Technology Guided Assessment for Urinary Tract Infection: Creating a Common Interprofessional Language

Abstract The Shared Meaning Model (SMM) is a grounded theory, derived in a previous study. This model demonstrates pathways for communication between nurse and primary care providers (PCPs) in the nursing home (NH), In this study we used the SMM for feasibility testing of a clinical decision support app (CDS app) using a descriptive, structured observational design. This study also provided a forum for initial testing of the SMM. The CDS app algorithm provided a common language to assess a resident with the goal of sharing this information with a PCP. The CDS app guided licensed vocational nurses (LVNs) (N=10) in assessing a standardized nursing home resident in a simulation setting experiencing symptoms of a potential urinary tract infection (UTI). Interviews with LVNs provided details of CDS app usability and concerns about using the CDS app with NH residents. Videos recorded LVNs interacting with the resident while using the CDS app on an iPad®. Time-stamps logged duration of the assessment. Bookmarked segments were used for discussion in LVN interviews. Videos were coded for eye contact, conversation, and touch between LVN and resident and documented personalized interactions. Findings indicated areas (lab values, drug names) for changes to language in the algorithm. In less than 12 minutes the CDS app enabled LVNs to collect information based on language used by PCPs to make decisions about the presence of a UTI. Relationships between initial constructs in the SMM were supported. This CDS app holds promise for building a common language to enhance interprofessional communication.

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Faculty Opinions recommendation of A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727626341.793555269 ◽

2019 ◽

Author(s):

Pranavi Sreeramoju

Keyword(s):

Urinary Tract Infection ◽

Nursing Home ◽

Urinary Tract ◽

Tract Infection ◽

Nursing Home Residents ◽

Implementation Project ◽

National Implementation

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Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.96 ◽

2017 ◽

Vol 38 (8) ◽

pp. 998-1001 ◽

Cited By ~ 10

Author(s):

Taniece Eure ◽

Lisa L. LaPlace ◽

Richard Melchreit ◽

Meghan Maloney ◽

Ruth Lynfield ◽

...

Keyword(s):

Urinary Tract Infection ◽

Nursing Home ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Nursing Home Residents ◽

Infect Control Hosp ◽

Antibiotic Prescribing ◽

Appropriate Use ◽

Tract Infections

We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH.Infect Control Hosp Epidemiol 2017;38:998–1001

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Tests for Urinary Tract Infection in Nursing Home Residents

JAMA ◽

10.1001/jama.2014.13554 ◽

2014 ◽

Vol 312 (16) ◽

pp. 1687 ◽

Cited By ~ 3

Author(s):

Manisha Juthani-Mehta ◽

Ann Datunashvili ◽

Mary Tinetti

Keyword(s):

Urinary Tract Infection ◽

Nursing Home ◽

Urinary Tract ◽

Tract Infection ◽

Nursing Home Residents

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589 Enhancing Care Providers’ CAUTI (Catheter-associated Urinary Tract Infection) Knowledge, Skills and Attitudes in the Burn Intensive Care Unit (BICU) and Burn Special Care (BSC) Environments

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.215 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S136-S137

Author(s):

Emily Beckwith ◽

Megan Zynkian

Keyword(s):

Urinary Tract Infection ◽

Quality Of Care ◽

Urinary Tract ◽

Tract Infection ◽

Antibiotic Use ◽

Special Care ◽

Care Providers ◽

Urinary Catheters ◽

Pain And Suffering

Abstract Introduction CAUTIs, or Catheter-associated Urinary Tract Infection, are one of the leading causes of healthcare associated infections. Since 2008, Centers for Medicare and Medicaid Services (CMS) stopped reimbursing hospital for the cost of CAUTIs, forcing hospitals to modify and improve care provided to patients with indwelling urinary catheters (IUC). They are reportable events to CMS, which can signify the quality of care provided at any medical institution. These infections also cause extra pain and suffering and can complicate any hospital stay. Treatment requires antibiotic use, which helps create and spread antibiotic-resistant organisms with excessive use. Methods BICU and BSC staff were evaluated for knowledge of IUC care, maintenance and policies using a quiz dispersed to RNs. This quiz identified knowledge gaps to help focus on specific topics for training. During Skills Day, all Burn RNs were given a mandatory training, including a PowerPoint presentation, hands-on training performing catheter care, and a handout with quick tips for maintenance. All technical partners (TP) were also trained, though they were not given the quiz. To assess effectiveness of training, RNs were encouraged to take a post-training quiz. Rates of CAUTI will also be closely monitored. Results For the pre-training quiz, average scores were 13.1 correct answers (out of 23 questions) or 56.5%. Post-training quiz scores were 18.5 correct answers (out of 23 questions) or 81%. Since the training in September 2018, no new CAUTIs have been recorded. Conclusions The training provided helped enhance burn staff skills to maintain and care for indwelling urinary catheters, as well as changed attitudes on the unit. Applicability of Research to Practice CAUTIs are a reflection of the quality of care an institution and unit provides its patients. It is also closely monitored and used to compare similar units across the nation. The training provided to the burn staff has shown to decrease the number of CAUTIs in the Burn ICU and Burn Special Care environments, thus decreasing costs, pain and suffering and antibiotic use.

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Preventing Catheter-Associated Urinary Tract Infection in Nursing Home Residents: Preliminary Results From a National Collaborative

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.269 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Lona Mody ◽

M. Todd Greene ◽

Jennifer Meddings ◽

Sarah Krein ◽

Barbara W. Trautner ◽

...

Keyword(s):

Urinary Tract Infection ◽

Nursing Home ◽

Urinary Tract ◽

Tract Infection ◽

Nursing Home Residents ◽

Preliminary Results

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1475. Understanding Prescribing Practices for Uncomplicated Urinary Tract Infections (UTIs) in the Primary Care Setting: A Pilot Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1339 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S538-S538

Author(s):

Mark Pinkerton ◽

Jahnavi Bongu ◽

Aimee James ◽

Michael Durkin

Keyword(s):

Primary Care ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Clinical Decision ◽

Primary Care Providers ◽

Care Providers ◽

Prescribing Practices ◽

Support Tools ◽

Tract Infections ◽

Clinical Decision Support Tools

Abstract Background Uncomplicated urinary tract infections (UTIs) should be treated empirically with a short course of narrow-spectrum antibiotics. However, many clinicians order unnecessary tests and treat with long courses of antibiotics. The objective of this study was to understand how internists clinically approach UTIs. Methods We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018 to 2019 to explore why clinical practices deviate from evidence-based guidelines. Interviews were transcribed, de-identified, and coded by two independent researchers using NVivo qualitative software. A Likert scale was used to evaluate preferences for possible interventions. Results Several common themes emerged. Both providers and residents ordered urine tests to “confirm” presence of urinary tract infections. Antibiotic prescriptions were often based on historical practice and anecdotal experience. Providers were more comfortable treating over the phone than residents and tended to prescribe longer courses of antibiotics. Both providers and residents voiced frustrations with guidelines being difficult to easily incorporate due to length and extraneous information. Preferences for receiving and incorporating guidelines into practice varied. Both groups felt benchmarking would improve prescribing practices, but had reservations about implementation. Pragmatic clinical decision support tools were favored by providers, with residents preferring order sets and attendings preferring nurse triage algorithms. Conclusion Misconceptions regarding urinary tract infection management were common among residents and community primary care providers. Multifaceted interventions that include provider education, synthesis of guidelines, and pragmatic clinical decision support tools are needed to improve antibiotic prescribing and diagnostic testing; optimal interventions to improve UTI management may vary based on provider training level. Disclosures All authors: No reported disclosures.

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