ratio, Urine Chlamydia (specify source):

Urinalysis (Chemical) GC (specify source):

Neonatal Bilirubin: Sputum

Child’s Age: days hours Throat Other Tests - one test per lineClinician/Practitioner’s tel. no. ( ) Wound (specify source):

Patient’s 24 hr telephone no. ( ) Urine

Therapeutic Drug Monitoring: Stool Culture

Name of Drug #1 Stool Ova & Parasites

Name of Drug #2 Other Swabs / Pus (specify source):

Time Collected #1 hr. #2 hr.

Time of Last Dose #1 hr. #2 hr.

Time of Next Dose #1 hr. #2 hr.

Fecal Occult Blood Test (FOBT) (check one) FOBT (non CCC) ColonCancerCheck FOBT (CCC) no other test can be ordered on this form

Laboratory Use Only

Time Date

Ministry of Healthand Long-Term CareLaboratory RequisitionRequisitioning Clinician / Practitioner

Laboratory Use Only

Name

Address

Clinician/Practitioner Number

Additional Clinical Information (e.g. diagnosis)

Note: Separate requisitions are required for cytology, histology / pathology and tests performed by Public Health Laboratory

Patient’s Last Name (as per OHIP Card)

Patient’s First & Middle Names (as per OHIP Card)

Patient’s Address (including Postal Code)Copy to: Clinician/PractitionerLast Name

I hereby certify the tests ordered are not for registered in or out patients of a hospital.

XClinician/Practitioner Signature

4422-84 (2012/11) © Queen’s Printer for Ontario, 2012 7530-4581

Date

Address

First Name

24 hour clock yyyy/mm/dd

OHIP/Insured Third Party / Uninsured WSIB

M F

Check (�) one: Province Other Provincial Registration Number Patient’s Telephone Contact Number

CPSO / Registration No. Health Number Version Date of Birth

Service Dateyyyy

yyyy

mm

mm

dd

ddSex

Clinician/Practitioner’s Contact Number for Urgent Results

( )

( )

Specify one below:

Rebekah Barrett, RN Medical Directive TCFHT-MD07



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AppendixE:

TCFHT-MD07_UncomplicatedUrinaryTractInfectionStamp

Donald DuckD.O.B.: Oct 11, 1930Alissia Valentinis M.D., C.C.F.P.Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 daysDonald DuckD.O.B.: Oct 11, 1930


Alissia Valentinis M.D., C.C.F.PCPSO #79090790 Bay Street

Suite 522, Box 58/59 Toronto, Ontario M5G 1N8

Tel: 416-591-1222 Fax: 416-591-1227

� For: Donald Duck187 Bay StreetToronto, ONN4N 5J5DOB: Oct 11, 1930 M416-555-5555 (H)

Apr 9, 2014

Macrobid100mg PO BID

Quantity: 5 days

Donald DuckD.O.B.: Oct 11, 1930

Alissia Valentinis M.D., C.C.F.P.

Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days











































































































1 of 1Macrobid100mg PO BID

Quantity: 5 days

Alissia Valentinis M.D., C.C.F.PCPSO #79090790 Bay Street

Suite 522, Box 58/59 Toronto, Ontario M5G 1N8

Tel: 416-591-1222 Fax: 416-591-1227

� For: Donald Duck187 Bay StreetToronto, ONN4N 5J5DOB: Oct 11, 1930 M416-555-5555 (H)

Apr 9, 2014

Macrobid100mg PO BID

Quantity: 5 days














































































































1 of 1Macrobid100mg PO BID

Quantity: 5 days



Alissia Valentinis M.D., C.C.F.P.Professional ID:

Rebekah Barrett, RN Medical Directive TCFHT-MD07



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S:-Hxof«dysuria,»«urinaryfrequency,»«urgency,»«suprapubicpain,»«cloudyurine,»«strong-smellingurine,»«hematuria»X•days-No«fever,»«chills,»«vomiting,»«backpain»«-Novaginalitchingorabnormaldischarge»-Not«pregnant,»«diabetic,»«post-menopausal»«-•LMP»«-Nohxofurinarycalculus»«-•UTIsinthelastyear»-«ConfirmedNKDA»«Allergiesto•noted»O:-T:•-«No»«Positive»CVAtenderness-Urinedip:•leuks,•nitrites,•protein,•blood-Urinecharacteristics:«clear,»«cloudy,»«hematuria,»«foulsmell»A:«SymptomsconsistentwithUTI»P:«UrinesenttolabforC&Sandurinalysis»«Rxfor•given»«-ReviewedmethodsofUTIprevention-properperinealcare,goodhydration,notholdingurineandvoidingimmediatelyaftersexualactivity;discussedbenefitsofcranberryjuice.»-AdvisedtoRTCifsymptomspersist/worsenorifdevelopsfever,chills,vomitingorbackpain-Advisedtocompletefullcourseofabx,evenifsymptomsimprove/resolve-Providertofollowupwithurinetestresults*actionsandinterventionsinaccordancewithMedicalDirectiveTCFHT-MD07

tcfht-md07 uncomplicated urinary tract infection

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