Urinary tract infection (UTI) was identified as the main reason to call a GP out-of-hours or to result in an unplanned admission to hospital from residential and nursing homes. Care home staff were using a urine dipstick to diagnose a urinary tract infection then calling a health care professional (HCP) for antibiotics, resulting in inappropriate use of antibiotics and over-treating what is perceived as a UTI in the absence of clinical symptoms.
Eastern AHSN provided Quality Improvement (QI) coaching to the nurses employed by South Norfolk Clinical Commissioning Group (CCG) to work with residential and nursing homes across central Norfolk and Waveney to support the implementation of the checklist approach.
The overarching aim was to reduce avoidable admissions to hospital from care homes. The Eastern AHSN believes this successful project is an easily replicable approach to the improved management or prevention of UTI and can directly impact by not only improving patient care with the added benefit of admission avoidance and reducing unnecessary clinical call outs.
Successful results and benefits:
- At the time of writing, 700 staff from 104 care homes across Norfolk have been trained in the management and prevention of UTI and how to complete the UTI checklist. Unplanned emergency admissions have reduced by 22% and a reduction in antibiotic prescribing has been seen within this cohort of care homes.
- Staff reported increased confidence in the management and prevention of UTI.
- Data from the checklists highlighted that a lot of UTIs were related to catheter management and obtaining samples from the bag, which became increasingly preventable from the change in treatment.
- Care workers were assuming residents had an UTI, but after the teaching sessions they realised it may be dehydration that could present the same symptoms and commenced re-hydration.
- If an UTI is suspected then the staff were taught to initially think dehydration and to increase fluid intake then to reassess the patient prior to making call outs.
- Care homes are not now doing routine urine dipsticks or using urine dipsticks as a diagnostic test to diagnose UTI’s which has improved our diagnosis of UTI.
- Feedback from care homes and primary care has been very positive with one care home manager emailing to say: “The UTI checklist is definitely used at our nursing home and we have noticed a positive difference since we started. Thank you for your support.”