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Certified Practice: Remote Nursing and RN First Call DSTs updated

posted Oct. 30, 2014

Every two years, the decision support tools (DSTs) for each category of CRNBC-certified practice undergo a review to ensure they reflect changes in best practice.

This announcement provides a summary of key changes approved in September 2014 to the Remote Nursing and RN First Call Certified Practice DSTs. The revised DSTs are posted on the CRNBC website. Be sure to replace any previous versions of DSTs with the revised versions.

The Remote Nursing and RN First Call Certified Practice Decision Support Tools (DSTs) have been reviewed and revised to reflect changes in best practice and to ensure clarity and consistency. The process included a literature review, consultation with clinicians and feedback from nurses who use the DSTs.

The references in all DSTs have been updated, and some editorial changes have been made to standardize the content. A summary of revisions is below. DSTs that have had no significant revisions are not listed.

**Please note that a lower age limit has now been specified for all Pediatric DSTs.**

Please review and incorporate into your practice the revised DSTs as they outline the current requirements for Remote Nursing and RN First call Certified Practice.

​adult &
pediatric
​Eye Assessment
  • ​Removed deficit in color vision as symptom requiring urgent referral
​adult & pediatric ​Conjunctivitis
  • ​A “wait and see” approach for 2-3 days has been added prior to starting antibiotics.
  • Client education/discharge information updated regarding school/work restrictions.
  • Cetirizine now safe to use in pregnancy and breastfeeding.
  • Moderate or severe pain added as an indication for consultation/ referral.
  • Antibiotic gtts changed from 5-7 to 7-10 days.
  • RN(C)s are able to treat children 6 months of age and older.
​pediatric ​Corneal Abraison
  • ​RN(C)s are able to treat children 2 years of age and older.
​pediatric ​Acute Otitis Media
  • ​Changes to antibiotics
  • RN(C)s are able to treat children 6 months of age and older.
​adult & pediatric ​Pharyngitis
  • ​Changes to antibiotics
  • RN(C)s are able to treat children 6 months of age and older.
​adult ​Ceruminosis
  • ​Client information/ discharge information updated.
​pediatric ​Cardio-Resp Assessment 
  • ​Vital signs chart updated
​adult ​UTI (Remote)
  • ​Definition added for complicated and uncomplicated UTIs.
  • Added the need for a C&S to confirm sensitivity of the organism to the chosen antibiotic in specific situations.
  • Differentiated treatment for complicated vs. uncomplicated UTIs.
  • Added the need for repeat C&S 1-2 weeks after antibiotics completed for complicated UTIs.
  • Changes to antibiotics
pediatric​ ​Lower UTI
  • ​RN(C)s able to treat children 2 years of age and older.
  • Specified that a referral is required for a pelvic exam for any female who has not been sexually active, or any female less than 14 years of age.
  • Changes to antibiotics.
​adult ​Female UTI (RNFC only)
  • ​Definition added regarding complicated vs. uncomplicated UTIs.
  • Clarity added that RN(C)s are able to treat uncomplicated UTIs only.
  • Changes to antibiotics
​adult ​Acute Bronchitis
  • ​Added swab for pertussis to diagnostic tests.
  • Changes to antibiotics.
​adult ​Abscess and Furuncle
  • ​Changes to antibiotics
​adult ​Cellulitis
  • ​Changes to antibiotics
​adult & pediatric ​Cellulitis
  • ​RN(C)s able to treat children 2 years of age and older.
  • Removed swabbing of nares for MRSA in diagnostic tests
  • Changes to antibiotics
​adult & pediatric ​Impetigo
  • ​Deleted cleansing with antimicrobial agent in non-pharmacologic interventions
  • Changes to antibiotics
  • Changed indication for antibiotics from “if lesions appear infected” to “if client febrile or systemic symptoms”
  • RN(C)s are able to treat children 6 months of age and older.
adult & ​pediatric ​Bites
  • ​Updated information regarding % of dog bites that become infected
  • Clarification regarding when prophylaxis should be used for dog bites
  • Clarification of when to suture
  • RN(C)s are able to treat children 1 year of age and older.
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