What is your facility's protocol for managing UTI's?

[DG5]

I would be interested in finding out what protocol you have for managing UTI's in your facility. In our facility, it seems that whenever a resident is confused or is suspected of having a UTI (foul smelling urine, positive uristix test), a C&S is sent off and if it comes back positive, the resident is immediately put onto an antibiotic. I am questioning if this does not follow evidence based nursing practice and what parametres should be set up to ensure that residents are not being overtreated with antibiotic therapy.

[CraigB-RN, MSN, RN]

I would be interested in finding out what protocol you have for managing UTI's in your facility. In our facility, it seems that whenever a resident is confused or is suspected of having a UTI (foul smelling urine, positive uristix test), a C&S is sent off and if it comes back positive, the resident is immediately put onto an antibiotic. I am questioning if this does not follow evidence based nursing practice and what parametres should be set up to ensure that residents are not being overtreated with antibiotic therapy.

Last time I checked, evidence based nursing practice had nothing to do with the provider placeing a patient on antiobitcs.

Clinically the key is symptomatic thought.

[ktwlpn, LPN]

we treat if they are symptomatic-and generally in the elderly increased confusion is the first sign of a UTI...Why not look at the common causes of UTI and work on prevention?

[CapeCodMermaid, RN]

Concentrated urine does not necessarily mean a UTI. We try to increase fluid intake before running to get a C&S. If there are symptoms, we dip the urine and then send it off to the lab. Too often, the docs put someone on an antibiotic before the results come back. Then when we find the C&S was negative, we try to get the docs to dc the antibiotic. Unfortunately, most of them won't.

Lots of fluids every day and NO indwelling catheters unless it's absolutely, positively necessary.

[donmomofnine]

We dip the urine. If they are symptomatic, the MD orders a C&S and usually starts ABT. The key, in my mind, is prevention. We try to get an order for cranberry tabs and sometimes also Vit C. This has proven helpful so far.

[gwenith, BSN, RN]

Sorry ICU perspective here - we used to do C&S twice a week on all patients but changed that to only those showing +ve for leucocytes in the Urine (we have one of those automated strip readers). This is a HUGE cost saver.

What I wanted to ask though - is anyone using cranberry as an adjunct to antibiotic therapy or even as a preventative??

[donmomofnine]

As I stated, cranberry tabs seem effective so far for a preventative in residents with history of frequent UTIs.

[CoffeeRTC, BSN, RN]

We only treat if syptomatic. Most of them are....confusion, agitation, fever, pain, burning, etc. We really don't have a preventative protocol. When someone has altered LOC, or co burning etc...we increase fluids and encourage cranberry juice...then we will get a UA, CS.

[Bird2]

I would be interested in finding out what protocol you have for managing UTI's in your facility. In our facility, it seems that whenever a resident is confused or is suspected of having a UTI (foul smelling urine, positive uristix test), a C&S is sent off and if it comes back positive, the resident is immediately put onto an antibiotic. I am questioning if this does not follow evidence based nursing practice and what parametres should be set up to ensure that residents are not being overtreated with antibiotic therapy.

The Centers of Medicare and Medicaid just sent out the advance copy of the F315 tag. F315 now covers urinary incontinence and catherers. It is 38 pages of interpetive guidelines and does discuss UTI's. This will give you a good idea of what the surveyors will be looking for when the come to your facility. Hope it helps.