EXPEDITED TREATMENT OF WOMEN WITH URINARY TRACT INFECTIONS - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Sat, 08/27/2011
Revised: 
Tue, 05/09/2017

Urinary Tract Infections are a common and disturbing problem for young women. Good evidence indicates that several findings are sufficiently predictive of the presence of a Urinary Tract Infection in symptomatic women to support empiric treatment for these women. This procedure provides specific guidelines to guide the RN in providing expedited treatment of uncomplicated urinary tract infections to women presenting to the UCSC Student Health Center.

Procedure

  • Adult female students presenting to the UCSC Student Health Center with complaints suggestive of a urinary tract infection are given the Patient Self Assessment Cystitis/Vaginitis form.
  • RN reviews Self-Assessment form with student.
  • Expedited treatment is not available to students who indicate:
  • Presence of any of the conditions listed under Significant Medical History
  • Presence of symptoms of vulvar or vaginal infection
  • Presence of risk for sexually transmitted infection
  • Pregnancy or possible pregnancy (until ruled out)
  • RN assesses vital signs. Temperature greater than 100.4 F requires clinician evaluation.
  • RN assesses for CVA tenderness. Significant CVA tenderness requires clinician evaluation. Students who do not qualify for expedited treatment are requested to provide a clean catch urine sample that is transported to lab for urinalysis The remaining urine sample is held in the lab so that the clinician may add a urine culture as indicated. Results of the urine dip are entered into the patient chart and the patient is set up for clinician evaluation.
  • Students who are not excluded from expedited treatment are given the option of expedited treatment or a same day appointment with a clinician.
  • After reviewing the students medication history and allergy history for contraindications or interactions, the student is given a prescription per the UCSC Student Health Center RN Standardized Procedure

Medication List for either:

  • Macrodantin, 100mg, #10, one every 12 hours for 5 days.
  • Cipro, 250mg, #6, one every 12 hours for 3 days.
  • Students who report allergy or reaction to either of these meds require a consultation with a clinician for an appropriate alternative treatment plan.
  • Students are offered OTC AZO (phenazopyridine), 2 every 8 hours as needed for dysuria. Warn student about the change in the color of the urine caused by the AZO.
  • Students are counseled on criteria for return for re-evaluation
  • Failure to resolve symptoms in 72 hours.Increased complaint at anytime, particularly fever with shaking chills, back or flank pain, nausea or vomiting.
  • Return of symptoms at completion of medication regimen.
  • Any additional complaints or concerns
  • RN reviews the UTI handout with patients.
  • RN develops and documents a plan to address STI concerns and/or contraceptive issues as identified.
  • Students are given the After Hours Provider handout in case they need to be evaluated when the Student Health Center is closed.

Experience, Training and/or Education:

  • Current CA RN license
  • Completion of the UCSC Student Health Center orientation specific to this procedure
  • Evaluation of Competency

Initial Competency:

  • Observes experienced RN implementing this procedure.
  • Demonstrates successful use of this procedure under direct RN supervision at least three times.
  • Submits a minimum of 5 chart notes demonstrating use of the procedure to the Clinic Director for review.

On-going Competency:

  • Chart reviews of this procedure occur as part of the on-going Quality Assurance program of the UCSC Student Health Center.

Scope of Supervision

  • No direct clinician supervision
  • Clinicians available as needed for consultation and referral

Criteria for Provider Consultation & Referral

  • Students who do not meet the criteria for expedited care require provider evaluation.
  • This includes students who identify Significant Medical History, who report temp >100.4, nausea and vomiting, or those who have had symptoms for more than 7 days.
  • Students with CVA tenderness or with a recorded temp >100.4 require clinician evaluation.
  • Students who report intolerance or allergy to Macrodantin and Cipro require a clinician consultation.

Documentation

  • RN documents according to the standards delineated in the UCSC Student Health Center Policy on Documentation of Care