How well are we doing in diagnosing and treating UTI in older people?

There is very good evidence that the use of a urine dipstick in the diagnosis of UTI in older people is not of value and may indeed cause harm (e.g. inappropriate courses of antibiotics, missed alternative diagnoses, etc.) This year’s AMR CQUIN has focussed on compliance with NICE / PHE guidelines. The results presented here are for the first quarter at CDDFT hospitals.

Patients were initially identified prospectively by ward pharmacists. However, this yielded too few patients and our data collection method was amended to retrospective collection, based on a primary discharge code of N39.0.

* 60% urine dipstick used inappropriately (target <10%)

* 52% treatment follows NICE guidelines / based on recent sensitivities / local guidelines (target >90%)

* 60% patients were prescribed coamoxiclav despite not being in NICE / PHE guidelines for lower UTI

* 86% MSU sent (target >90%)

* 84% diagnosis based on symptoms / signs consistent with UTI (target >90%)

Despite numerous efforts (posters, walk-arounds, teaching) over the last 2 years to educate staff regarding appropriate use of urine dipsticks and antibiotics, our results were unsatisfactory. To remedy this, we have implemented the action plan described below, aimed at engendering an improvement in compliance with the guidelines and patient management.

1. Educational screensavers on computers

2. Removal of dipstick stickers from MAU clerking

3. Change of dipsticks to ones with no leucocytes and nitrites

4. Education and engagement of MAU & ED ward staff

5. Additional of new category to antibiotic formulary (?UTI/?LRTI not septic) to counter excessive coamoxiclav use