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Pain Management Profile Urine Drug Testing – Adult – Ambulatory [115]

Pain Management Profile Urine Drug Testing – Adult – Ambulatory [115] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 115

Delegation Protocol Title:
Pain Management Profile Urine Drug Testing – Adult – Ambulatory

Delegation Protocol Applies To:
UW Health Primary Care Clinics, UWHC Pain Clinic and Headache Clinic

Target Patient Population:
Adult patients on chronic opioid therapy (90 consecutive days or more on opiate prescription(s))

Delegation Protocol Champion:
Sandra Kamnetz, MD – Department of Family Medicine

Delegation Protocol Workgroup:
Alexander Young, MD – Department of Family Medicine
Randall Brown, MD – Department of Family Medicine
Peter Newcomer, MD – Department of Internal Medicine
Richard Welnick, MD – UWMF Department of Administration
Nathan Rudin, MD – Department of Orthopedics/Rehabilitation
Julie Fagan, MD – Department of Internal Medicine
Mark Beamsley, MD – Department of Family Medicine

Responsible Department:
Department of Medicine
Department of Family Medicine

Purpose Statement:
To delegate authority from the provider managing the patient’s opioid therapy to clinical staff to order
urine drug testing.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RN’s), Licensed Practical Nurses (LPN’s), Medical Assistants (MA’s) and pharmacists
(RPhs) trained in the use of this delegation protocol.

Guidelines for Implementation:
1. RN, LPN, MA, or Pharmacist will review the patient’s medical record and place orders for urine drug
screening testing necessary. The UW Health Opiate Management Therapy Policy requires each
patient to be tested at least once in a 12 month period. This may be done as part of a variety of
workflows including rooming, previsit planning, outreach and prescription renewal.
2. In cases where the patient’s provider has stated in his/her progress note to test more frequently,
the RN, LPN, MA, or Pharmacist will order appropriately.
3. Contraindications: If the patient meets any of the following contraindications, they are excluded
from the use of this delegation protocol:
3.1. Patients diagnosed with cancer.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

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3.2. Terminally ill patients with a prognosis of less than 6 months.
3.3. Patients enrolled in a hospice program.
4. The staff member will place appropriate testing order using the RN Delegation Protocol – Urine Drug
Testing – Pain Management – Adult Smart Set.

Order Mode: Cosign Required Protocol/Policy

References:
1. Webster, Lynn R. The role of urine drug testing in chronic pain management: 2013 Update.
PainMedicineNews. December 2013.
2. Magnani B, Kwong T. Urine drug testing for pain management. Clinics in Laboratory Medicine. 2012
vol.:32 iss:3 pg:379-90
Collateral Documents/Tools:
1. UW Health Opiate Therapy Management Policy - 1.2.3.
2. RN Delegation Protocol – Urine Drug Testing - Pain Management – Adult [5404] Smart Set
Approved By:
UW Health Ambulatory Protocol Committee: December 2014
UW Health Laboratory Practices Committee: January 2015
UW Health Center for Clinical Knowledge Management Council: June 2015
UWHC Medical Board: July 2015
UW Health Chief Ambulatory Medical Officer: July 2015

Effective Date: July 2015

Scheduled for Review: July 2017



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