Urinalysis competency

Competency standard to be achieved

Perform dipstick urinalysis and interpret the results

Assessment timeframe
To be negotiated with clinical supervisor, assessor or line manager

Workplace learning delivery overview

A combination of the following will be implemented:
• Self-directed learning
• Coaching or mentoring
• Workplace application

Learning activities / resources

Task Description Completed
Y/N
1. Complete self- Complete self-assessment using the learning needs assessment tool and
assessment discuss learning needs and assessment or verification processes with
clinical supervisor or line manager
2. Access local Infection prevention
policies and Infection control
procedures relevant
to role Consent to treatment/informed consent

3. Complete on the Observe a minimum of five specimen collections and urinalysis by a

job urinalysis training Continence Nurse Consultant, Urology Nurse Consultant or equivalent

4. Undertake Undertake a minimum of five dipstick urinalysis assessments supervised

supervised clinical by a Continence Nurse Consultant, Urology Nurse Consultant or
practice and equivalent and obtain feedback about performance
feedback sessions
5. Review the
following NICE clinical guideline 171. The management of urinary incontinence in
presentations women. Sections 1.1.6 – 1.1.10.
https://pathways.nice.org.uk/pathways/urinary-incontinence-in-
women#path=view%3A/pathways/urinary-incontinence-in-women/
assessment-and-investigation-of-urinary-incontinence-in-
women.xml&content=view-node%3Anodes-urine-testing, September
2013.
US National Library of Medicine
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010405/#i684-
references
(Element 3, 5, 6, 7)

6. Review the YouTube videos on urinalysis: Urinalysis part 1 <www.youtube.com/watch?

following video v=EBwmr65AbGM>; Urinalysis part 2 <www.youtube.com/watch?
demonstrations v=sE7zL5YlGYs>; Urinalysis part 3 <www.youtube.com/watch?
v=nWHac8CENAg>
(Elements 5 and 6)
About the competency standard
Domain Description
Descriptor This unit of competency describes the skills and knowledge required to perform
analysis of urine using the dipstick method (test strips), and make appropriate clinical
decisions based on the results.
Pre-requisites Physiotherapist registered to practice in Australia via AHPRA
Postgraduate qualifications in Women’s Health Physiotherapy (such as University of
Melbourne Postgraduate Certificate in Physiotherapy or equivalent)
Application The application of knowledge and skills described in this competency unit relate to
physiotherapists working, or planning to work in, an Advanced Practice Continence
and Women’s Health Physiotherapy role.
The skills and knowledge described in this competency standard are considered
advanced skills for physiotherapists working in this context and are therefore limited
in application only by clinicians with a relevant postgraduate certificate or clinical
Master’s degree.
Work performed requires the application of knowledge and skills to demonstrate
autonomy, well-developed judgement and responsibility in contexts that require self-
directed work and learning, and with broad parameters to provide specialist advice
and functions.
Currently there are no legal restrictions on physiotherapists performing these skills.
Skills recognition Prior work experience or training may be accepted to verify competence in the work
role described here, but will be assessed on a case-by-case basis against this
standard by an appropriate medical representative/specialist or other appropriate
nominee. This process will only be offered to clinicians holding relevant pre-
requisites.
Re-credentialing/ Once competency is achieved, ongoing competency will be maintained via case
ongoing competency presentation to the medical representative/specialist or other appropriate nominee
requirements annually as a minimum. This will be recorded in the clinician’s continuing
professional development file.
Elements and performance criteria
Element Performance criteria
Element describes the The performance criteria specify the level of performance required to demonstrate
essential outcome of achievement of the element. Terms in bold are elaborated in the range statement.
urinalysis

1. Determine patient 1.1 Identify indications for urinalysis

suitability for 1.2 Identify if there are any contraindications to performing urinalysis
urinalysis
1.3 Identify if there any precautions to performing urinalysis
2. Gain informed 2.1 Select the appropriate setting to request informed consent
consent for 2.2 Explain the test procedure to the patient
urinalysis
2.3 Identify patients who require extra precautions when gaining informed consent
and take appropriate action
2.4 Maintain culturally sensitive practice
2.5 Gain valid informed consent in accordance with the local protocols
3. Prepare to collect 3.1 Prepare the environment for the collection and gather all necessary equipment
the urine sample 3.2 Give the patient the necessary instructions to collect a non-contaminated
specimen
3.3 Offer the patient assistance to collect their sample if they require it
4. Manage the 4.1 Ensure the sample is secure (lid tightened) and correctly labelled with the
sample once appropriate patient identification sticker
collected
5. Perform 5.1 Perform the urinalysis within the appropriate timeframe
urinalysis of collection
5.2 Perform macroscopic urinalysis of the sample
5.3 Perform dipstick urinalysis of the sample using Combur 10 test strips
(manufactured by Roche) or equivalent
5.4 Assess urine odour (if present)
6. Evaluate results 6.1 Evaluate macroscopic results
of urinalysis 6.2 Evaluate dipstick results
6.3 Identify any potential for false positive or false negative results
7. Formulate 7.1 Determine whether sample should be sent to pathology for further testing and
ongoing actions if so complete the relevant paperwork (with medial sign off and according to local
procedure)
7.2 Determine what other ongoing actions need to be taken (if any)
7.3 Determine what follow up procedures need to be completed if sample sent to
pathology
8. Report and 8.1 Document urinalysis findings according to accepted standards
document urinalysis 8.2 Document onward management plan (if any) in patient progress notes
information
9. Apply risk 9.1 Minimise risk associated with urinalysis
management 9.2 Identify adverse events (actual or ‘near miss’) associated
with urinalysis and take appropriate action

Required knowledge and skills

This describes the essential skills and knowledge and their level required for the competency.
Essential knowledge
• A broad and coherent theoretical and technical knowledge of normal and abnormal urine composition
• A thorough working knowledge of indications, contraindications and precautions for urinalysis
• A thorough working theoretical knowledge of how to perform urinalysis
• A thorough working knowledge of what action to take with abnormal urinalysis
• A good working knowledge of the evidence base for the use of the urinalysis
• A good working knowledge of local policies and procedures that relate to urinalysis

Essential skills
• Understand and respects patients’ rights, privacy and dignity
• Communicate effectively with patients, co-workers and supervisors
• Apply ethical principles to the collection, maintenance, use and dissemination of data and information
• Compete urinalysis in an accurate and timely manner
• Utilise urinalysis findings to make decisions about onward management
• Identify any limitations to personal competence as it applies to the job role and consult with a more senior staff
member.
• Demonstrate clear and accurate documentation
• Manage risk to self and client
Range statement
The range statement elaborates terms in italics found in the competency.
Urinalysis refers to:
• A diagnostic physical, chemical, and microscopic examination of a urine sample (specimen).
Indications for urinalysis in the urogynaecology clinic may include:
• To check for blood in the urine
• To diagnose or exclude a urinary tract infection
• To check for early signs of disease
• (All patients attending the clinic will undergo routine dipstick urinalysis)
Contraindications to performing urinalysis may include:
• Lack of consent to performing the test
Precautions to performing urinalysis may include:
• Patients with poor manual dexterity, who may require assistance in sample collection
• Patients with an active UTI who may experience pain with urination
Appropriate setting may include:
• An area which allows for patient privacy and confidentiality to be maintained
Patients refer to:
• Adults >18 years of age only
Precautions for obtaining informed consent refer to:
• Patients who do not speak/have difficulty speaking and understanding English, in which case use a professional
interpreter as appropriate as appropriate to explain procedure and gain consent
• Vulnerable patients, for example psychiatric history, intellectual disability, psycho-sexual problems, past
physical/sexual abuse. Offer the opportunity to have a chaperone (relative, friend or carer) with them, or to
postpone examination until next consultation if unaccompanied at first visit.
Culturally sensitive refers to:
• Ensuring that procedures or service activities are sensitive to the cultural context of the patient
Written consent refers to:
• Valid informed consent that is in the written form and is required in certain circumstances
Verbal consent refers to:
• Valid informed consent that is received verbally and is usually adequate for simple examinations which involve
minimal or no risk to the patient, including external and internal examinations. This is at the discretion of the
treating physiotherapist
Valid informed consent refers to:
• Competency – patient must be competent to give consent
• Timing – must be prior to the examination
• Informed – patient must be fully informed regarding the benefits and risks of examination
• Voluntary – consent must be given voluntarily by patient, without coercion. Patient has right to withdraw their
consent at any time before or during the examination
• Specific – must be clear what examination the patient is consenting to (for example, external perineal or internal
vaginal/anal)
Equipment may include:
• Collection pot
• Sterile wipes
• Urinalysis test strips
• Gloves
• Pathology referral forms and sealable pathology bag
Instructions to collect a non-contaminated specimen may include:
• Wash hands prior to collecting sample
• Patient should clean the urethral meatus with proprietary sterile wipes in a downward motion, front to back
• Pass a small amount of urine into the toilet and then collect a midstream specimen into the sterile container, and
then finish passing urine into the toilet
• Put lid on and tighten it firmly
• Wash hands after collecting sample
An appropriate time frame is:
• Within one hour (60 minutes) of collection
Macroscopic urinalysis includes observation of:
• Amount
• Colour
• Clarity and cloudiness
• Other visible characteristics, such as presence of blood or blood clots, precipitates or sediments
Dipstick urinalysis includes:
• Using test strips that are not out-dated and properly stored
• Performing the test accurately, ensuring the sample is mixed and the test strip is fully immersed in the sample
for adequate time
• Dry the edges of the test strip on absorbent paper
• Allow necessary time for reaction to occur (one to two minutes) according to test strip requirements
Macroscopic results may include:
• Evidence of dehydration, infection, liver disease or muscle breakdown with alterations in colour, clarity and
cloudiness
• Change of colour due to certain medications
Dipstick results may include:
• Evidence of blood, protein, glucose, leukocyte esterase, nitrites, albumin, chorionic gonadotropin (commonly
assessed)
• Ketones, urobilinogen, bilirubin, specific gravity pH (less commonly assessed)
False positive and false negative results may include:
• See: <http://www.aafp.org/afp/2005/0315/p1153.pdf> (Table 2)
The sample should be sent to pathology for further testing if:
• There are UTI symptoms and the urine is positive for leukocytes and/or nitrites
• There are UTI symptoms and the urine is negative for leukocytes and/or nitrites
• There are no UTI symptoms but the urine is positive for leukocytes and/or nitrites
• There is haematuria not associated with menstruation
Other ongoing actions may include:
• Discussion with medical staff to arrange antibiotics or discuss further management
Adverse events may include:
• Patient refuses to give a sample
• Sample contamination or spillage
• Failure to refer to pathology if indicated
Evidence guide
The evidence guide provides advice on assessment and must be read in conjunction with the performance criteria,
required skills and knowledge, and the range statement.
Critical aspects for assessment and evidence required to demonstrate competence in this unit:
• The candidate must provide evidence of the essential knowledge as well as skill
• Observation of workplace performance is essential for this unit
• Consistency of performance should be demonstrated over a range of situations relevant to the workplace
Context of and specific resources for assessment:
• Assessment must include demonstrated workplace application
• Relevant guidelines, standards and procedures
• Resources essential for assessment: urine samples from consenting patients, equipment required for urinalysis
and documentation, supervisory medical practitioner
Method of assessment:
• Observation in the workplace under direct supervision
– five observing the assessor and five under assessment conditions
• Evidence gathered from clinical work environment
• Direct questioning could be used to assess knowledge
• Case study and scenarios as a basis for discussion of issues and strategies to contribute to best practice
• Utilising mock-up examples of urinalysis to make clinical decisions
Dipstick urinalysis and interpretation
Learning needs assessment tool
Candidate’s name:
Assessment timeframe:
Name(s) of assessor(s):
Rate your level of confidence against the following performance criteria:
0 – Not relevant to my role
1 – I require training and development in most of all of this area
2 – I require further training in some aspects of this area
3 – I am confident I already do this competently

Elements and performance criteria Rating Action plan / evidence

(0–3)

Determine patient suitability for dipstick urinalysis

1.1 Identify indications for urinalysis

1.2 Identify if there are any contraindications to performing urinalysis

1.3 Identify if there any precautions to performing urinalysis

Gain informed consent for urinalysis

2.1 Select the appropriate setting to request informed consent

2.2 Explain the test procedure to the patient
2.3 Identify patients who require extra precautions when gaining informed consent and
take appropriate action
2.4 Maintain culturally sensitive practice
2.5 Gain valid informed consent for assessment in accordance with local policies and
procedures
Elements and performance criteria Rating Action plan / evidence
(0–3)
2.6 Document informed consent in patient notes

Prepare to collect the urine sample

3.1 Prepare the environment for the collection and gather all necessary equipment
3.2 Give the patient the necessary instructions to collect a non-contaminated specimen
3.3 Offer the patient assistance to collect their sample if they require it

Measure the post-void residual bladder volume using a bladder scanner

4.1 Ensure the sample is secure (lid tightened) and correctly labelled with the
appropriate patient identification sticker

Perform urinalysis

5.1 Perform the urinalysis within the appropriate time frame of collection
5.2 Perform macroscopic urinalysis of the sample
5.3 Perform dipstick urinalysis of the sample using Combur 10 test strips (manufactured
by Roche) or equivalent
5.4 Assess urine odour (if present)

Evaluate results of urinalysis

6.1 Evaluate macroscopic results

6.2 Evaluate dipstick results
6.3 Identify any potential for false positive or false negative results

Formulate ongoing actions

7.1 Determine whether sample should be sent to pathology for further testing and if so
complete the relevant paperwork (according to local procedure)
7.2 Determine what other ongoing actions need to be taken (if any)
Elements and performance criteria Rating Action plan / evidence
(0–3)
7.3 Determine what follow-up procedures need to be completed if sample is sent to
pathology

Report and document urinalysis information

8.1 Document urinalysis findings according to accepted standards

8.2 Document onward management plan (if any) in patient notes

Apply risk management

9.1 Minimise risk associated with urinalysis

9.2 Identify adverse events (actual or ‘near miss’) associated with urinalysis and take
appropriate action

Essential knowledge

A broad and coherent theoretical and technical knowledge of normal and abnormal urine
composition
A thorough working knowledge of indications, contraindications and precautions for
urinalysis
A thorough working theoretical knowledge of how to perform urinalysis
A thorough working knowledge of what action to take with abnormal urinalysis
A good working knowledge of the evidence base for the use of urinalysis
A good working knowledge of the local policies and procedures that relate to urinalysis

Essential skills

Understand and respects patients’ rights, privacy and dignity

Communicate effectively with patients, co-workers and supervisors
Apply ethical principles to the collection, maintenance, use and dissemination of data
and information
Complete urinalysis in an accurate and timely manner
Elements and performance criteria Rating Action plan / evidence
(0–3)
Utilise assessment findings to make decisions about onward management
Assess, plan, implement and evaluate safe and effective treatment
Identify any limitations to personal competence as it applies to the job role and consult
with a more senior staff member
Demonstrate clear and accurate documentation according to documentation tools
Manage risk to self and client
Clinical log
Candidate’s name:

No. Date Observation/ supervision Assessment findings Supervisor name (print) Signed
1
2
3
4
5
6
7
8
9
10
11
12

(Please note the minimum requirement for competency is to observe a minimum of five specimen collections and urinalysis by a Continence Nurse
Specialist and to undertake a minimum of five dipstick urinalysis assessments supervised by a Continence Nurse Specialist and obtain feedback about
performance.)
Dipstick urinalysis and interpretation
Competency assessment master sheet
Candidate’s name:
Assessment timeframe:
Name(s) of assessor(s):
Rate the candidate’s evidence with a score of zero to five according to the Bondy scale (see below):
0 – Not relevant to role
1 – Independent
2 – Supervised
3 – Assisted
4 – Marginal
5 – Dependent

Elements and performance criteria Rating Comments / evidence

(0–5)

Determine patient suitability for dipstick urinalysis

1.1 Identify indications for urinalysis

1.2 Identify if there are any contraindications to performing urinalysis

1.3 Identify if there any precautions to performing urinalysis

Gain informed consent for urinalysis

2.1 Select the appropriate setting to request informed consent

2.2 Explain the test procedure to the patient
2.3 Identify patients who require extra precautions when gaining informed consent and
take appropriate action
2.4 Maintain culturally sensitive practice
Elements and performance criteria Rating Comments / evidence
(0–5)
2.5 Gain valid informed consent for assessment in accordance with local policies and
procedures
2.6 Document informed consent in patient notes

Prepare to collect the urine sample

3.1 Prepare the environment for the collection and gather all necessary equipment
3.2 Give the patient the necessary instructions to collect a non-contaminated specimen
3.3 Offer the patient assistance to collect their sample if they require it

Measure the post-void residual bladder volume using a bladder scanner

4.1 Ensure the sample is secure (lid tightened) and correctly labelled with the
appropriate patient identification sticker

Perform urinalysis

5.1 Perform the urinalysis within the appropriate time frame of collection
5.2 Perform macroscopic urinalysis of the sample
5.3 Perform dipstick urinalysis of the sample using Combur 10 test strips
(manufactured by Roche) or equivalent
5.4 Assess urine odour (if present)

Evaluate results of urinalysis

6.1 Evaluate macroscopic results

6.2 Evaluate dipstick results
6.3 Identify any potential for false positive or false negative results
Elements and performance criteria Rating Comments / evidence
(0–5)

Formulate ongoing actions

7.1 Determine whether sample should be sent to pathology for further testing and if so
complete the relevant paperwork (according to local procedure)
7.2 Determine what other ongoing actions need to be taken (if any)
7.3 Determine what follow-up procedures need to be completed if sample is sent to
pathology

Report and document urinalysis information

8.1 Document urinalysis findings according to accepted standards

8.2 Document onward management plan (if any) in patient notes

Apply risk management

9.1 Minimise risk associated with urinalysis

9.2 Identify adverse events (actual or ‘near miss’) associated with urinalysis and take
appropriate action
Bondy rating scale
Scale label Standard of procedure Quality of performance Level of assistance required

Independent (5) Safe: Achieved intended outcome
Accurate: Behaviour is
appropriate to context
Supervised( 4) Safe: Achieved intended outcome
Accurate: Behaviour is
appropriate to context
Assisted (3) Safe: Achieved most objectives
for intended outcome
Proficient Confident Expedient No supporting cues required
Proficient Occasional supportive cues
Confident
Reasonably expedient
Proficient throughout most of the Frequent verbal and occasional physical
performance when assisted directives in addition to supportive cues

Accurate: Behaviour generally

appropriate to context
Marginal (2) Safe only with guidance: Unskilled Continuous verbal and frequent physical directive
Incomplete achievement of Inefficient cues
intended outcome

Not completely accurate

Dependent (1) Unsafe: Unable to demonstrate Unskilled Continuous verbal and physical directive cues
behaviour Unable to demonstrate behaviour/
procedure
Lack of insight into behaviour
appropriate to context
X Not observed
Reference: Bondy KN 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing Education, vol. 22, no. 9, pp. 376–81.
Overall competency result or performance level achieved in assessment timeframe (circle)

Dependent Marginal Assisted Supervised Independent

Signed:
Comments/further action
The Department would like to acknowledge the contribution of the Victorian health services involved in the development of the ‘Advanced Practice Continence
and Women’s Health’ competency resources: The Royal Women’s Hospital (Dr Margaret Sherburn, Sarah Cleaver), Monash Health (Robyn Brennen, Jane
Carlin, Sarah Lorentzen, Hayley Irving), Barwon Health (Debra Schultz, Fiona Brennan, Sharon Hakkenes, Yvonne McNeel, Hannah Graetz, Naomi Nalder).

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© State of Victoria, Department of Health and Human Services December, 2016.

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