Standardized Procedure for UTI: General Policy

This document provides a standardized procedure for Obstetrics(UTI) and guidelines for performing certain functions without immediate physician supervision. It includes information on development and review, scope and setting, education and training, supervision and evaluation, consultations, patient records, definition, epidemiology, history, symptoms, diagnostic tests, management, prevention, and development and approval of the standardized procedure.

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Standardized procedure for UTI: GENERAL POLICY
1. Purpose
A. The components of BRN’s ( Standardized procedure for Obstetrics(UTI) )
guidelines for Obstetrics(UTI) provide a purpose to build a standardized
procedure to perform certain functions when you are not provided with the
immediate supervision of a physician.
2. Development and review
A. IDC ( interdisciplinary committee) consisting of physicians and administrative
representatives is a medium whose efforts helped in the development of all standardized
procedures.
B. IDC will approve all the standardized procedures, review them every 3 years and
will make sure that the approval sheets of all professionals are covered by the procedures, signed
and dated (Nursinglicensure.org, 2019).
C. An agreement to the standardized procedures will be represented by all the
supervising physicians upon hire and will be evidenced by a signed and dated approval sheet.
3. Scope and setting
A. The NPs may have different specialities. They may operate different functions
according to their training speciality area including management, assessment, x-rays, physical
therapies, diet management, treatment of chronic illness and appraisal of health status, being
aware of the fact that the features provided may not be limited to ordering laboratory procedures
(Chcf.org, 2018).
B. Management of medication regimens and such standardized procedure functions are
performed under the direct or indirect availability of consulting physicians.
4. Education and training/qualifications
● A current California registered nursing license is must for every NP performing
standardized procedure functions
● A graduation certificate of an approved Nurse Practitioner program is needed
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● NPs must be certified by CA BRN
● A current healthcare provider card is needed which must be provided by American Heart
Association
● All the NPs must complete competency validation checklist upto hire which will be
reviewed and updated annually by the IDC
5. Supervision and evaluation
● An individual physician is not allowed to supervise more than 4 NPs at a single time
● In the time period of one week, supervising physicians have to review the cases of a
minimum of 10% of the NPs. Then a documentary has to be prepared regarding the
supervised cases within a time period of 30 days (Gopee, 2015).
● The selection of the cases will be random unless a medical professional requests for the
review of a selected case
● The evaluation of nurses’ competence will be done in three stages in performance of
standardized procedure functions. The first one is INITIAL in which the nurse manager
evaluate from the feedbacks collected from colleagues and physicians after the time span
of 3 months, 6 months and 12 months. The second and third stages are ROUTINE and
FOLLOW-UP in which same procedure of evaluation is followed but the time span is
annually after the first year in case of ROUTINE. In case of FOLLOW-UP, evaluation is
carried out at appropriate intervals until acceptable skills are acquired (Salvatore et al.,
2011).
6. Consultations
Consultation from physicians is obtained during individual procedures or when there is a doubt
in an appropriate.
7. Patient records
NPs have to make a documentary of a complete electronic medical record of each patient. The
record will also contain the information related to the existing clinic and medical staff policies.
Protocol
1. Definition
Obstetrics is the field or branch of medicine and surgery which deals with childbirth and
midwifery. Urinary Tract Infections(UTI), as the name, it is a type of infection which that arises
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in urinary tract. It is termed as bladder infection if it affects the lower urinary tract and it is called
kidney infection if it affects the upper urinary tract. Female anatomy, sexual intercourse,
obesity, diabetes, etc are some risk factors (Montini & Hewitt, 2009).
2. Epidemiology
● Being one of the most frequent bacterial infection, it occurs most frequently between 16
to 35 years of age
● 10% of the women are affected annually by this infection as well as 10% of people are
affected during childhood (Salvatore et al., 2011).
3. History
Earlier during 18th and 19th century, Obstetrics was not known. After its development, it was
very easy to deal with pregnancy related problems. UTI has been affecting women since ancient
times and it’s treatment was found in 1930s when antibiotics were developed.
4. Symptoms
● Burning in the urinary tract at the time of urination
● Urinating frequently without vaginal discharge and significant pain
● Pain in the lower back
● Appearance of blood and visible pus in the urine (Okonko et al., 2009)
5. Diagnostic tests
● Diagnostic tests are generally based on clinical presentation
● Different tests include diagnosis via urinalysis and urine microscopy
6. Differential diagnosis
● In case of UTI infection(Obstetrics), rapid urine tests are used to diagnose the problem
● A midstream urine culture is a standard diagnostic tool for complicated UTIs, which is of
great significance in Obstetrics.
● Urethral catheterization is also used but it may be costly and bring discomfort to the
patient
● Rapid diagnostic test is also used in Obstetrics because it is more specific and effective.
Microscopic urinalysis is one of them. Microscopic urinalysis is one of them (Kalsoom et
al., 2012).
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7. Management
UTIs are caused due to the bacteria that enter the bladder via the urethra or due to the blood.
Personal hygiene is must in such cases.
Treatment:-
● In Obstetrics some antibiotics such as sulfamethoxazole/Trimethoprim
(Septra,Bactrim),Fosfomycin (Monurol),Ceftriaxone(Rocephin),etc play a major role in
the treatment of UTI
● Some people who have bacteria in their urine should not be given antibiotics
● During treatment, symptoms must be provided within 36 hours. Most of the people
(generally 50%) recover during the first week.
● In case of complicated UTI observed in Obstetrics, antibiotic resistance may help in
improving the future of the people (Arinzon, Shabat, Peisakh & Berner, 2012).
● One must drink plenty of water in order to treat UTI
● Intake of vitamin C and drinking cranberry juice can also help
● For a better treatment, consumption of a mixture of one spoon of apple cider vinegar
with 8 ounces of water, thrice a day, is recommended.
8. Prevention
People must ignore the misconceptions and use safety measures. Immediate urinating after
intercourse, personal hygiene, bathing, using underwear of proper hygiene may help in
preventing from such infections. Unprescribed medicines or methods must not be used without
proper consultancy of a physician (Eriksson, Gustafson, Fagerström & Olofsson, 2010).
In case of suffering from UTI(Obstetrics), consulting a physician as soon as possible may help in
solving the problem before time. Proper medicines according to proper schedule must be taken. .
9. Development and approval of the standardized procedure
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The above standardized procedure was developed and approved by organization’s
interdisciplinary committee (IDC). the procedure will be reviewed and approved every 3 years or
more as per the need.
Revision date:-
Review date:-
10. The following members approved the standardized procedure of the IDC-
_______________________________ Date_______________________
Pediatric Department Chair
_______________________________ Date_______________________
Supervising Physician
_______________________________ Date_______________________
Director of Nursing Practice
_______________________________ Date_______________________
Administration
11. A file will be maintained which will include the list of nurse practitioners and will be kept
in the department in which they practice and hospital administration.
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References:-
Arinzon, Z., Shabat, S., Peisakh, A., & Berner, Y. (2012). Clinical presentation of urinary
tract infection (UTI) differs with aging in women. Archives of gerontology and geriatrics,
55(1), 145-147.
California’s Nurse Practitioners: How Scope of Practice Laws Impact Care. (2018).
Retrieved from
https://www.chcf.org/wp-content/uploads/2018/09/NursePractitionerScopePracticeLaws.
pdf
Eriksson, I., Gustafson, Y., Fagerström, L., & Olofsson, B. (2010). Prevalence and factors
associated with urinary tract infections (UTIs) in very old women. Archives of
gerontology and geriatrics, 50(2), 132-135.
Gopee, N. (2015). Mentoring and supervision in healthcare. Sage.
Kalsoom, B. A. N. O., Jafar, K. H. A. N., Begum, H., Munir, S., ul AKBAR, N., Ansari, J.
A., & Anees, M. (2012). Patterns of antibiotic sensitivity of bacterial pathogens among
urinary tract infections (UTI) patients in a Pakistani population. African Journal of
Microbiology Research, 6(2), 414-420.
Montini, G., & Hewitt, I. (2009). Urinary tract infections: to prophylaxis or not to
prophylaxis?. Pediatric Nephrology, 24(9), 1605-1609.
Nursing Licensure in California. (2019). Retrieved from
https://www.nursinglicensure.org/state/nursing-license-california.html
Okonko, I. O., Ijandipe, L. A., Ilusanya, O. A., Donbraye-Emmanuel, O. B., Ejembi, J.,
Udeze, A. O., ... & Nkang, A. O. (2009). Incidence of urinary tract infection (UTI)
among pregnant women in Ibadan, South-Western Nigeria. African Journal of
Biotechnology, 8(23).
Salvatore, S., Salvatore, S., Cattoni, E., Siesto, G., Serati, M., Sorice, P., & Torella, M.
(2011). Urinary tract infections in women. European journal of obstetrics & gynecology
and reproductive biology, 156(2), 131-136.
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