1. SIGN Guidance advises not to use dipstick test in elderly in the diagnosis of UTI
What’s the problem with dipsticks?
Dipsticks are cheap, widely available and everyone can do them
Prevalence of asymptomatic bacteriuria in elderly care home is high (~50% women, ~40% men)
The positive predictive value of dipstick for UTI in elderly patient is therefore low ~50%
Dipsticks are commonly misinterpreted by healthcare staff especially in elderly patients, leading to unnecessary antibiotic use
Number needed to harm from treating asymptomatic bacteriuria = 3

2. Summary of baseline data test-run
One GP practice’s prescribing to 6 care homes
Does not include OOH prescribing
148 prescriptions to 51 residents in 12 months
Sample of prescriptions for UTI reviewed by Clinical Pharmacist:
“Task from reception” in all but one case
Phoned call from care home  reception create task for GP  Prescription issued
Clinical Assessment
2/3rds of episodes had no clinical details recorded at all in patient record.
Urine Dipstick
All patients had urine dipstick, poor recording of results
80% were positive. 20% were negative and treated as UTI anyway! Incorrect interpretation of dipstick, as used for both PPV and not for NPV
Only information recorded in patient record was positive dipstick in a significant proportion of patients
Church Walk data

3. To Key messages from NHS BaNES Project ‘To Dip or Not To Dip’
Used an evidence-based algorithm based on SIGN guideline 88, to diagnose UTI in care home residents
Educational intervention and resources focused on use of the guidance and good hydration / avoiding AKI
Results:
67% relative reduction in the number of antibiotic prescriptions
56% relative reduction (24% absolute reduction) in the number of care home residents prescribed antibiotics for UTI
82% relative reduction in the number of residents prescribed prophylactic antibiotics for UTI
Improved appropriate management of UTI according to SIGN
Reduction in unplanned admissions for UTI, urosepsis and AKI
Reduced calls to GP practices for inappropriately diagnosed UTI

4. ENHCCG Project Outline