Evaluation of Inappropriate Use of Antibiotics in the Long-Term Care Community

The number of antibiotics prescribed in the 65 and older population significantly increased related to the diagnosis of urinary tract infections (UTIs). Although empiric treatment is necessary at times, it can lead to antibiotic resistance; therefore, clinical symptomology with an active infection verified by diagnostic testing is the requirement for the treatment of a UTI. This project addressed the practice-focused question of how the implementation of an evidenced-based antibiotic stewardship program (ASP) in a nursing home on the East Coast may impact the overuse of antibiotics in that clinical setting. The project, guided by the theory of planned behavior, was used to evaluate current practice, improve patient outcomes, and increase nurse and provider communication. The use of an algorithm for the diagnosis and treatment of a UTI was implemented to guide clinical practice and provide direction for appropriate treatment. Patient data from 3 months post ASP program implementation was reviewed, indicating 17 patients were prescribed antibiotic treatment for a UTI. Patients under the age of 65 years were excluded leaving 13 patients in the study. Of the 13 patients receiving antibiotic treatment with a urinalysis completed, nine (69.23%) were positive for microorganisms higher than 100,000 colony forming units, indicating a UTI. The remaining 4 patients (30.76%) were negative for an active infection. Three of the 4 patients continued to receive antibiotic treatment after the negative urinalysis result, indicating incorrect use of the algorithm due to treatment continuation after a negative urinalysis. Older patients are more susceptible to UTIs due to urinary retention and other diseases. Inappropriately using antibiotics to treat patients without an active infection can have detrimental health effects on the older population. This project holds significance to promote social change for nurses and patients with an algorithm to guide recognition and treatment for UTIs in older adults