UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: 24 HOUR pH MONITOR
SCHEDULING and PATIENT INSTRUCTION
Effective Date: October, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed May, 2008 May 2010 September 2012
PURPOSE: To provide guidelines for scheduling a UWMF patient for a 24-hour pH test.
DEFINITION: A 24-hour pH test measures the pH of the esophagus. It is used to rule in or rule out Reflux
Disease and is generally completed on those patients complaining of chronic cough or upper chest pain.
POLICY: The clinical staff will utilize the following guidelines to schedule a 24-hour pH test for UWMF
Tests are scheduled for a 30 minute appointment Monday or Wednesday mornings.
DO NOT schedule the day before a holiday.
Patient MUST return the next day (24 hours) to have the probe removed.
Tests can be scheduled 2 per day; and should be scheduled at least 2 hours apart.
Note: Dr Magenheim and Dr Williams patients are to be scheduled at 8:00am with a 7:00am arrival
Current procedure is done by Dr.’s Magenheim and Williams
1. Check provider’s order and clarify any inconsistencies.
2. Call the patient 7-days prior to the test.
Introduce yourself and identify the patient.
3. Explain procedure to the patient and instruct the patient to:
o Stay on PPI, no need to stop unless otherwise instructed by physician.
Take antacids as needed during this 7-day time period.
Have nothing by mouth after midnight for an AM procedure.
o Clear liquid breakfast OK for a PM procedure.
Arrive at Meriter Registration 1-hour before the scheduled appointment time.
Wear a button/zipper front top.
DO NOT apply facial or body make-up, lotions, oils, or powders.
Patient may drive home safely alone, as patient will not be sedated.
POST PROCEDURE INSTRUCTIONS:
1. Instruct the patient:
To resume their usual diet and normal activities.
Not take a shower to prevent the monitor from getting wet.
o Okay to sponge bathe
They must return to the Meriter endoscopy department to remove probe in exactly 24 hours.
4. Schedule follow-up appointment following the procedure (if indicated by provider).
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: Laurie Woodhouse, Manager, UWMF Gastroenterology Clinic
Division of Gastroenterology & Hepatology Date
Medical Director Date