19 * UTI OVER-DIAGNOSIS IN OLDER ADULTS-INTERVENTION WITH EDUCATION AND SIGN 88

Abstract

Evidence-base: Inaccurate diagnosis of urinary tract infection (UTI) is common resulting in non UTI diseases being missed and inappropriate antibiotic prescribing (Woodford HJ, George J. JAGS 2009; 57: 107–114). Anecdotal dipstick misuse, misunderstanding of asymptomatic bacteriuria (ASB) and poor quality urine samples was felt contributory to local evidence of UTI over-diagnosis. Education and introduction of the SIGN 88 guideline was undertaken in 5 acute geriatric/stroke wards with retrospective and prospective data collection over November 2012-October 2013.Change strategies: We adopted the SIGN 88 guideline for older people because it is unique as it directs non-use of urine dipstick for UTI diagnosis. We held multiple educational sessions to capture as many staff as possible. Staff members were encouraged to disseminate information within teams. Education focused on dipstick pitfalls, ASB, midstream urine collection (MSU) only if technically feasible, not sending catheter urine samples labelled as ‘MSU’, and the new guideline.Change effects: Ward orders for antibiotics pre and post intervention indicated a fall in trimethoprim use following the intervention. Discharge diagnoses for respiratory tract infection were unchanged by the intervention. Estimated savings for reduced processing of urine samples amounted to £3500 every 2 months.Conclusion: Improvements can be made in relation to UTI diagnosis using education and age-specific guidelines. Better use of urine cultures can lead to improved positive predictive value and reduced unnecessary testing.Pre-InterventionPost-InterventionDischarge Summaries16151601Total discharges in 6/12Discharge diagnosis ‘UTI’416 (25.8%)270 (16.9%)Case note review of UTI: n= 18New dysuria/frequency02/18 (11.1%)04/15 (26.7%)Loin/Supra-pubic tenderness03/18 (16.7%)03/15 (20%)Most common symptoms:Confusion10/18 (55.6%)06/15 (40%)Falls07/18 (38.9%)02/15 (13.3%)Immobility07/18 (38.9%)02/15 (13.3%)UTI likely04/18 (22.2%)10/15 (66.7%)Urine microbiology: 2 month periodTotal urine samples1032132Urine indicative of UTI58 (5.6%)22 (16.7%) ABSTRACT FROM PUBLISHER (Copyright of Age & Ageing is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.)