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Laboratory Screening and Chronic Disease Monitoring Laboratory Test Ordering in Primary Care - Adult/Pediatric - Ambulatory [93]

Laboratory Screening and Chronic Disease Monitoring Laboratory Test Ordering in Primary Care - Adult/Pediatric - Ambulatory [93] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


1

Delegation Protocol Number: 93

Delegation Protocol Title:
Laboratory Screening and Chronic Disease Monitoring Laboratory Test Ordering in Primary Care -
Adult/Pediatric - Ambulatory

Delegation Protocol Applies To:
UW Health Primary Care Clinics (Family Medicine, Internal Medicine, OB/Gyn, Geriatrics and Pediatrics)

Target Patient Population:
Adult and pediatric patients

Delegation Protocol Champions:
Sandy Kamnetz, MD – Department of Family Medicine
Elizabeth Trowbridge, MD – Department of Medicine
Grace Flood, MD – Associate Medical Director QSI
David Kunstman, MD – Department of Family Medicine
Kristen Lewicki, MD – Department of Medicine
Gail Allen, MD – Department of Pediatrics
Jeff Sleeth, MD – Department of Pediatrics
Jennie Hounshell, MD – Department of Family Medicine

Delegation Protocol Reviewers:
Cheryl DeVault, BSN, RN, OCN – Clinic Operations Manager – Yahara Clinic
Michelle Key, RN, BSN – Clinical Staff Education
Elizabeth Kolk, RN, MBA – UWHC Internal Medicine – Women’s Health
Cheryl Franz, RN, BSN, CDE - UWMF Diabetes Care Coordinator
Robin Valley-Massey, RN, BSN – Clinical Operations Manager – East, West Pediatrics and East Pediatric
Urology

Responsible Departments:
Department of Family Medicine, Department of Medicine, Department of Pediatrics

Purpose Statement:
To delegate authority from the patient’s UW Health Primary Care Provider to Registered Nurses (RNs),
Licensed Practical Nurses (LPNs) and Medical Assistants (MAs) to place orders for due laboratory tests.

Who May Carry Out This Delegation Protocol:
RNs and MAs who have been trained in the use of this delegation protocol.

Guidelines for Implementation:
1. This protocol is initiated when delegated staff identify patients with overdue or due soon laboratory
tests. Due laboratory tests may be identified via review of the patient’s medical record including the
problem list, health maintenance, medications, and previous laboratory results, Health Maintenance
or Reporting Workbench reports.
2. Preventive Screening Laboratory Tests (Tables 1 and 2)
2.1. RN/MA may order the preventive screening laboratory tests identified in tables 1 and 2.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

2

2.2. Colorectal screening, including colonoscopy and fecal occult blood may not be ordered per
protocol. A provider’s order is required.
3. Chronic Disease Monitoring (Table 3)
3.1. RN/MA will review Table 3 and the problem list to identify the labs needed based on the
patient’s problem list.
3.2. RN/MA will review the patient’s medication list and refer to the clinic’s prescription renewal
protocol to identify labs needed for prescription refill. Still will look to see what labs are
coming due in the next 6 months and enter orders for the required labs for those medications.
4. To avoid duplicates, staff will review Open Orders to identify any unreleased orders for these items
prior to placing any orders.
5. This delegation protocol only authorizes staff to order the listed laboratory tests. Additional tests
Provider preference labs are not listed in this protocol and cannot be ordered by staff.
6. If the associated diagnosis needs to be updated, orders will be pended and routed to provider for
approval.
Table 1. Pediatric Preventive Screening
Indication Laboratory Test
Anemia CBC without differential
Lead Lead
Lipids Lipid Panel (fasting)

May order non-fasting total cholesterol and High-Density Lipoprotein
(HDL) if unable to fast.

Table 2 Adult Preventive Screening
Indication Laboratory Test
Diabetes A1c
Lipids Lipid Panel (fasting)

May order non-fasting total cholesterol and High-Density Lipoprotein
(HDL) if unable to fast.


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

3

Table 3. – Chronic Disease Monitoring - Adult
Creatinine (Cr) Potassium (K) Sodium (Na) BUN Urine
Microalbumin
/Creatinine Ratio
(UMACR)
Thyroid
Stimulating
Hormone
(TSH)
A1c Lipid Panel (Fasting)
If unable to fast,
may order total
cholesterol and HDL
Diabetes Mellitus
Type 1
q12 months q12 months
only if taking
diuretics, ACE,
ARB or
spironolactone
q12 months
only if taking
diuretics
q12 months q12 months q3 months if last
A1c >/= problem list
goal (or 7.0% if no
goal specified)

q6 months if last
A1c < problem list
goal (or 7.0% if no
goal specified)
q12 months
Diabetes Mellitus
Type 2
q12 months q12 months
only if taking
diuretics, ACE,
ARB or
spironolactone
q12 months
only if taking
diuretics
q12 months q3 months if last
A1c >/= problem list
goal (or 7.0% if no
goal specified)

q6 months if last
A1c < problem list
goal (or 7.0% if no
goal specified)
q12 months
Dyslipidemia q12 months
Hypertension 1-2 weeks
after
medication
initiation, at
each dose
change, and
q12 months
only if taking
diuretics, ACE,
ARB or
spironolactone
1-2 weeks after
medication
initiation, at
each dose
change, and
q12 months
only if taking
diuretics, ACE,
ARB or
spironolactone
After diuretic
(including
spironolactone)
initiation, and
at each dose
change and q
12 months

Hypothyroidism
Hyperthyroidism
q12 months
Heart Failure q6 months q6 months q6
months


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

4

Order Mode: Cosign Required, Protocol/Policy

References:

1. UW Health. Preventive Health Care Adult/Adolescent/Pediatric – In Primary Care Setting – Clinical Practice
Guideline - 2016. https://uconnect.wisc.edu/clinical/cckm-tools/content/?path=/content/cpg/preventive-
health/name-97724-en.cckm. Accessed September 13, 2016.
2. UW Health Secondary Prevention of Atherosclerotic Cardiovascular Disease – Adult – Inpatient/Ambulatory
Clinical Practice Guideline. 2015. https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/cardiovascular/name-97484-en.cckm. Accessed September 13, 2016.
3. UW Health. Standards of Medical Care in Diabetes – Pediatric/Adult – Inpatient/Ambulatory Clinical Practice
Guideline 2016. https://uconnect.wisc.edu/clinical/cckm-tools/content/?path=/content/cpg/diabetes-and-
endocrinology/name-97503-en.cckm. Accessed September 13, 2016.
4. UW Health. Diagnosis and Management Hypertension - Adult – Ambulatory - Clinical Practice Guideline.
2016. https://uconnect.wisc.edu/clinical/cckm-tools/content/?path=/content/cpg/cardiovascular/name-
97486-en.cckm. Accessed September 13, 2016.
5. UW Health. Management of Chronic Left Ventricular Systolic Heart Failure – Adult – Inpatient/Ambulatory -
Clinical Practice Guideline. 2015. https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/cardiovascular/name-97485-en.cckm. Accessed September 13, 2016.
Collateral Documents/Tools:
Best Practice Advisories
UWOP B HM PREVENTIVE SCREENING – ADULT
UWOP B HM PREVENTIVE SCREENING – PEDS
UWOP B HM PREVENTIVE SCREENING (PAP 30+)
Smart Sets
PREVENTIVE SCREENING - ADULT HM
PREVENTIVE SCREENING - PEDIATRIC HM
Reporting Workbench
MULTI-CONDITION

Approved By:
UW Health Ambulatory Protocol Committee: July 2012; *August 2014; *March 2016
UW Health Laboratory Practices Committee: July 2012; *September 2014; *March 2016
UWHC Pharmacy and Therapeutics Committee: July 2012; *September 2014; *April 2016
UWHC Medical Board: August 2012; *September 2014
UW Health Chief Clinical Officer: *September 2014; *April 2016

Effective Date: November 2016

Scheduled for Review: November 2018
* Expedited review process

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

5

Appendix A

Medications By Class
Angiotensin-Converting Enzyme Inhibitors (ACE-I)
• benazepril (LOTENSIN)
• benazepril-HCTZ (LOTENSIN HCT)
• captopril (CAPOTEN)
• captopril-HCTZ (CAPOZIDE)
• enalapril (VASOTEC)
• enalapril-HCTZ (VASERETIC)
• fosinopril (MONOPRIL)
• lisinopril (PRINIVIL, ZESTRIL)
• lisinopril-HCTZ (PRINZIDE, ZESTORETIC)
• perindopril (ACEON)
• quinapril (ACCUPRIL)
• ramipril (ALTACE)
• ramipril-HCTZ (ALTACE HCT)
• trandolapril (MAVIK)
Angiotensin Receptor Blockers (ARB)
• azilsartan (EDARBI)
• candesartan (ATACAND)
• candesartan-HCTZ (ATACAND HCT)
• losartan (COZAAR)
• losartan-HCTZ (HYZAAR)
• olmesartan (BENICAR)
• olmesartan-HCTZ (BENICAR HCT)
• irbesartan (AVAPRO)
• irbesartan-HCTZ (AVALIDE)
• telmisartan (MYCARDIS)
• telmisartan-HCTZ (MYCARDIS HCT)
• valsartan (DIOVAN)
• valsartan-HCTZ (DIOVAN HCT)
Diuretics
• amiloride
• amiloride-HCTZ
• bendroflumethiazide
• bumetanide (BUMEX)
• chlorothiazide (DIURIL)
• chlorthalidone
• ethacrynic acid
• furosemide (LASIX)
• hydrochlorothiazide

• indapamide
• methyclothiazide
• metolazone
• spironolactone
• spironolactone-HCTZ
• torsemide (DEMADEX)
• triamterene
• triamterene-HCTZ (DYAZIDE, MAXIDE)
HCTZ = hydrochlorothiazide

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