scholarly journals 1107. Impact of Routine Education and Data Feedback on the Durability of an Antimicrobial Stewardship Intervention for Outpatient Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S394-S394
Author(s):  
Jason Funaro ◽  
Rebekah W Moehring ◽  
Beiyu Liu ◽  
Hui-Jie Lee ◽  
Christina Sarubbi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Phase 1 ◽  
Urgent Care ◽  
Phase 2 ◽  
Intervention Phase ◽  
Data Feedback ◽  
Specific Feedback ◽  
Initial Intervention ◽  
Tract Infections

Abstract Background Achieving lasting, sustainable effects in outpatient AS interventions has been a challenge for many programs. Our group observed an initial benefit of an outpatient AS intervention focused on diagnosis and management of urinary tract infections (UTIs). However, prescribing habits trended back toward baseline over time. This study aimed to evaluate the impact of routine education and comparative data feedback on the durability of an outpatient AS intervention for UTIs. Methods We conducted a prospective quasi-experimental study at one primary care (PC) and one urgent care (UC) clinic to evaluate the durability of an outpatient AS intervention implemented in August 2017 and November 2017, respectively. Clinicians who treated adult patients with a diagnosis of acute UTI at either clinic participated in the study. The initial intervention (phase 1) included development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines. Approximately 12 months after the initial intervention, routine education along with clinic- and comparative provider-specific feedback reports were emailed to clinicians at regular intervals (phase 2). The primary outcome was percent of encounters in which first- or second-line antibiotics were prescribed. Pre- and post-intervention phase and trend changes were assessed using an interrupted time-series approach. Results Data were collected on 792 and 3,720 UTI encounters at PC and UC, respectively. In the 12 months after the initial intervention, rates of guideline concordance were 73% at PC and 57% at UC (Figures 1 and 2). After routine data feedback was provided for approximately 7 months at PC and 5 months at UC, rates of guideline concordance remained relatively stable at 75% for PC and 61% at UC. An initial 37% relative reduction in fluoroquinolone (FQ) use was observed during phase 1 which was further reduced by an additional 18% during phase 2. Conclusion Routine provision of clinic-specific feedback and peer comparisons sustained rates of guideline-concordant prescribing at two outpatient clinics. This intervention required significant resources for data analysis and delivery, but it was successful in decreasing rates of FQ prescribing and maintaining clinician engagement. Disclosures All authors: No reported disclosures.

scholarly journals Impact of Education and Data Feedback on Guideline Concordant Prescribing for Urinary Tract Infections in the Outpatient Setting

2021 ◽  
Author(s):  
Jason R Funaro ◽  
Rebekah W Moehring ◽  
Beiyu Liu ◽  
Hui-Jie Lee ◽  
Siyun Yang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Phase 1 ◽  
Routine Data ◽  
Prescribing Patterns ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Phase 2 ◽  
Data Feedback ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are the most common outpatient indication for antibiotics and an important target for antimicrobial stewardship (AS) activities. With The Joint Commission standards now requiring outpatient AS, data supporting effective strategies are needed. Methods We conducted a two-phase, prospective, quasi-experimental study to estimate the effect of an outpatient AS intervention on guideline-concordant antibiotic prescribing in a primary care (PC) and urgent care (UC) clinic between August 2017 and July 2019. Phase 1 of the intervention included the development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines, presented during educational sessions with clinic providers. Phase 2, consisting of routine clinic- and provider-specific feedback, began approximately twelve months after the initial education. The primary outcome was percent of encounters with first- or second-line antibiotics prescribed according to clinic-specific guidelines, and was assessed using an interrupted time series approach. Results Data were collected on 4,724 distinct patients seen during 6,318 UTI encounters. The percent of guideline-concordant prescribing increased by 22% (95% CI: 12% to 32%) after Phase 1 education, but decreased by 0.5% every two weeks afterwards (95% CI: -0.9% to 0%). Following routine data feedback in Phase 2, guideline concordance stabilized and significant further decline was not seen (-0.6%, 95% CI: -1.6% to 0.4%). This shift in prescribing patterns resulted in a 52% decrease in fluoroquinolone use. Conclusions Clinicians increased guideline-concordant prescribing, reduced UTI diagnoses, and limited use of high-collateral damage agents following this outpatient AS intervention. Routine data feedback was effective to maintain the response to the initial education.

scholarly journals 1115. Reducing Broad-Spectrum Antibiotics for Uncomplicated Urinary Tract Infections: A Multimodal Stewardship Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S396-S397
Author(s):  
Maryrose R Laguio-Vila ◽  
Mary L Staicu ◽  
Mary Lourdes Brundige ◽  
Jose Alcantara-Contreras ◽  
Hongmei Yang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Phase I ◽  
Urinary Tract Infections ◽  
Broad Spectrum ◽  
Phase 1 ◽  
Phase 2 ◽  
Intervention Phase ◽  
Broad Spectrum Antibiotics ◽  
Stewardship Program ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are the second most common reason for antibiotics in hospitalized patients, with most receiving broad-spectrum antibiotics (BSA) regardless of infection severity. The antimicrobial stewardship program (ASP) conducted a multimodal stewardship intervention targeting reduction in one BSA, ceftriaxone, and promoted narrow-spectrum antibiotics (NSA) such as cefazolin and cephalexin for uncomplicated UTIs. Methods Phase 1: In February 2018, the ASP created a pocket card (Figure 1) containing (1) a urinary antibiogram outlining the most common urine pathogens and their local susceptibility to NSA and (2) NSA guidelines for UTIs with 0–1 systemic inflammatory response syndrome (SIRS) criteria. ASP performed a daily prospective audit with feedback on all new orders of ceftriaxone and promoted prescription of NSA. Phase 2: In August 2018, a Best Practice Alert (BPA) in the electronic medical record (EMR) was designed to interrupt providers ordering ceftriaxone with the indication of a UTI, and prompted NSA prescription instead. Quarterly didactic sessions on UTI antibiotic use and BPA functionality were done. We compared antibiotics usage rates across the 3 study phases (pre-intervention, phase I and phase II) by computing rate ratios (RRs) using Poisson regression. Results Compared with pre-intervention, phase 1 resulted in a significant decrease in ceftriaxone DOT (RR: 1.06, CI: 1.03–1.09, P < 0.001) and ceftriaxone orders for UTI (RR: 1.14, P < 0.001) and an increase in cefazolin DOT (RR: 0.89, P = 0.029) and orders for UTI (RR; 0.12, P < 0.001). It also resulted in a significant increase in cephalexin DOT (RR: 0.92, P = 0.002) and orders for UTI (RR: 0.58, P < 0.001). In phase 2, an additional significant reduction in ceftriaxone DOT (RR: 1.04, CI: 1.01–1.08, P = 0.018) and orders for UTI (RR: 1.62, P < 0.001) and an increase in cefazolin DOT (RR: 0.96, P < 0.001) and orders for UTI (RR; 0.56, P < 0.001) occurred, when comparing phase I to phase 2. It also resulted in a decrease in cephalexin DOT (RR: 0.83, P < 0.001) and orders for UTI (RR: 0.70, P < 0.001). Conclusion A multimodal stewardship intervention using a pocket card with guidelines and urine antibiogram, and an EMR BPA successfully reduced BSA and increased NSA for treatment of uncomplicated UTIs. Disclosures All authors: No reported disclosures.

scholarly journals Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative

2021 ◽  
Author(s):  
Marilyn Rantz ◽  
G. F. Petroski ◽  
L. L. Popejoy ◽  
A. A. Vogelsmeier ◽  
K. E. Canada ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Phase 1 ◽  
Quality Measures ◽  
The State ◽  
Full Time ◽  
Improve Quality ◽  
Phase 2 ◽  
Intervention Phase ◽  
Tract Infections

Abstract Objectives To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. Design A four group comparative analysis of longitudinal data from September 2013 thru December 2019. Setting NHs in the interventions of both Phases 1 (2012–2016) and 2 (2016–2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406). Participants NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only. Measurements Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups. Results The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) outperformed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state. Conclusion These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.

scholarly journals 204. Impact of Education and Data Feedback Interventions on Outpatient Prescribing for Urinary Tract Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S89-S89
Author(s):  
Jason Funaro ◽  
Rebekah W Moehring ◽  
Siyun Yang ◽  
Hui-Jie Lee ◽  
Christina Sarubbi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Data Feedback ◽  
Feedback Interventions ◽  
Tract Infections

scholarly journals 1156. Running on Empty: Enlisting Transportation Services in Quality Improvement Initiatives as a Safeguard Against Catheter-Associated Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S413-S413
Author(s):  
Dale Lobo ◽  
Dominique Wright ◽  
Sylvia Suarez-Ponce ◽  
Melissa Green ◽  
Deborah Parilla ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Best Practices ◽  
Phase 1 ◽  
Phase 2 ◽  
Icu Patients ◽  
Usual Practice ◽  
Transportation Services ◽  
Patient Transport ◽  
Tract Infections

Abstract Background Patient transportation for off unit procedures is associated with transfers from bed to chair to examination tables, frequent elevation of the urine collection bag (UCB) above the bladder and urinary reflux (UR) of bacteria-laden urine into the bladder, significantly increasing risks of catheter-associated urinary tract infection (CAUTIs). If UCBs were systematically emptied prior to transportation the likelihood of UR would be greatly diminished, potentially reducing CAUTIs. Methods During a 5-week period transportation services (TS) collected baseline data on UCB status of all ICU patients, classifying them as empty/good to go vs. full/not good to go (Phase 1). Then, TS were educated on the importance of reducing UR as part of CAUTI reduction and were empowered to request UCBs be emptied. In parallel, unit-based staff were instructed to drain CBs prior to patient transport off unit and to expect the TS would refuse transport if CB was not emptied (Figure 1). Wireless voice-activated communications devices were used to improve coordination between TS and unit staff. During a 3 month (Phase 2) period, TS again collected data on the UCB status of ICU patients while reinforcing the need to empty UCBs. Results At baseline it was a coin toss as to whether a patient’s UCB would be empty or full at the time of transportation, while over 90% of UCB were emptied in Phase 2 (47.1% and 52.9%, vs. 90.6% and 9.4%, empty and unemptied in Phase 1 and Phase 2, respectfully, P < 0.001) (Figure 2). Figure 3 shows the detailed UCB status (empty at TS arrival, emptied upon TS request, transported full, transport refused) during Phase 2, with significant month upon month improvements (P = 0.014). Conclusion Despite longstanding existing hospital policies promoting best practices, including the need to empty UCBs prior to transport, we found this was commonly ignored in usual practice. Recruiting the TS to enforce UCBs are empty at the time of transportation proved a very effective way to markedly improve best practices. If representative of general practices elsewhere, this suggests leveraging TS can help ensure UCBs are emptied prior to patient transport and reduce CAUTI risk. It also exemplifies how ancillary services can be recruited to play an active role in quality improvement/patient safety projects. Disclosures All authors: No reported disclosures.

scholarly journals Quality Initiative to Reduce Catheter-Associated Urinary Tract Infections Using Cleansing Cloths With a Standardized Method

2020 ◽  
Vol 41 (S1) ◽  
pp. s525-s525
Author(s):  
Lauren Droske ◽  
Parul Patel ◽  
Donna Schora ◽  
Jignesh Patel ◽  
Ruby Barza ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Data Collection ◽  
Urinary Tract Infections ◽  
Large Scale ◽  
Phase 1 ◽  
Study Cohort ◽  
Hospital System ◽  
Patient Demographics ◽  
Tract Infections ◽  
Hospital Acquired

Background: Catheter-associated urinary tract infections (CAUTIs) account for >15% of hospital-acquired infections, resulting in increased length of stay and costs. Consequently, methods to improve indwelling urinary catheter (IUC) care and maintenance are warranted to reduce the risk of hospital-acquired CAUTIs. This study was a prospective quality improvement (QI) project to reduce CAUTIs using prepackaged cloths (ReadyCleanse by Medline Industries) and a simple, standardized cleaning process for care and maintenance of IUCs. Methods: This study is an ongoing QI project at NorthShore University HealthSystem, a 4-hospital system located north of Chicago, Illinois, with 750 beds and ∼64,000 annual admissions. The study consists of a 1.5-month staff training on proper product use (phase 1), followed by an intervention using the cloths for IUC care (phase 2). Each package contains 5 individual cloths corresponding to a simple, 5-step, cleansing protocol. IUC care and maintenance are performed twice daily on a routine basis and after each incontinent episode. Beginning July 2018, current practice (soap and wash cloth) was replaced with the ReadyCleanse cloths, and on August 1, 2018, data collection began. Adult patients admitted at all 4 NorthShore Hospitals with an IUC for >24 hours are enrolled in the study. From patient electronic health records, we collected patient demographics, reason for IUC insertion, days of catheter use, and development of CAUTI (according to the NHSN definition). During the intervention, observations of compliance and performance of catheter care were also performed. For the analysis described here, results for the first 14 months of the study were compared to CAUTI numbers from the 14-month period prior to the start of the study (February 2017–March 2018); the data presented represent ∼50% of the planned data collection. Results: As of September 30, 2019, 4,969 patients were prospectively enrolled in the study: 1,491 patients from hospital A, 1,451 from hospital B, 1,091 from hospital C, and 936 from hospital D. Patient demographics for the study cohort were 47% female, with a median age of 77 years and an average of 3.9 catheter days per patient. Systemwide, observational audits for compliance using the cloths averaged 95%. Upon completion of study month 14, 22 CAUTIs had been identified, compared to 26 CAUTIs for the comparison period, indicating a 15% reduction. Conclusion: Implementation of this simple, standardized alternative for IUC care is feasible on a large scale and may have potential for reducing CAUTI rates.Funding: Medline Industries supported this study.Disclosures: None

Cefiderocol versus imipenem-cilastatin for the treatment of complicated urinary tract infections caused by Gram-negative uropathogens: a phase 2, randomised, double-blind, non-inferiority trial

2018 ◽  
Vol 18 (12) ◽  
pp. 1319-1328 ◽  
Author(s):  
Simon Portsmouth ◽  
David van Veenhuyzen ◽  
Roger Echols ◽  
Mitsuaki Machida ◽  
Juan Camilo Arjona Ferreira ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Phase 2 ◽  
Double Blind ◽  
Gram Negative ◽  
Tract Infections

Vaginal Mucosal Vaccine for Recurrent Urinary Tract Infections in Women: Results of a Phase 2 Clinical Trial

2007 ◽  
Vol 177 (4) ◽  
pp. 1349-1353 ◽  
Author(s):  
Walter J. Hopkins ◽  
Johny Elkahwaji ◽  
Lori M. Beierle ◽  
Glen E. Leverson ◽  
David T. Uehling
Keyword(s):  
Clinical Trial ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Mucosal Vaccine ◽  
Phase 2 ◽  
Recurrent Urinary Tract Infections ◽  
Phase 2 Clinical Trial ◽  
Tract Infections
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