Help! UTIs in LTC

[RNAndi]

I'm a relatively new nurse working in LTC. Im trying to reduce the incidence of UTIs and pressure ulcers in my facility. So far the conventional methods of prevention have done little to prevent UTIs or pressure ulcers from forming. So I'm asking any other nurses that may have had experience in this area, what works? Any ideas to help increase other staff (nurses and CNAs) to be more diligent with their cares and documentations? thanks in advance for any help!

[middleagednurse]

Two important factors are hygiene and hydration. I have worked in LTCs and no one seems to consider the importance of these factors. People who feed the residents need to give the residents more liquids, one cup of liquid per meal is not enough. Also, residents need to have perineal care on a regular basis.

[ponymom]

All directly related to proper staffing which, in Ltc, just isn't likely to happen any time soon..

[quiltynurse56, LPN, LVN]

Two important factors are hygiene and hydration. I have worked in LTCs and no one seems to consider the importance of these factors. People who feed the residents need to give the residents more liquids, one cup of liquid per meal is not enough. Also, residents need to have perineal care on a regular basis.

THIS.

[RNAndi]

I've been trying to keep a turning schedule for my residents at risk for ulcers, and I try to go in with my aides on all pericares but I just can't get the time to get everything one. So I focus on the ones prone to UTI. last month I worked almost every day and I saw a significant reduction in the reddened areas on people at risk for ulcers. Then I took three days off to take my RN boards and they were all pretty much back to where they were at the beginning of the month. One actually got larger. Maybe I'm fighting an uphill battle but there has to be something I can do right? I've been trying to get the other nurses on board and show them it possible to do but I'm not sure if they even try. And as for the UTI rate I haven't had much success with the peri cares and encouraging fluids. Thank you all for your help by the way I really appreciate it!

[lmccrn62, MSN, RN]

Educate physicians to decrease treating a urine culture deemed positive. If no fever or elevated serum WBC just increase po fluids and monitor. There is specific CDC criteria to diagnose a UTI

[RNAndi]

thanks! i wasn't aware of this one

[Silverdragon102, BSN]

I work LTC in Canada and where I work this is what we do.

Clients at each meal gets three drinks, Water, Juice and tea/coffee. We also try and a fluid pass in the afternoon to all those that are awake and the ones in bed get a glass when they get up. We also do a snack and fluid pass before we start putting clients to bed. Urine sample is only done on those with symptoms and that is after we tried to push fluids first. Urine testing isn't always done as generally most elderly urine is contaminated to a certain level as proven by research

[dishes, BSN, RN]

For those who push fluids, what is done to ensure patients are voiding sufficiently? If patients have a history of CVA, dementia, Parkinsons, diabetes, BPH etc they may have difficulty voiding or fail to void sufficiently.

[RNAndi]

I like this, I'm going to see what we can do for increasing fluid passes through out the day. Thank you so much for the idea

[Kitiger, RN]

Have you gone to management with your concerns? Before you go in, know what rate of UTIs and/or pressure ulcers is usual in a facility such as yours, and know how many have had UTIs and/or pressure ulcers on your floor. Look up the protocols for your facility before talking to management. I would start there, concentrating on protocols that the home already has. If they don't have any, I would volunteer to help write them.

I wouldn't say much about the aides or other nurses at first, unless management asks you directly. Go on record as one who wants to work on a specific problem ... not as one who wants to get the other employees in line.

Yeah, you do want to get them in line, but you do not want them to start out defensive.

I'm sorry to say this, but if you encourage more fluids for your residents - which you should - you may get push-back from your aides. They might not want to take the time to help people to the bathroom, and they really might not want to change as many diapers.

You might want to start by working with management to educate/persuade the aides. Could you find or make some one-page hand-outs explaining why adequate hydration is so important? This might be all new to them; so many people do not drink enough!

Do they turn people at least every 2 hours? First, be sure that it is in your protocols. They need to see that it is in fact part of their job to turn people every 2 hours.

You could have all the high-risk residents turned left on even hours, and turned right on odd hours, making it harder for the aides to skip a turn.

Perhaps you should start out just with the hydration. If you start with too many changes at once, you will get more resistance.

[RNAndi]

Wow good ideas and approaches. At our facility our ADON just left and I am trying to help the DON with what I can. There are only three RNs in out building one is ADON the other MDS so I'm the only one free to work on this and my DON asked me to see if I could find some ideas, everything I've looked up is push fluids, rotate, frequent and thorough peri care so I was seeing if there are any additional things that other more experienced nurses have had success with. Love the ideas I've been getting. Again thanks everyone for your help, you guys are the best!