Date of Award

2018

Document Type

Open Access Dissertation

Department

College of Nursing

Sub-Department

Nursing Practice

First Advisor

Beverly Baliko

Abstract

Urinary tract infections are one of the most commonly reported infections in long-term care. Current practices often rely on non-specific symptoms, rather than specific genitourinary symptoms, to aid in the decision to obtain a urine culture. The literature does not support this practice due to the high prevalence of asymptomatic bacteriuria among long-term care patients, which does not have adverse outcomes when untreated. Antibiotics do not eradicate asymptomatic bacteriuria and place patients at risk of adverse reactions and increased risk of multi-drug resistant organisms. This clinical improvement project applied the Loeb criteria in two long-term care facilities to reduce the frequency of asymptomatic bacteriuria treated with antibiotics. The Stetler Model was chosen as the model for research utilization, providing the practitioner with a process to guide the evaluation of research findings and application to clinical practice. The Loeb criteria provide guidelines for initiation of an antibiotic for urinary tract infections; their application in the long-term care has been associated with improved recognition of asymptomatic bacteriuria and reduced inappropriate antibiotic use in this vulnerable population (Loeb et al., 2005). Nursing staff and providers were educated on the Loeb criteria, which was implemented from June 2017 through November 2017. Retrospective data collection pre- and intervention occurred over the six- month period and outcomes were compared. Both facilities experienced a notable reduction of asymptomatic bacteriuria treated with antibiotics (62.5% for facility A and 45.8% for facility B).

Challenges for the facilities included inconsistent provider adherence to the criteria and high staff turnover. Overall, benefit from implementation of the Loeb criteria was observed, but continuing evaluation after placement of protocols will provide a clearer picture of patient outcomes. Nurse practitioners can apply evidence-based criteria, such as the Loeb criteria in order to reduce unnecessary antibiotic prescribing for asymptomatic bacteriuria. Nurse practitioners can be leaders in antibiotic stewardship programs, which have been mandated by the Center for Medicare and Medicaid, in longterm care.

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