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Urology Ordering Urinalysis for Office Visit - Adult/Pediatric - Ambulatory [73]

Urology Ordering Urinalysis for Office Visit - Adult/Pediatric - Ambulatory [73] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 73

Delegation Protocol Title:
Urology Ordering Urinalysis for Office Visit – Adult/Pediatric – Ambulatory

Delegation Protocol Applies To:
Adult and pediatric patients seen in UW Health Urology Clinics

Target Patient Population:
Patients with select indications scheduled for an office visit at a UW Health Urology Clinic.

Delegation Protocol Champion:
Stephen Nakada, MD, Department of Urology Chair
Patrick McKenna, MD, Department of Urology

Delegation Protocol Workgroup:
Sherry Siekert, MS, RN, Clinic Manager - Urology
Beth Collien, MT, CLS – Urology
Julie Hunter, MSN, Pediatric Clinic CNS

Responsible Department:
Department of Urology

Purpose Statement:
This protocol delegates authority from providers in the adult and pediatric Urology clinics to Registered Nurses
(RNs), Licensed Practical Nurses (LPNs), Medical Assistants (MAs) and Urology Clinic medical laboratory
technologists (MT) and medical laboratory technicians (MLTs) in those clinics to order a urinalysis for patients
scheduled for an office visit. This is a diagnostic part of their clinic visit and facilitates availability of those results
for the visit.

Who May Carry Out This Protocol:
RNs, LPNs, MAs and Urology Clinic MT and MLTs who are trained in the use of this delegation protocol

Guidelines for Implementation:
1. This protocol is initiated when patients are scheduled to be seen in the Urology clinics for any of the
following diagnosis, signs or symptoms:
Back pain
Bladder disorder
Bladder instillation
Bladder neck contracture
Benign prostatic hypertrophy
Bladder diverticulum
Bladder extrophy
Bladder prolapse
Bladder pain
Calculus of kidney, ureter or bladder
Chronic kidney disease
Condyloma Acuminatum
Cystitis
Cystocele- female
Cystoscopy
Dysuria
Ectopic Ureter
Enuresis
Epididymal tumor first visit
Epididymitis/Orchitis first visit
Flank pain
Glomerulonephritis
Hematospermia
Hematuria
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Hydrocele first visit
Hydronephrosis
Hypospadias – post op if had stent
Hypogonadism – 1
st
visit only
Impotence – first visit
Incontinence
Interstitial cystitis
Kidney donor – post op
Low testosterone – 1
st
visit only
Malignant neoplasm bladder, kidney or penis
Medullary Cystic kidney
Medullary sponge kidney
Multicystic kidney
Myelomeningocele/spina bifida
Neurogenic bladder
Nocturia
Nocturnal enuresis
Overactive bladder
Pelvic pain
Penile lesion
Penile prosthesis
Phimosis/Paraphimosis
Polycystic kidney
Post urethral valve surgery
Presurgical work up for upper or lower urinary
tract
Prostatic hyperplasia
Prostate Specific Antigen – Elevated
Proteinuria
Prune Belly
Pyelonephritis
Recurrent UTI
Renal cyst
Renal dysplasia
Renal failure
Renal infarction
Renal mass
Renal stones
Renal transplant
Scrotal mass
Scrotal nodule
Spermatocele
Stenosis first visit
Testicular pain – 1
st
visit only
Ureteropelvic Junction (UPJ) Obstruction
Ureteral obstruction
Ureteral stricture
Urethral fistula
Urethral obstruction
Urethral stricture
Urethritis
Urinary hesitancy
Urinary urgency
Urinary frequency or Polyuria
Urinary retention – if able to void
Vesicoureteral fistula
Vesicoureteral reflux
Viral wart
Voiding difficulty
Voiding dysfunction

2. Each adult and pediatric urology clinic follows its own workflows on checking schedules, placing orders,
printing labels, specimen collection and specimen labeling.
2.1.1. The order for a urinalysis will be entered in the electronic medical record (EMR) by the RN, LPN,
MA, MT or MLT according to the workflow developed in each clinic. The authorizing provider will be
the encounter provider.

Order Mode: Cosign Required Protocol/Policy

References: N/A

Collateral Documents/Tools: N/A

Approved By:
UW Health Ambulatory Protocol Committee: November 2012
UW Health Lab Practice Committee: November 2012; March 2015 (expedited review)
CKM Council: December 2012; March 2015 (expedited review)
UWHC Medical Board: January 2013; March 2015 (expedited review)
UW Health Chief Ambulatory Medical Officer: January 2013; March 2015 (expedited review)

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


Effective Date: March 2015

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