1. How we are improving testing and diagnosis of UTIs at Rice Eventide Marcia Astuto, RN Nurse educator / Infection control nurse Olga Topchyyeva, LPN Rosie O’Neill, LPN Nurse managers

2. Goals Eliminate unnecessary treatment of “UTI” Reduce inappropriate antibiotic use

3. How it is going

4. What we did Unit managers educated nursing staff on their units Distributed and posted educational materials Unit managers and Nurse educator discussed all orders for UA’s Reinforced need for better assessment and “looking outside the bladder” Licensed social worker – educated and provided literature to psych services – met 1:1 with Psych NP – re-educated PRN Our UTI team did a presentation for all nurses; included re- education and UTI data. Implemented ABC form (UTI protocol): completed on all residents when considering obtaining a UA / C&S. Great guide! Periodically post “Infection Control Report” from our hospital’s lab, which reveals a significant decrease in UTIs.

5. What seemed to matter? Leadership truly embraced the program and that was contagious (Administration, LSW, Unit managers, DON, Medical Director) People saw others making change and it spread from person to person We had data! We could look at our data and see no ill effect on the residents. Saw symptoms resolve without testing and treatment Staff saw the impact of the changes they were making Ongoing focus Looked at each case and identified need for additional conversations/ education Building change into the system Using the ABC form built the conversation and the practice change into our ongoing care processes

6. Challenges and Strategies Overcoming initial staff resistance – Ongoing review of cases – Continued encouragement from leadership Staff Turnover – Share the program with them – Incorporate tools and education into new staff orientation Community physicians with few patients in our facility Never connected with a hospital in our area