Emerge Surgical Nurse Practitioner CLINICAL PRACTICE GUIDELINE - Urinary Tract Infection Nurse Practitioner Medical Practitioner +/‐ Nurse Practitioner Primary Assessment History Focused clinical assessment Pain assessment Initial management/ analgesia Imaging / Diagnostics Pathology Scope Uncomplicated Urinary Tract Infection. Patients with pain associated with their presenting complaint. Consider referral to MO if:  Uncontrolled pain +/‐ nausea, tachycardia.  currently on multiple pain medication  Previously treated UTI, not responsive to antibiotics. Initial Assessment and Interventions Airway, breathing, circulation Observations; temp, BP, heart rate, Document pain, onset, duration, symptoms. History of previous UTIs or urological procedure. Co‐morbidities. Urinalysis; haematuria Check for dysuria, frequency, urgency, incontinence Abdominal examination/ suprapubic discomfort. Burning on micturition, flank or back pain. See Medications: Check fluid intake adequate. Working Diagnosis and Investigations Bladder scan; Ultrasound Urine for MC&S Bloods FBC; U&Es; PSA (males) Interpretation of results & management decisions Treatment Goals Relieve diagnosed infection and associated symptoms. Referrals GP Patient Discharge Education When to return/ Review in < 1 week, check pathology where indicated. Return if symptoms persist or worsen. follow up appointments Medication Verbal and /or written instructions from NP / pharmacist. instructions Specific Care Discuss hygiene / use of cotton blend underwear (females) Letters GP Outcomes Identify patients suitable for NP CPG Identify patients not suitable for NP CPG and redirect to MO or ED. Outcomes Predisposing conditions will be considered when determining a diagnosis. The need for MSU is determined. The need for analgesia will be considered. Outcomes Detection of residual and/or retention of urine. Prescribe where detected organism is susceptible. Outcomes Outcomes Correct use of anti‐ infectives. Page 1 of 3 Emerge Surgical Nurse Practitioner CLINICAL PRACTICE GUIDELINE - Urinary Tract Infection Medications Oral medications Trimethoprim 300mg OD (nocte) 5/7; 10‐14 days for relapsing UTI or male patients or; Cephalexin 500mg oral, tds 7‐14/7 or Amoxycillin+clavulanic acid orally 500‐875mg bd 5‐10/7 Alternatives: Nitrofurantoin [macrodantin] 50‐100mg oral qid. With food Norfloxacin 400mg oral, bd, 1hr before or 2hrs after food. 7‐10 days. Oestradiol 25mcg pessaries [vagifem] 1x inserted vaginally od for 2 weeks, then bi‐weekly. Analgesia Non Prescription Unexpected representation Outcomes Choice of medication based on pathology result where indicated. Relief from cystitis symptoms in peri menopausal women Analgesia given is See separate analgesia clinical protocol. Analgesia requirements determined by ongoing assessment appropriate to allergies, current medications and of pain. Patients with excessive or unrelieved pain with analgesia to medical history be reviewed by Medical Practitioner. Cranberry supplements Ural sachet 4g x1 qid / prn Evaluation Strategies Review patient notes. References AMH: The Royal Australian College of General Practitioners. ASCEPT., & Pharmaceutical Society of Australia. (2007). Australian Medicines Handbook. Adelaide, South Australia: AMH Nicoll, D., McPhee, S., Pignone, M., Detmer, W., Chou, T., & Dunstan, R. (2012). Pocket Guide to Diagnostic Tests, 3rd edition (Australia). McGraw‐Hill: Sydney, NSW. Page 2 of 3 Emerge Surgical Nurse Practitioner CLINICAL PRACTICE GUIDELINE - Urinary Tract Infection Authorship and Endorsement Reviewed and authorised by: This CPG was originally written by: Kym Cullen Nurse Practitioner Emerge Surgical General, Bariatric and Oncology Services Mandurah WA 6210 Dr Gordon Padovan FRACS, FRCS (Canada) Signature: ____________________ Date: __________ Dr James Moyle FRAGP. General Practitioner. Signature: ____________________ Date: __________ Mr Brett Lukatelichi B.Pharm Pharmacist, Warnbro Pharmacy. Signature: ____________________ Date: _________ Key Terms GP ‐ General Practitioner NP ‐ Nurse Practitioner MO ‐ Medical Officer CPG ‐ Clinical Practice Guideline ED ‐ Emergency Department [Hospital] S1‐S4; S8 ‐ Schedule of the drug administration act Developed: 06/2013 Review Date: 06/2016 Page 3 of 3