This section defines the condition that triggers the use of the particular protocol. There may be more than one set of criteria that trigger the same protocol. The criteria will be very specific. A differential diagnosis has no place in a strict protocol:

Diagnostic Criteria for Strep Throat

1. Positive strep culture or rapid strep test on pharyngeal swab

2. Sore throat or cervical adenopathy in a household or day care contact to a laboratory- confirmed case of strep throat

3. Asymptomatic member of a household with two or more laboratory- confirmed cases of strep throat

4. Established patient with two or more laboratory-confirmed episodes of strep throat who now has symptoms that are typical for strep in this patient

5. Any sore throat in a patient with a history of rheumatic fever

This list gives five circumstances that trigger the protocol and allow the NPP to treat the patient for strep throat. The criteria take into account medical history, physical examination, patient complaints, laboratory tests, and living situation. The NPP may do the entire history, examination, and laboratory tests but is not called upon to judge what constitutes the need for treatment of strep throat. This diagnostic judgment is made by the physician in authorizing the protocol. A nurse who treated a patient for strep throat because he or she thought the throat was so red that it could not be anything else would be acting outside the protocol.