To the Editor:
Regarding "A protocol for the urine dipstick/pad method" by Susan Midthun in the July/August 2006 issue of JWOCN,1 I'd like to thank the author for proposing the development of a protocol for health care professionals who use this method of assessment in the care of the elderly. One problem that I have seen with the use of this method is a lack of protocol, resulting in the mismanagement and prolonged treatment of urinary tract infections in nursing home residents. A protocol would be helpful to educate nursing staff on when this method is appropriate and bring about an acceptable standard of practice. This method is being used with incontinent nursing home residents, and a protocol is much needed to improve the outcomes of its use with this population.
Frail nursing home residents who are incontinent are often unable to perform the tasks necessary for obtaining a clean midstream voided urine sample. Often when this happens, a catheterized urine specimen is obtained.2 When other noninvasive methods of urine collection have failed, the dipstick/pad method of analysis would be helpful. This protocol could be implemented to help identify the need for laboratory urinalysis and/or culture and sensitivity in the frail elderly without subjecting the resident to invasive and costly procedures, such as urinary catheterization, unnecessarily. Another possible use for this protocol may be to confirm the resolution of a urinary tract infection, post antibiotic treatment. It is more cost effective than catheterization and eliminates the possibility of re-infection if proper technique is not maintained.
This protocol, however, is limited to the particular products tested by the researcher and cannot necessarily be applied to the use of other products. Manufacturer-based protocols are needed. Evidenced-based research with the use of other dipstick and incontinence pad products would be helpful to facilitate a more widespread and acceptable use of this method of urinalysis in nursing home residents.
Melissa Pickett, BSN, RN
University of Missouri, Columbia
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