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Overview


Does the patient have ANY of the following:
Does the patient have ANY of the following:Urinary Signs and Symptoms
NHSE PATHWAYS
NHSE PATHWAYS
Consider the risk of deterioration, red flags or serious illness
Consider the risk of deterioration, red flags or serious illness
Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life threatening emergency
Consider calculating NEWS2 Score ahea...
Urgent same day referral
  • General practice
  • Relevant out of hours service
Urgent same day referral...
Onward referral
  • General practice
  • Sexual health clinics
  • Other provider as appropriate
Onward referral...
No symptoms
No symptoms
1 symptom
1 symptom
2 or 3 symptoms
2 or 3 symptoms
Are there other urinary symptoms:
Are there other urinary symptoms:...
UTI less likely
UTI less likely
UTI equally likely to other diagnosis
UTI equally likely to other diagnos...
Shared decision making approach using
TARGET UTI resources
Shared decision making approach usi...Self-care and pain relief
Onward referral
  • General practice
  • Sexual health clinics
  • Other provider as appropriate
Onward referral...
In patients that describe their symptoms as mild consider pain relief and self care as first line treatment
In patients that describe their sym...

Content sourced and adapted from NHS Pharmacy First – Clinical Pathways and Patient Group Directions (PGDs) on the NHS England website, licensed under the Open Government Licence v3.0.

Content sourced and adapted from NHS Pharmacy First – Clinical Pathways and Patient Group Directions (PGDs) on the NHS England website, licensed under the Open Government Licence v3.0.
YES
YES
NO
NO
YES
YES
NO
NO
YES
YES
NO
NO
FOR ALL PATIENTS:
  • If symptoms worsen rapidly or significantly at any time, OR do not improve in 48 hours of taking antibiotics
  • Share self-care and safety-netting advice using TARGET UTI leaflet
FOR ALL PATIENTS:...
NICE CKS
NICE CKS
NHSE PGD
NHSE PGD
UTIs
UTIs
NHS
NHS
Gateway Point
Gateway Point
Check for any new signs/symptoms of PYELONEPHRITIS:
Check for any new signs/symptoms of PYELONEPHRITIS:
Gateway Point
Gateway Point
Does the patient have any of the 3 key diagnostic signs/symptoms:
Does the patient have any of the 3 key diagnostic signs/symptoms:
NO
NO
YES
YES
Onward referral
  • General practice
  • Other provider as appropriate
Onward referral...
Uncomplicated Urinary Tract Infection
Uncomplicated Urinary Tract Infection
(For women aged 16 to under 65 years who do not have diabetes with suspected lower UTIs)
(For women aged 16 to under 65 years who do not have diabetes with suspected lower UTIs)
Exclude: pregnant individuals, urinary catheter, recurrent UTI (2 episodes in last 6 months, or 3 episodes in last 12 months)
Exclude: pregnant individuals, urinary catheter, recurrent UTI (2 episodes in last 6 months, or 3 episodes in...View PGD in right panelView PGD in right panel
Digital PGD
 Digital PGD
  • Kidney pain/tenderness in back under ribs
  • Flu like illness
  • Shaking chills (rigors) or temperature 37.9°C or above
  • Nausea/vomiting
Kidney pain/tenderness in back under ribs Flu like illness Sha...
  • Vaginal discharge: 80% do not have UTI (treat over the counter if signs and symptoms of thrush)
  • Urethritis: caused by irritation or inflammation
  • Check sexual history to exclude sexually transmitted infections
  • Check for signs and symptoms of pregnancy- ask about missed or lighter periods- carry out a pregnancy test if unsure
  • Genitourinary syndrome of menopause (vulvovaginal atrophy)
  • Is the patient immunosuppressed?
...
  • Dysuria (Acute pain or burning sensation when passing urine or at the end of urination)
  • New nocturia (needing to pass urine in the night)
  • Urine cloudy to the naked eye (visual inspection by pharmacist if practicable)
Dysuria (Acute pain or burning sensation when passing urine or at the end of urination) New...
In patients with moderate to severe symptoms,
offer Nitrofurantoin for 3 days
(subject to inclusion/exclusion criteria in PGD)
plus self-care
In patients with moderate to severe symptoms,...
Ask patient to return to Pharmacy if
no improvement in 48 hours for pharmacist reassessment
Ask patient to return to Pharmacy i...Text is not SVG - cannot display