Promoting Antibiotic Stewardship for UTIs in Skilled Nursing Facilities

Urinary tract infections (UTIs) can be hard to diagnose and treat in the resident who lives in a long-term care facility. Residents often do not have typical UTI symptoms, such as burning with urination or urinary hesitancy. UTIs can often mimic other conditions such as worsening dementia or even other infections, such as pneumonia. Asymptomatic bacteriuria without infection further complicates accurate diagnosis and can lead to unnecessary culture and use of antibiotics in this population. Appropriate nursing assessment of residents for possible UTI is key in order to communicate to providers to ensure the appropriate diagnosis is made and treatment can be started if indicated. This is due to the fact that UTIs carry a high risk of morbidity and mortality in this population. The purpose of this evidence-based quality improvement project was to determine the effects an antibiotic stewardship program in selected long-term care facilities utilizing the Loeb Criteria through an SBAR communication tool on the number of urine cultures and nursing knowledge and attitudes on UTIs and the Loeb Criteria. There was a statistically significant positive change between the pre- and post-test scores for nursing knowledge immediately following the educational intervention, however, this change in knowledge did not continue at six weeks post-intervention. Urine cultures were reduced by twenty-seven percent after the intervention; however, this was not statistically significant.