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New OB Patient Laboratory and Diagnostic Test Ordering – Adult – Ambulatory [116]

New OB Patient Laboratory and Diagnostic Test Ordering – Adult – Ambulatory [116] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols




Delegation Protocol Number: 116

Delegation Protocol Title:
New OB Patient Laboratory and Diagnostic Test Ordering – Adult - Ambulatory

Delegation Protocol Applies To:
UW Health OB/Gyn Clinics and Family Medicine Clinics with OB/Gyn services providing OB Care

Target Patient Population:
Pregnant patients scheduled for a New Obstetrics (OB) visit with the Registered Nurse

Delegation Protocol Champions:
Makeba Williams, MD - Department of Obstetrics/Gynecology
Jacqueline Gerhart, MD - Department of Family Medicine

Delegation Protocol Reviewers:
Jenny Accola, RN, BSN – Clinic Coordinator – UW OB/GYN
Linda Kiefer, RN – Clinical Supervisor – UW Health Deforest-Windsor Clinic

Responsible Department:
Department of Obstetrics/Gynecology
Department of Family Medicine

Purpose Statement:
To delegate authority from the patient’s OB/GYN provider to Registered Nurses (RNs) to place orders for
laboratory and diagnostic tests for new obstetrics patient.

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

Guidelines for Implementation:
1. This protocol is initiated when a patient is scheduled for a new OB visit with the RN.
2. The RN will use the OB Initial Visit Smart Set to place the order for the indicated tests. The orders will be
signed by the RN and routed to the OB provider for cosignature. Prior to placing any orders the RN will
perform a chart review to determine if any of the indicated tests have been previously ordered to avoid
duplicates.
3. The tests should be performed immediately following the RN New OB visit. If the patient does not arrive for
the provider clinic visit after the tests have been performed, the RN will notify the provider of the reason, if
known, and obtain further direction. The RN will notify the patient of the results and ask if she wants the
results sent to another care provider.


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

Table 1. Laboratory and Diagnostic Tests
Indication Orders Comments
Routine New OB
• CBC without differential
• Antibody Screening
• Hepatitis B Surface Antigen
• RPR
• Rubella Titer
• Prenatal ABO and Rh
• Urinalysis and urine culture
• HIV 1,2 Antibody
Order for all patients
Estimated Date of Delivery
(EDD)
• OB Ultrasound Order for all patients with uncertain
date of delivery
Increased Risk of Diabetes/Pre-
Diabetes
• Fasting Blood Glucose Screen high risk patients as per
Delegation Protocol #22 (Gestational
Diabetes Screening
Increased Risk of Preeclampsia
• ALT
• AST
• BUN
• Creatine
• Hemoglobin A1C
• 24 hour urine total protein or
protein creatinine ratio
• Uric acid
Order if patient has current or history
of :
• chronic hypertension,
• pre-eclampsia,
• kidney disease [recurrent urinary
tract infections (>3/year),
pyelonephritis, chronic kidney
disease],
• Type 2 diabetes
Increased Risk of Thyroid
Disease
• Thyroid Stimulating Hormone
(TSH, reflex T4)
Order if primary relative has current
or history of thyroid disease


Order Mode: Cosign Required, Protocol/Policy

References:
1. Akkerman D, Cleland L, Croft G, Eskuchen K, Heim C, Levine A, Setterlund L, Stark C, Vickers J, Westby E.
Institute for Clinical Systems Improvement. Routine Prenatal Care. Updated July
2012. https://www.icsi.org/_asset/13n9y4/Prenatal.pdf. Accessed December 23, 2014
2. American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Guidelines for
Perinatal Care. 7th ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American
College of Obstetricians and Gynecologists, 2012.
3. Zolotor, AJ and Carlough MC. Update on Prenatal Care. Am Fam Physician. 2014:89(3):199-208.
4. ACOG Committee Opinion “Preconception and Prenatal Carrier Screening for Genetic Diseases in Individuals of
Eastern European Jewish Descent” #442 10/2009 reaffirmed 2014.

Collateral Documents/Tools:
1. Gestational Diabetes Screening Delegation Protocol – Outpatient – OB/Gyn, Family Medicine
2. Preventive Health Care - Adult/ Pediatric –Primary Care Clinical Practice Guideline (CPG)

Approved By:
UW Health Ambulatory Protocol Committee: April 2015, December 2015; *November 2016
UW Health Lab Practices Committee: May 2015, December 2015; *November 2016
UW Health Center for Clinical Knowledge Management Council: June 2015, December 2015; *November 2016
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

UWHC Medical Board: June 2015, January 2016; *November 2016
UW Health Chief Clinical Officer: June 2015; *November 2016

Effective Date: December 2016

Scheduled for Review: December 2018

* expedited review process
December 2015 – addition of Family Medicine Clinics with OB/Gyn services as delegates and removal of genetic
testing orders.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org