/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/delegationpractice-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/ambulatory-delegation-protocols/,

/clinical/cckm-tools/content/delegationpractice-protocols/ambulatory-delegation-protocols/name-97435-en.cckm

201711331

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Ambulatory Delegation Protocols

Bone Age Imaging for Growth Evaluations in Endocrinology - Pediatric - Ambulatory [127]

Bone Age Imaging for Growth Evaluations in Endocrinology - Pediatric - Ambulatory [127] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 127

Delegation Protocol Title:
Bone Age Imaging for Growth Evaluations in Endocrinology – Pediatric – Ambulatory

Delegation Protocol Applies To:
New patients referred to Pediatric Endocrinology for short stature, precocious puberty, delayed puberty
or decreased growth velocity with no bone age scan previously ordered.

Target Patient Population:
Endocrinology patients in the pediatric endocrine clinic at the American Family Children’s Hospital

Delegation Protocol Champion:
Ellen Connor, MD – Department of Pediatrics - Endocrinology

Delegation Protocol Reviewers:
Betsy Bazur-Leidy, RN – Pediatric Specialties
Kelly Dunphy, RN – Pediatric Specialties
Amy Groener, RN – Pediatric Specialties

Responsible Department:
Department of Pediatric Endocrinology

Purpose Statement:
To delegate authority from the encounter provider to the Registered Nurses (RNs) to enter orders under
specific conditions clearly indicated below

Who May Carry Out This Delegation Protocol:
RNs trained in the use of this protocol.

Guidelines for Implementation:
1. RN will review referral request to determine indication and look for previously ordered bone age x-
ray. If previous bone age x-ray completed this delegation protocol does not apply and the RN will
discuss with the provider.
2. If patient is being referred for short stature, precocious puberty, delayed puberty or decreased
growth velocity, RN will place order for Bone Age XRay (Left Hand) Code: R77072L if not previously
ordered in the past 6 months.
2.1. For testing the RN will answer the following questions:
2.1.1. What specific question(s) would you like answered by this exam?-answer evaluate skeletal
maturation in a ____ year and ____ months old _____ (enter age & gender)
2.1.2. Relevant recent/ past history?-answer referred by ________ (PCP or other provider) for
__________(diagnosis)
Order Mode: Cosign Required, Protocol/Policy
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

2

References:
Kappy, M., Allen, D., Geffner M. (2014). Pediatric Endocrinology, 2
nd
edition, 33-34.

Collateral Documents/Tools: NA

Approved By:
UW Health Ambulatory Protocol Committee: November 2015
UW Health Radiology: November 2015
UW Health Knowledge Management Council: November 2015
UWHC Medical Board: December 2015
UW Health Chief Clinical Officer: December 2015

Effective Date: December 2015

Scheduled for Review: December 2018



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