Improving Evaluation & Treatment of UTI in the Elderly:

A Cross-Continuum Approach to Antibiotic Stewardship

Southbridge Rehabilitation and HealthCare Center And Harrington

Memorial Hospital

Goals • Educate Licensed Nurses, MD’s and family members

on ASB, UTI’s and Antibiotics• Reduce unnecessary antibiotic use • Joint collaboration between our facilities to facilitate

change • Create a culture change

– Mental Status change does not always mean UTI– Not treating does not mean Do Nothing

“Don’t just do something – stand there!”

How it is Going at Southbridge Rehabilitation and HealthCare Center

Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-130%

20%

40%

60%

80%

100%

23% 18%

50% 44%

67%

50%

86%

Run Chart 1. Percentage of LTC residents with UTI meeting the protocol signs and symptoms

% residents meeting the protocol signs and s...

Per

cen

tag

e

Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-1

3

Feb-13

Mar-1

3

Apr-13

May-

13

Jun-1

3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

28.30

9.32

26.07

13.6918.78 20.81

13.7410.18

28.02

14.35 16.10

0.00

Run Chart 2. Facility UTI and urine testing rates among patients ≥ 70 years of age

Facility UTI rate per 10,000 resident days Urine cultures performered per 10,000 resident days

UT

I an

d U

rin

e T

es

tin

g R

ate

s

What we did• Medical Director attended the UTI conference and

participated in the education process• Educated and facilitated culture change within the

facility with help from the Medical Director, Nursing Management Team, Staff Development/ Infection Control and frontline Licensed Nurses

• Had an educated discussion with psychiatrist about reducing orders for routine UA+CS during psychiatric evaluations

• Created an easy to use form for Licensed Nurses using the McGeer's Criteria and Interact UTI Care Pathway

• Worked with Harrington Hospital to collectively reach our goals

How is it going at Harrington Hospital

Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-130

0.25

0.5

0.75

1

1.25Run Chart 1. Rates of ED visitors ≥ 70 years of age with

diagnosis of UTI and signs and symptoms

% patients with specfic signs and symptoms% patients with ≥1 non-specific signs or symptoms in the absence of specific symptoms

What Seemed to Matter

• SRHCC’s Medical Director was committed to this project and being involved in the culture change. He is also a physician at Harrington Hospital and a PCP in the community. His unique relationship with both the facilities helped to facilitate collaboration and bring positive results. Since January 2013 we have not sent a resident to the ER with UTI symptoms and no resident has transferred from our facility to the ER at Harrington and quickly returned with the diagnosis of a UTI

• Education and empowering the Licensed Nurses to monitor before we treat has also had a large impact on the results of the project