According to Melodie Johnson, Director of Senior Services at McKenzie County Healthcare Systems Long Term Care, their facility had a problem that needed confronting; recurrent Urinary Tract Infections (UTIs). This issue was evidenced by a CASPER Quality Measure rate of 7.1%, which put them in the 79th percentile. To seek improvement, the team implemented a Performance Improvement Project (PIP) in October 2016.
“Not only was the rate on our QM report a concern, but UTIs are a hazard to elders. We weren’t sure that our residents were truly experiencing the rate of UTIs that was being reflected in the MDS and QM report. If this was the case, then we were also concerned about the impact of recurrent use of antibiotics when unnecessary that could lead to superbugs in our community,” stated Johnson.
The home’s QAPI team consisted of their Director of Nursing; Director of Senior Services; Dietary Manager; a Clinical Nurse and the Activities Manager. This team led the change by investigating the root causes of the current rates. They sought out a new protocol that would align with current treatment recommendations. They found that some of their long-term staff had firm ideas that in case of a behavior change, the first step is to always take a urine sample.
Administration was supportive of their efforts to develop a new protocol and provide education to staff, residents and family members. Once approached about the new protocol, nursing staff had additional supportive recommendations and joined in the effort that has led to amazing results.
Johnson added, “We have monitored our residents for any of the symptoms that previously would have led to an automatic request for a Urine Analysis (UA). One resident who had a history of recurrent UTIs started complaining of burning. Before requesting a UA, staff explored any possible changes in care that could be contributing to this concern. They found that the resident had been switching her usual cranberry juice for V-8. With the resident’s consent, her menu was changed back to cranberry juice and her symptoms dissipated.”
Adopting this new policy and consistent application of the new protocol has resulted in zero residents being treated for a UTI unless the protocol was followed. “Taking little steps can change an issue,” Johnson added. “By December 2016, our UTI QM rate reflected a rate of 0% and we have maintained that rate since then.”
Do you have a similar success? If so, we would like to tell your story. Please connect with Keri McDermott, Communications Director, and we will feature your organization or community in a future News story.
AHRQ Toolkit to Reduce Urinary Tract Infections in Long-Term Care
AHRQ has released a toolkit to help nursing homes reduce Catheter-Associated UTIs (CAUTIs) and other Healthcare-Associated Infections (HAIs). Click on the links below to explore the toolkit which provides evidence based processes, tools and resources.
Main Page – Toolkit to Reduce CAUTI and Other HAIs in LTC facilities
Implementation Guide and Resources Page
Sustainability Guide and Resources Page
Resources and Tools Page