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Standard Rooming Criteria - Adult/Pediatric - Ambulatory

Standard Rooming Criteria - Adult/Pediatric - Ambulatory - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, In the Clinic


1
Standard Rooming Criteria –
Adult/Pediatric – Ambulatory
Clinical Practice Guideline
Table of Contents
EXECUTIVE SUMMARY ........................................................................................................... 3
SCOPE ...................................................................................................................................... 4
METHODOLOGY ...................................................................................................................... 5
INTRODUCTION ....................................................................................................................... 6
RECOMMENDATIONS .............................................................................................................. 6
1. Assess Vital Signs ....................................................................................................................... 6
2. Measure Growth .......................................................................................................................... 8
3. Perform Screening Assessments ................................................................................................ 9
4. Complete Clinical Documentation ............................................................................................. 12
TABLE 1. STANDARDIZED ROOMING CRITERIA FOR PEDIATRIC PATIENTS ..................13
TABLE 2. STANDARDIZED ROOMING CRITERIA FOR ADULT PATIENTS .........................14
UW HEALTH IMPLEMENTATION ............................................................................................15
REFERENCES .........................................................................................................................15
CPG Contact for Pediatric Content:
Name: Gail Allen, MD – Department of Pediatrics
Phone Number: (608) 828-7602
Email Address: gsallen@pediatrics.wisc.edu
CPG Contact for Adult Content:
Name: James Bigham, MD – Department of Family Medicine
Phone Number: (608) 274-1100
Email Address: james.bigham@uwmf.wisc.edu
Note: Active Table of Contents
Click to follow link
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
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2
CPG Contact for Changes:
Name: Lindsey Spencer, MS- Center for Clinical Knowledge Management (CCKM )
Phone Number: (608) 890-6403
Email Address: lspencer2@uwhealth.org
Coordinating Team Members:
Jeff Sleeth, MD – Department of Pediatrics
Amy Bauman, MD – Department of Family Medicine
Michael Struck, MD - Department of Ophthalmology
Gregg Heatley, MD - Department of Ophthalmology
J. Scott McMurray, MD – Department of ENT/Otolaryngology
Jennifer Ploch – Department of Audiology
Shelly Key, RN – Clinical Staff Education
Jennifer Lochner, MD – Family Medicine (Temperature Measurement Only)
Patricia Deffner-Valley, MD – Pediatrics (Temperature Measurement Only)
Melissa Jones - Clinical Staff Education (Temperature Measurement Only)
Julia Hunter, CNS – Children’s Hospital Administration (Temperature Measurement Only)
Review Individuals/Bodies:
Richard Ellis, MD – Department of Pediatrics
Melissa Stiles, MD – Department of Family Medicine
Elizabeth Chapman, MD – Department of Medicine- Geriatrics
Committee Approvals/Dates:
Primary Care Leadership Committee (PCLC) (05/16/14)
Clinical Knowledge Management (CKM) Council (05/22/14)
- Minor revisions (03/26/15)
Release Date: March 2015
Next Review Date: May 2016
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

3
Executive Summary
Guideline Overview
This guideline serves to standardize the measurements obtained by rooming staff for
pediatric and adult primary care patients, based upon the type of clinic visit.
Key Practice Recommendations
1. Assess vital signs
2. Measure growth
3. Perform screening assessments
4. Complete clinical documentation
Companion Documents
1. Table 1. Standardized Rooming Criteria for Pediatric Patients
2. Table 2. Standardized Rooming Criteria for Adult Patients
3. UW Health Preventive Health Care - Adult/Pediatric - Primary Care Clinical Practice
Guideline
4. UW Health Hypertension – Adult Clinical Practice Guideline
5. UW Health Body Mass Index (BMI) Screening and Follow-up – Adult –
Ambulatory/Primary Care Clinical Practice Guideline
6. UW Health Body Mass Index (BMI) Screening and Follow-up – Pediatric –Ambulatory/
Primary Care Clinical Practice Guideline
7. UW Health Tobacco Cessation – Pediatric/Adult – Ambulatory Clinical Practice
Guideline
Pertinent UW Health Policies & Procedures
1. UWMF Clinical Policies and Procedures - MF Measuring Temperature
2. UWMF Clinical Policies and Procedures - MF Measuring A Pulse
3. UWMF Clinical Policies and Procedures - MF Measuring Respiratory Rate
4. UWMF Clinical Policies and Procedures - MF Blood Pressure Measurement
5. UWMF Clinical Policies and Procedures - MF Measuring Weight in Adults and Children
6. UWMF Clinical Policies and Procedures - MF Measuring Height in Adults and Children
7. UWMF Clinical Policies and Procedures - MF Measuring Length of Infants
8. UWMF Clinical Policies and Procedures - MF Measuring Head Circumference in Infants
9. UWMF Clinical Policies and Procedures - MF Vision Screening
10. UWMF Clinical Policies and Procedures – UWMF Allergy Verification
11. UWHC Departmental Policy 13.26 - Hearing Screen of Newborns
12. UWHC Departmental Policy 8.02 – Assessment and Reassessment of Patients and
Documentation in Clinics
Patient Resources:
1. Healthwise: Vision Tests: General Info
2. Healthwise: Hearing Tests: Pediatrics
3. Healthwise: Hearing Tests Abnormal Results: Pediatric: General Info
4. Healthwise: Hearing Loss: Pediatric: General Info
5. Healthwise: Urine Test
6. Healthwise: Pregnancy Test: HCG (Human Chorionic Gonadotropin) Test
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

4
Scope
Disease/Condition(s): Baseline measurements obtained during primary care visits
Clinical Specialty: Primary Care
Intended Users:
Primary Care Physicians, Nurse Practitioners, Advanced Practice Nurses, Registered
Nurses, Medical Assistants
CPG objective(s):
To provide clinic health professionals with standardized rooming guidelines
Target Population:
Pediatric, adolescent, and adult primary care patients
NOTE: This guideline is not intended to diagnose or treat any condition. Once a health
issue or condition has been identified, other clinical practice guidelines will take
precedence during any further diagnosis and management.
Interventions and Practices Considered:
1. Prevention/risk assessment screening of key clinical and behavioral parameters
2. Patient-centered, team-based approach and shared decision making
Major Outcomes Considered:
1. Effectiveness of screening tests
2. Predictive value of screening tests
Guideline Metrics:
1. Retrospective assessment of total time to complete rooming process.
2. Evaluation of clinic staff, provider, and patient satisfaction.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

5
Methodology
Methods Used to Collect/Select the Evidence:
1. Hand searches of published literature
2. Search of electronic databases
Methods Used to Assess the Quality and Strength of the Evidence:
Weighing according to rating scheme (provided below).
Rating Scheme for the Strength of the Evidence:
A modified Grading of Recommendations Assessment, Development and Evaluation (GRADE)
scale developed by the American Heart Association and American College of Cardiology
(Figure 1) was used to assess the Quality and Strength of the Evidence in this Clinical Practice
Guideline.
Figure 1
Methods Used to Analyze the Evidence and Formulate the Recommendations:
1. Systematic Reviews
2. Expert Opinion and consideration for patient experience
Cost Analysis: A formal cost analysis was not performed.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

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Introduction
At UW Health, rooming evaluation criteria of patients upon clinical visits has been
developed and standardized, where possible, to efficiently direct collection of important
patient data to help physicians in their assessment of patients’ health. The purpose of
this guideline is to document that these criteria are evidence-based and appropriately
evaluated.
Recommendations
1. Assess Vital Signs
Vital signs support identification of acute medical problems such as infection, and can
also be a marker of chronic disease states (i.e., hypertension or obesity).
Temperature
Routine measurement of the patient’s temperature is not always necessary. In
instances where a temperature measurement is required or desired, typically when a
patient is ill, the technique and appropriate site for measurement should be dependent
upon patient age.
It is recommended that a rectal measurement is used in patients under 3 months of age
unless contraindicated.1-5 (UW Health Class I, LOE C) Contraindications for rectal
measurement include: gastrointestinal or rectal bleeding, prematurity, oncology
diagnosis, neutropenic patients, and diarrhea.2-4 Patients younger than 3 months of age
with contraindications or older patients (3 months to adulthood) should have their
temperature measured axillary or orally.1,3 (UW Health Class I, LOE C) For additional details
regarding temperature collection, see UWMF Policy - Measuring Temperature.
Pulse
A pulse or heart rate measurement should be obtained at every clinical visit, regardless
of patient age or reason for visit.1 (UW Health Class I, LOE C) A radial or apical pulse may
be assessed; see UWMF Policy - Measuring A Pulse for details.
Respiratory Rate (Resp.)
Respiratory rate is recorded as the number of cycles (one full inspiration and expiration
per minute. Rates can vary due to age and may be affected by factors including
exercise, smoking, anxiety, acute pain, illness, medication, and neurologic injury.1
Measurement of respiratory rate should be obtained at every pediatric non-specific
acute ill or health supervision/well child visit and every adult clinic visit. (UW Health Class I,
LOE C) Respiratory rates should also be measured during the following visit types for
patients 3-18 years (UW Health Class I, LOE C):
ξ Injury
ξ RAD/Asthma
ξ Headache
ξ Suspected UTI
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7
For additional information, including a list of supplies and required procedure see
UWMF Policy - Measuring Respiratory Rate.
Blood Pressure (BP)
Factors such as food intake, strenuous exercise, smoking, caffeine, or a cold exam
room may influence blood pressure results and should be avoided 30-60 minutes prior
to taking the patient’s blood pressure.1 The UWMF Policy - Blood Pressure
Measurement provides procedural instructions for measuring blood pressure in clinic
patients.
Blood pressure measurements should be obtained during the following visit types for
patients older than 3 years (UW Health Class I, LOE C):
ξ All visits (adults only)6,7
ξ Medication Check/Addition
ξ Injury
ξ RAD/Asthma
ξ Headache
ξ Suspected UTI
ξ Thyroid
ξ Behavior/Coping/Mental Health
Patients under 3 years of age
Patients under the age of 3 years with specific risk conditions (see below) or changes in
risk may have their blood pressure obtained every 6 months during health supervision
visits8 or other non-specific acute illness visits. (UW Health Class IIb, LOE C)
Positive risk factors for blood pressure screening include: 8-11
ξ History of prematurity, low birth weight, or neonatal complications requiring ICU
care
ξ Congenital heart disease (repaired, unrepaired, or family history)
ξ Elevated body mass index (BMI)/obesity
ξ Recurrent UTI, hematuria, or proteinuria
ξ Known renal disease or urologic malformations
ξ Solid organ transplant
ξ Malignancy or bone marrow transplant
ξ Treatment with drugs known to raise blood pressure
ξ Other systemic illnesses associated with hypertension (i.e., neurofibromatosis,
evidence of elevated intracranial pressure, tuberous sclerosis, etc.).
Patients age 3-18 years
Patients over the age of 3 years may have their blood pressure measured annually,
preferably during their health supervision visits. (UW Health Class IIb, LOE C)
Blood pressure measurements should not be obtained during every clinic visit (UW Health
Class III, LOE C), despite current recommendations from the National High Blood Pressure
Education Program (NHBPEP) Working Group on Children and Adolescents.11,12 The
U.S. Preventive Services Task Force (USPSTF) found no direct evidence that routine
blood pressure measurement accurately identifies children and adolescents who are at
increased risk for cardiovascular disease in adulthood.9
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8
Patients older than 18 years of age
Adult patients should have their blood pressure measured at every clinical visit.7 (UW
Health Class I, LOE B) It is recommended that measurements are obtained using an
appropriately sized cuff after the patient has emptied their bladder and rested for 5
minutes.
Last Menstrual Period (LMP)
Documentation of a patient’s last menstrual period should be completed for all women
of childbearing age during every health supervision visit (adolescents) and every clinic
visit (adults). (UW Health Class I, LOE C) This documentation is valuable to clinicians as
identification of abnormal menstrual patterns may permit early identification of potential
health concerns or conditions such as pregnancy, abnormal hormonal development,
anorexia nervosa, inflammatory bowel disease, and other chronic illnesses.13
2. Measure Growth
Measurement of the standard growth parameters throughout childhood and
adolescence is essential for assessing normal development. In adulthood, growth and
development measurements can be useful in determining medication dosing or
identifying potential health concerns or conditions such as obesity.
Weight
Weight measurements should be obtained at every clinical visit (newborn to adult).
8,10,12,14
(UW Health Class I, LOE C) Patients under 1 year of age should be measured
naked15, while patients 1-3 years should only be wearing a dry diaper or underwear.
Older patients (age 3-adult) may wear one layer of light clothing (but no shoes) while
being weighed. Specific methods for obtaining a patient’s weight are detailed in the
UWMF Policy - Measuring Weight in Adults and Children.
Patients should remain undressed/not replace their outer clothing until seen by the
provider. Rooming staff should offer gowns and/or blankets upon rooming for comfort
and privacy as needed.
Height/Length
A length board should be used to obtain length measurements for patients during their
Health Supervision/Well Child visits at ages 0, 3, 6, 9, and 12 months.10,12 (UW Health
Class I, LOE C) See UWMF Policy - Measuring Length of Infants for additional details
regarding the use of a length board.
Beginning at age 2, rooming staff may complete either a height or length measurement
on pediatric patients. Height should be completed using a stadiometer only if the patient
is willing and able to stand still, otherwise staff should complete a length measurement
until age 3.10,15 (UW Health Class I, LOE C)
Height measurements should be obtained annually in adult patients 18 years and
older.14 (UW Health Class I, LOE C) Reference UWMF Policy - Measuring Height in Adults
and Children for additional instructions on the methodology of measuring height.
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9
A previously documented height measurement may be used for blood pressure
calculation in Health Link for patients 3-18 years of age during the following visit types
(Note: If height has not been measured within the last six months, a new measurement
should be obtained):
ξMedication Check/Addition
ξInjury
ξRAD/Asthma
ξHeadache
ξSuspected UTI
ξBehavior/Coping/Mental Health
ξAll other non-specific acute illness
visits
Head Circumference
It is recommended that a head circumference measurement is obtained at every health
supervision visit until the patient is 24 months of age.8,10,15 (UW Health Class I, LOE C) This
recommendation is consistent with the 2014 American Academy of Pediatric
Recommendations for Pediatric Preventive Health Care8 and differs from previous
statements by Bright Futures10 to complete this measurement until the patient is 30
months of age. Procedural instructions can be found in the UWMF Policy - Measuring
Head Circumference in Infants.
3. Perform Screening Assessments
Pain
Pain status should be screened and documented during every clinic visit, regardless of
patient age or reason for visit. (UW Health Class I, LOE C) Rooming staff should document
the location, severity, duration and quality of pain as described by the patient in relation
to their visit within Health Link. These recommendations are consistent with UWHC
Policy 8.02 and Joint Commission Standard PC.01.02.07.16
Use of a particular pain rating scale at UW Health should be used based upon patient
age and condition (i.e., cognitive or verbal ability):
ξ Numeric Pain Scale17 (ages 8 and above)
ξ Pain Face Scale18 (ages 4-8 years)
ξ FLACC-R Pain Scale19
(ages 1 and above who are verbally unable to report pain)
ξ Neonatal/Infant Pain Scale20 (ages less than 1 year).
Urine Analysis (UA)
It is recommended that a urine analysis with microscopy is collected for adult patients
during the following visit types, in order to assess pregnancy, infection, or other illness:
ξ First obstetrician (OB) appointment
ξ Complaint of abdominal pain
ξ Complaint of urinary symptoms including frequent urination, dysuria, hematuria,
or malodorous urine. (UW Health Class I, LOE C)
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10
Vision
If the patient wears corrective eye glasses or contact lenses, all vision testing should be
completed while the patient is wearing the glasses or contacts. If a patient has been
seen by an ophthalmologist within the past year of their last health supervision visit,
vision testing is not necessary. Rooming staff should document the occurrence of the
previous specialty visit.
Patients age 3-5 years
It is recommended that vision screening occur at the ages of 3, 4, and 5 years to detect
the presence of amblyopia or its risk factors.10,21 (UW Health Class IIa, LOE B) If the patient
is uncooperative and the test cannot be completed, reschedule the assessment.
Patients age 6-18 years
Vision screening tests should be completed one time between the following ages:
ξ 6-8 years
ξ 10-12 years
ξ 13-15 years
ξ 16-18 years (UW Health Class IIa, LOE C).
These recommendation are consistent with the 2013 American Academy of Family
Physicians (AAFP) report22 for pediatric vision screening every 1-2 years after the age
of 5 years; however they are slightly discrepant from previously published guidelines8,10
which indicate screening at patient ages 3, 4, 5, 6, 8, 10, 12, 15, and 18 years.
Hearing
Hearing loss can affect one’s ability to develop communication, language, and social
skills, and may negatively impact academic achievement and socio-emotional
development.23 It is important to complete newborn hearing screening as well as follow-
up screening, as many children become hearing impaired after the neonatal period and
are therefore not identified by newborn-screening alone.24
Newborn Patients (age 0-1 months)
If an initial hearing screening test was not performed before the newborn was
discharged from the hospital, one should be completed within the first month of life.
10,23,25
(UW Health Class I, LOE B) Newborn hearing screening is supported by state and
federal legislation including Wisconsin Statute (253.115)26 and the Patient Protection
and Affordable Care Act.27
Patients age 4-10 years
Hearing screening tests should be completed one time between the following ages:
ξ 4-6 years (if patient is uncooperative, reschedule assessment in 6 months)
ξ 8-10 years (UW Health Class IIa, LOE C).
This recommendation is at variance with previously published guidelines8,10,28 which
indicate hearing screening at patient ages 4, 5, 6, 8, and 10 years. However, there is
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

11
currently no evidence to support an association with more frequent screening intervals
and improved outcomes.
Annual screening between the ages of 3-8 years is required in Medicaid patients, see
https://www.forwardhealth.wi.gov/WIPortal/Online%20Handbooks/Print/tabid/154/Default.aspx?ia=1&p=1
&sa=24&s=2&c=61&nt=Description%20of%20Required%20Components%20of%20a%20HealthCheck%
20Screening.
If a patient age 3-10 years has been seen by an audiologist within the past year of their
last health supervision visit, hearing testing is not necessary. Rooming staff should
document the occurrence of the previous specialty visit.
Patients age 11-18 years
Current evidence suggests that hearing loss may occur due to secondhand tobacco
smoke exposure or excessive exposure to noise.29 These studies are limited by
inconsistent definitions of hearing loss, and varying frequency and threshold values for
accurate testing.29-31 At this time, no recommendation can be made related to hearing
screening in the adolescent patient population.
Screening at age 12 and 16 years is required in Medicaid patients, see
https://www.forwardhealth.wi.gov/WIPortal/Online%20Handbooks/Print/tabid/154/Default.aspx?ia=1&p=1
&sa=24&s=2&c=61&nt=Description%20of%20Required%20Components%20of%20a%20HealthCheck%
20Screening.
Hearing Screening Test Procedure
All hearing tests should be completed in an acoustically appropriate environment.32 The
pure tone audiometric sweep test can be used to evaluate hearing32 (see Figure 1).
Figure 1. Pure Tone Hearing Testing Procedures
Patient Response
to All 3 Freq.
Patient Response
to 1-2 Freq. No Response
20dB Test
20 dB at 3 frequencies:
1000 Hz, 2000 Hz, 4000 Hz
Pass Complete 25 dB
Test
Complete 25 dB
Test
25 dB Test
25 dB at 3 frequencies:
1000 Hz, 2000 Hz, 4000 Hz
At-Risk
Repeat Screening in
8-12 weeks
At-Risk
Repeat Screening in
8-12 weeks
Fail
Refer to Audiologist
Initial hearing screening tests should be completed at 20 dB at 3 frequencies: 1000 Hz,
2000 Hz, and 4000 Hz.30,32 (UW Health Class I, LOE B) Patients who respond to all 3
frequencies at 20 dB are considered to have “passed”. These patients do not require
further audiologic intervention and should be re-screened per routine.
Patients who do not respond to 20 dB at all 3 frequencies should complete a secondary
test of the 3 frequencies at 25 dB.30,32 (UW Health Class I, LOE C) Patients who are able to
respond to 25 dB at a given frequency are considered “at-risk”, and repeat screening
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12
should be completed within 8-12 weeks. If on repeat assessment, the patient continues
not to respond at the 20 dB threshold, a referral for formal audiology screening is
recommended. (UW Health Class I, LOE C)
Patients who do not respond to 25 dB at any frequency should be considered a “failed”
hearing screen. These patients require a referral for formal audiologic testing. (UW Health
Class I, LOE C)
4. Complete Clinical Documentation
Tobacco History (Tobacco Hx)
All pediatric (school age to adolescent) (UW Health Class I, LOE B) and adult patients (UW
Health Class I, LOE A) should be assessed for tobacco use or secondhand smoke
exposure during every primary care clinic visit, when vital signs are obtained. These
recommendations are consistent with the USPSTF, UW Health Preventive Health Care
–Adult/Pediatric – Ambulatory and UW Health Tobacco Cessation – Adult/Pediatric –
Inpatient/Ambulatory guidelines. Primary care physicians are encouraged to provide
interventions to prevent initiation of tobacco use in school-age children and
adolescents33, and to promote tobacco cessation in adults who smoke.34 Patients
determined to use tobacco or who are exposed to secondhand smoke should be
assessed and treated using the recommendations within the UW Health Tobacco
Cessation – Adult/Pediatric – Inpatient/Ambulatory Guideline.
Medications (Meds.)/ Allergies
Medication reconciliation should be performed during every clinic visit type, regardless
of patient age. (UW Health Class I, LOE C) Rooming staff should document any current
medications, as well as the patient’s perception of effectiveness or side effects, as
appropriate.
Any allergies or adverse reactions should be documented in Health Link during every
clinic visit. (UW Health Class I, LOE C)
Health Maintenance (HM)
Preventive health care is used to ensure that patients are receiving appropriate
screening to prevent or attenuate disease at various life stages. Screening can be
completed via questionnaires, laboratory tests, or procedures as outlined within the UW
Health Preventive Health Care – Pediatric/Adult – Ambulatory Guideline. UW Health
utilizes decision support tools within Health Link to track which preventable diseases or
conditions for which the patient needs to be screened at various ages. It is
recommended that documentation is completed for these types of alerts.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
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13
Table 1. Standardized Rooming Criteria for Pediatric Patients
Temp. Pulse Resp. BP Weight Height/
Length
Head
Circ. Vision Hearing LMP
Tobacco
Hx/ HM Pain
Meds./
Allergy
Non-specific Acute Ill Visits for Patients 0-18 years
0 – 1 year
X
(Rectal < 3 mo.) X X
If at
risk**
Naked * X X X
1 – 3 years X X X
If at
risk**
Dry diaper or
underwear * X X X
3 – 18 years X X X
If at
risk**
One layer of
clothing, no shoes
* X X X
Health Supervision/Well Child Check for Patients 0-18 years
0, 2, 4, 6, 9, 12,
15, 18 mo.
If complains of
illness
(Rectal < 3 mo.)
X X
If at
risk**
Naked, dry
diaper, or
underwear
Length
board
X
If not done at
birth
X X X
2 years
If complains of
illness
X X
If at
risk**
Dry diaper or
underwear
Length
(Height if
standing)
X X X X
3 – 18 years
If complains of
illness
X X X
One layer of
clothing, no shoes
No hair
accessories,
hats, or
shoes
3, 4,5
yrs.***
Test once
between
6-8, 10-12,
13-15, 16-
18 yrs.
Test once
between
4-6, 8-10 yrs.***
Medicaid
requires testing
at 3, 4, 5, 6, 7,
8, 12,16 yrs.
All
women
of child
bearing
age
X X X
Specific Visit Type for Patients 3-18 years
Med
Check/Addition X X X * Initial only X X X
Injury X X X X * X X X
RAD/Asthma X X X X X * X X X
Headache X X X X X * X X X
Suspected UTI X X X X X * X X X
Thyroid X X X X X X X X
Behavioral/Coping/
Mental Health X X X * X X X
* Height- Enter for BP calculation in Health Link (new measurement if not done in last 6 months). *** If seen by specialist (ophthalmologist/audiologist) within last year, do not test but document in Health Link.
**Blood pressure should be obtained every 6 months on patient with positive risk factors:
ξHistory of prematurity, low birth weight, or neonatal complications
requiring ICU care
ξElevated BMI/obesity
ξTreatment with drugs known to raise BP
ξCongenital heart disease (repaired, unrepaired, or family history)
ξRecurrent UTI, hematuria or proteinuria
ξKnown renal disease or urologic malformations
ξSolid organ transplant; malignancy or bone marrow transplant
ξOther systemic illnesses associated with hypertension (i.e.,
neurofibromatosis or evidence of elevated intracranial pressure).
Last revised: 05/2015 UW Health Standard Rooming Criteria CPG
Contact the Center for Clinical Knowledge Management (CCKM) for revisions.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

14
Table 2. Standardized Rooming Criteria for Adult Patients
Temp. Pulse Resp. BP Weight Height LMP Tobacco Hx Pain
Meds./
Allergy HM UA
Visit
Type
Abdominal Pain
Frequent Urination
Illness
Preoperative
All All All All *
All
(For women
of child
bearing age)
All All All All
Abdominal Pain
First OB Appt.
Flank Pain
Urinary Symptoms**
*Height: Measure if no result entered in Health Link within the last 12 months.
** Urinary symptoms may include frequent urination, dysuria, hematuria, or malodorous urine.
Last revised: 05/2014
UW Health Standard Rooming Criteria CPG
Contact the Center for Clinical Knowledge Management (CCKM) for revisions.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

15
UW Health Implementation
Potential Benefits:
Following these guidelines should lead to standardized patient rooming procedures, which may
result in increased patient satisfaction and enhanced clarification for measurements desired by the
provider prior to entering the patient room.
Potential Harms: No apparent identifiable harms.
Qualifying Statements
This guideline is NOT intended to diagnose or treat any condition. Once a health issue or condition
has been uncovered, other guidelines and clinical policies and practice will take precedence during
any further diagnosis and management.
Tools/ Plan
1. Guideline will be housed on U-Connect in a dedicated for Clinical Practice Guidelines.
2. Links to the guideline will be created on the PCLC Workspace and within appropriate Health
Link or equivalent tools. Smart text and smart phrases will be updated as necessary.
3. Staff will receive an introduction to the guideline principles during the Package 1 Clinic
Training.
4. The creation of additional Best Practice Alerts (BPAs) and/or a delegation protocol for
hearing screening and collection of urine analyses will be considered by the Center for
Clinical Knowledge Management.
5. Release of the guideline will be advertised in the Clinical Knowledge Management Corner
with the Best Practice Newsletter.
Disclaimer
CPGs are described to assist clinicians by providing a framework for the evaluation and treatment
of patients. This Clinical Practice Guideline outlines the preferred approach for most patients. It is
not intended to replace a clinician’s judgment or to establish a protocol for all patients. It is
understood that some patients will not fit the clinical condition contemplated by a guideline and that
a guideline will rarely establish the only appropriate approach to a problem.
References
1. Monahan FD, Mosby Inc., NursingConsult (Online service). Mosby's expert physical exam handbook
rapid inpatient and outpatient assessments. 3rd ed. St. Louis, Mo.: Mosby Elsevier; 2009:
http://www.nursingconsult.com/nursing/books/978-0323-05791-2/browse?isbn=978-0323-05791-2.
2. Leduc D, Woods S, Baxter C, Gorodzinsky F, Munk P, Noonan P. Temperature measurement in
paediatrics. Paediatrics and Child Health. 2000;5(5):4.
3. Asher C. Position Statement for Measurement of Temperature/Fever in Children. In: Northington L,
ed. Pensacola, FL: Society of Pediatric Nurses; 2008.
4. Association EN. Clinical Practice Guideline: Non-invasive Temperature Measurement in the
Emergency Department. In: Committee EENRD, ed2011.
5. Stine CA, Flook DM, Vincze DL. Rectal versus axillary temperatures: is there a significant difference
in infants less than 1 year of age? J Pediatr Nurs. 2012;27(3):265-270.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

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6. Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of
hypertension in the community: a statement by the American Society of Hypertension and the
International Society of Hypertension. J Clin Hypertens (Greenwich). 2014;16(1):14-26.
7. Force USPT. Screening for High Blood Pressure in Adults. 2007;
http://www.uspreventiveservicestaskforce.org/uspstf/uspshype.htm.
8. COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE BRIGFPSW. 2014
recommendations for pediatric preventive health care. Pediatrics. 2014;133(3):568-570.
9. Force USPST. Screening for Hypertension in Children and Adolescents. 2013;
http://www.uspreventiveservicestaskforce.org/uspstf13/hypechild/hypechldfinalrec.htm#copyright.
Accessed March 27, 2014.
10. Bright Futures. In: Hagan J, Shaw J, Duncan P, eds. Guidelines for Health Supervision of Infants,
Children, and Adolescents. Third ed. Elk Grove Village, IL: The American Academy of Pediatrics;
2008.
11. Adolescents NHBPEPWGoHBPiCa. The fourth report on the diagnosis, evaluation, and treatment of
high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555-576.
12. Kimmel S, Ratliff-Schaub K. Growth and Development. Textbook of Family Medicine. 2011(23).
13. Diaz A, Laufer MR, Breech LL, Adolescence AAoPCo, Care ACoOaGCoAH. Menstruation in girls
and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118(5):2245-2250.
14. Fitch A, Everling L, Fox C, et al. Health Care Guideline Prevention and Management of Obesity for
Adults. Institute for Clinical Systems Improvement. 2013.
https://www.icsi.org/_asset/s935hy/ObesityAdults.pdf.
15. Keane V. Assessment of Growth. Nelson Textbook of Pediatrics. 2011(13):39.e31-39.e36.
16. Elements of Performance for PC.01.02.07. In: Commission TJ, ed. PC.01.02.072011.
17. von Baeyer CL, Spagrud LJ, McCormick JC, Choo E, Neville K, Connelly MA. Three new datasets
supporting use of the Numerical Rating Scale (NRS-11) for children's self-reports of pain intensity.
Pain. 2009;143(3):223-227.
18. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale-
Revised: toward a common metric in pediatric pain measurement. Pain. 2001;93(2):173-183.
19. Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs,
activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit
Care. 2010;19(1):55-61; quiz 62.
20. Suraseranivongse S, Kaosaard R, Intakong P, et al. A comparison of postoperative pain scales in
neonates. Br J Anaesth. 2006;97(4):540-544.
21. Force USPST. Screening for Visual Impairment in Children Ages 1 to 5 Years. 2011;
http://www.uspreventiveservicestaskforce.org/uspstf/uspsvsch.htm. Accessed March 27, 2014.
22. Bell AL, Rodes ME, Collier Kellar L. Childhood eye examination. Am Fam Physician.
2013;88(4):241-248.
23. American Academy of Pediatrics JiCoIH. Year 2007 position statement: Principles and guidelines for
early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.
24. Haddad J. Hearing Loss. Nelson Textbook of Pediatrics. 2011(629):2188-2196.
25. Force USPST. Universal Screening for Hearing Loss in Newborns. 2008;
http://www.uspreventiveservicestaskforce.org/uspstf08/newbornhear/newbhearrs.htm. Accessed
March 27, 2014.
26. Newborn hearing screening. In: Court WS, ed. 253. Vol 253.115: Wisconsin Legislative Documents;
1999.
27. Services USDoHaH. Preventive Care for Children. 2014;
http://www.hhs.gov/healthcare/prevention/children/index.html. Accessed May 1, 2014.
28. Harlor AD, Bower C, Medicine CoPaA, Surgery SoO-HaN. Hearing assessment in infants and
children: recommendations beyond neonatal screening. Pediatrics. 2009;124(4):1252-1263.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org

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29. Vasconcellos AP, Kyle ME, Gilani S, Shin JJ. Personally Modifiable Risk Factors Associated with
Pediatric Hearing Loss: A Systematic Review. Otolaryngol Head Neck Surg. 2014.
30. Meinke DK, Dice N. Comparison of audiometric screening criteria for the identification of noise-
induced hearing loss in adolescents. Am J Audiol. 2007;16(2):S190-202.
31. Sekhar DL, Rhoades JA, Longenecker AL, et al. Improving detection of adolescent hearing loss.
Arch Pediatr Adolesc Med. 2011;165(12):1094-1100.
32. Andersen K. American Academy of Audiology Clinical Practice Guidelines. Childhood Hearing
Screening2011:
http://www.audiology.org/resources/documentlibrary/Documents/ChildhoodScreeningGuidelines.pdf
.
33. Force USPST. Primary Care Interventions to Prevent Tobacco Use in Children and Adolescents.
2013; http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac.htm.
34. Force USPST. Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in
Adults and Pregnant Women. 2009;
http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac2.htm.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2015CCKM@uwhealth.org