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Prostate Biopsy Preprocedure Orders in Urology - Adult - Ambulatory [148]

Prostate Biopsy Preprocedure Orders in Urology - Adult - Ambulatory [148] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 148

Delegation Protocol Title:
Prostate Biopsy Preprocedure Orders in Urology - Adult - Ambulatory

Delegation Protocol Applies To:
UW Health Urology Clinics

Target Patient Population:
Adult patients undergoing prostate biopsy

Delegation Protocol Champions:
David Jarrard, MD – Department of Urology
David Paolone, MD – Department of Urology

Delegation Protocol Reviewers:
Alexander Lepak, MD – Department of Medicine – Infectious Disease
Bunmi Kumapayi, RN, MS, NP-BC – Department of Urology
Tamra Roberts, RN, BSN – Urology
Susan Benck, RN, BSN – Urology
Zachary Lenhart, MHA – Clinic Manager, Urology
Lucas Schulz, PharmD – Department of Pharmacy

Responsible Department:
Department of Urology

Purpose Statement:
To delegate authority from the Urology Provider performing the biopsy to Registered Nurses (RNs) to place
orders for medications for prostate biopsies.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) trained in the use of this delegation protocol.

Guidelines for Implementation:
1. This delegation protocol is initiated when an individual is scheduled for a prostate biopsy in a UW Health
Urology clinic.
2. The RN will review the patient’s medical record and interview the patient as needed to obtain the following
information prior to the scheduled biopsy:
2.1. History of urosepsis
2.2. Patient is a healthcare provider and may have developed some resistance to bacterial organisms
requiring additional antibiotics
2.3. Presence of indwelling catheter or performs intermittent self-catheterization
2.4. Allergies to fluoroquinolones, cephalosporins, or sulfa antibiotics
2.5. History of treatment with ciprofloxacin or sulfamethoxazole/trimethoprim in the last 3 months
2.6. Taking aspirin. If taking aspirin, does patient have a cardiac or peripheral vascular stent
2.7. Taking other antiplatelet/anticoagulation medications such as warfarin (Coumadin), clopidogrel (Plavix),
dabigatran (Pradaxa), rivaroxaban (Xarelto), or apixaban (Eliquis)
2.8. Taking nonsteroidal anti-inflammatory drugs (NSAIDs), vitamins or herbal supplements
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

3. The RN will consult with the Urologist performing the biopsy regarding prophylactic antibiotic ordering in
the following scenarios:
3.1. Patient has a history of urosepsis
3.2. Patient has a history of C difficile infection
3.3. Patient has a coronary artery or peripheral vascular stent
3.4. Patient has taken fluoroquinolones in the last 3 months
3.5. Patient is allergic to both fluoroquinolones and sulfamethoxazole/trimethoprim (BACTRIM)
4. Antimicrobial Prophylaxis
4.1. The RN will order the appropriate prophylaxis based on the patient’s history
4.2. The standard antibiotic regimen is ciprofloxacin 500 mg orally 2 hours prior to the procedure and 12
hours following the procedure
4.3. If the patient has taken ciprofloxacin in the last 3 months or is a healthcare provider, the RN will order
ceftriaxone 1 g intramuscularly to be administered when the patient arrives for the procedure
4.4. If the patient is allergic to fluoroquinolones, the RN will order sulfamethoxazole-trimethoprim (BACTRIM
DS), one 800-160 mg tablet, 2 hours prior to the procedure and 12 hours following the procedure
5. Periprocedural Medications
5.1. The RN will instruct the patient in stopping certain medications prior to the biopsy as follows:
5.1.1. If the patient is taking aspirin and does not have a coronary artery or peripheral vascular stent,
he/she will be informed to stop taking the aspirin for 7 days prior to the procedure
5.1.2. If the patient is on any NSAIDs, vitamins, or herbal supplements, he/she will be informed to stop
taking these medications 7 days prior to the procedure
5.2. The RN will consult the provider for direction regarding when patient should stop taking specific
medication(s) prior to the procedure
5.2.1. If the patient is taking aspirin and has a coronary artery or peripheral vascular stent
5.2.2. If the patient is taking any antiplatelet/anticoagulation medication
6. Bowel Preparation
6.1. The RN will place an order for a phosphate (Fleet) enema, 118 mL to be administered 1.5 hours prior to
leaving for the scheduled prostate biopsy

Order Mode: Protocol/Policy, Without Cosign

References:
1. Anastasiadis, A., Zapala, L., Cordeiro, E., Antoniewicz, A., Dimitriadis, G., & De Reijke, T. (2013).
Complications of prostate biopsy.Expert Review of Anticancer Therapy, 13(7), 829-37. doi:
http://dx.doi.org/10.1586/14737140.2013.811056
2. Atilgan, D., Gençten, Y., Kölükçü, E., Kiliç, S., Uluocak, N., Parlaktas, B. S., & Erdemir, F. (2015). Comparison
between ciprofloxacin and trimethoprim-sulfamethoxazole in antibiotic prophylaxis for transrectal prostate
biopsy. Turkish Journal of Urology, 41(1), 27-31. Retrieved from
http://search.proquest.com/docview/1672902934?accountid=458
3. Cech, P., & Luptak, J. (2014). Complications of transrectal prostate biopsy. Acta Medica Martiniana, 14(1),
27-32. doi: http://dx.doi.org/10.2478/acm-2014-0004
4. Schaeffer, A. J., Montrosi, F., Scattoni, V., Perronicel, R., Song, J., Haverstock, D.C., & Pertel, P.E. (2007).
Comparison of a 3-day with a 1-day regimen of an extended-release formulation of ciprofloxacin as
antimicrobial prophylaxis for patients undergoing transrectal needle biopsy of the prostate. BJU
International, 100(1), 51-57.
5. Shigemura, K., Tanaka, K., Yasuda, M., Ishihara, S., Muratani, T., Deguchi, T., Matsumoto, T., Kamidono, S.,
Nakano Y., Arakawa, S., Fujisawa, M. (2005). Efficacy of 1-day prophylaxis medication with fluoroquinolone
for prostate biopsy. World Journal of Urology, 23(5), 356-60. doi: http://dx.doi.org/10.1007/s00345-005-
0024-4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

6. Wolf, S. J., Bennett, C. J., Dmochowski, R.R, Hollenbeck, B.K., Pearle, M.S., Schaeffer, A.J., Pace, K.T. (2008).
Best practice policy statement on urologic surgery antimicrobial prophylaxis. American Urological
Association. Retrieved from https://www.auanet.org/education/guidelines/antimicrobial-prophylaxis.cfm


Collateral Documents: NA

Approved By:
UW Health Ambulatory Protocol Committee: April 2016
UWHC Antimicrobial Taskforce Subcommittee: October 2016
UWHC Pharmacy & Therapeutics Committee: October 2016
UWHC Medical Board: November 2016
UW Health Chief Clinical Officer: November 2016

Effective Date: December 2016

Scheduled For Review: December 2019
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org