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Allergy Department Spirometry Ordering - Adult/Pediatric - Ambulatory [104]

Allergy Department Spirometry Ordering - Adult/Pediatric - Ambulatory [104] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols



Delegation Protocol Number: 104

Delegation Protocol Title:
Allergy Department Spirometry Ordering - Adult/Pediatric - Ambulatory

Delegation Protocol Applies To:
UW Health Allergy Clinics

Target Patient Population:
Any adult or pediatric patient with asthma or symptoms suggestive of asthma

Delegation Protocol Champions:
Thomas Puchner, MD – Department of Medicine – Allergy
Sameer Mathur, MD – Department of Medicine - Allergy

Delegation Protocol Reviewers:
Elizabeth Frederick, RN – 20 South Park Allergy
Donna Croxford, Ambulatory Clinic Operations Manager – Neurology and Allergy

Responsible Department:
Department of Internal Medicine

Purpose Statement:
To delegate authority from the encounter provider to clinical staff to order and perform spirometry as part of
the rooming process

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) and Medical Assistants (MA’s) trained in the use of this delegation protocol and who
have demonstrated competency in spirometry testing.

Guidelines for Implementation:
1. This protocol is initiated when patients are scheduled to be seen in the Allergy clinics and have any of the
following diagnosis, symptoms or medications:
• Asthma
• Chest tightness/pain
• Cough, exercise induced cough, nighttime cough
• Shortness of breath
• Wheezing
• Active order for daily maintenance inhaler or rescue inhaler
• Chronic Obstructive Pulmonary Disease (COPD)
• Vocal Cord Dysfunction (VCD)/Paradoxical Vocal Fold Motion
2. Prior to rooming the patient the staff will review the medical record to determine if the patient needs
spirometry based on the criteria above. If the patient has a history of recent chest surgery, rib injury,
severe asthma or severe cough or if the patient seems unable or unwilling to perform the procedure the
staff will consult with the provider prior to ordering.
3. If spirometry is indicated the staff will enter orders and then sign based on the type of spirometer used:
3.1. If the spirometer requires a signed order interfaced from Health Link before the test can be performed
(e.g., Midmark used at West and East Clinic locations) the staff will enter and sign the order for pre-
rooming spirometry. Associated diagnosis should be transferred from existing problem list or entered
by clinic staff as “uncomplicated asthma”, with a frequency of “unspecified”. The test may be
performed after signing the order. The provider will review the associated diagnosis as part of the visit
and change as needed to reflect current patient diagnosis.
3.2. If the spirometer does not require a signed order interfaced from Health Link (e.g., Koko used at 20 S.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Park Clinic) the staff will enter the order for pre-rooming spirometry and pend the order for provider
signature. The provider will associate a diagnosis with the order based on the results of the encounter
and sign the order. The test may be performed prior to the provider’s signature.

Order Mode: Cosign Required, Protocol/Policy

References:
1. UW Health. Diagnosis and Management of Asthma – Adult/Pediatric – Inpatient/Ambulatory Clinical
Practice Guideline. September 2016. https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/respiratory/name-97737-en.cckm . Accessed March 10, 2017.
2. U.S. Department of Health and Human Services/National Health Institute. Expert Panel Report 3:
Guidelines for the Diagnosis and Management of Asthma. Full Report: 2007.

Collateral Documents/Tools:
N/A

Approved By:
UW Health Ambulatory Protocol Committee: April 2014; *April 2017
UW Health Clinical Knowledge Management Council: June 2014; *May 2017
UWHC Medical Board: July 2014; *May 2017
UW Health Chief Medical Officer: July 2014; *May 2017

Effective Date: May 2017

Scheduled for Review: May 2020
*Expedited Review Process

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