Possible interventions:

• How to talk to providers about giving abx – giving shorter durations
  • Reevaluating patients a day or 2 later
  • State that Dr. Rees and Ryan are working on this
• Another issue: amount of prescribing for UTIs in the clinic
  • Do not see the prescriptions happening at the time
  • Walk-in clinic interventions – mainly education
    • Creating a guideline (and see if prescriptions in clinic follow guideline)
• Reducing duration
• Recommendations for narrower spectrum abx
• Compare mid-level vs providers for UTI vs ASB

Stewardship team:

• Sean Rees, Director of Emergency Medicine
• Ryan Algate, Pharmacy Director
• Chelsea Lindstrom, IP Nurse
• Natasha Thimons, Lab Manager

Facility background:

Data collection:

• To start data collection: find random UAs (all UAs, not just positive)
  • Will capture 10 cases from all UAs
• Looking at all components of facility (not just ER)
• All data collection completed by end of March

Questions:

• What are we doing and why?
  • Identifying intervention for ASB – need to understand system and baseline data
• UA reflexing to culture criteria:
  • Depends on urine dipstick and microscopic – sent for culture
    • Positive for nitrites
    • Positive for leukoestrates
    • Positive for red cells
    • Greater than 10 WBC?
    • More than 50 squamous epithelial – considered contaminated
  • ED: UA with micro then make a decision
  • Clinic: order – reflex to micro and culture
    • Epic choice may be different
  • Potentially intervene or investigate the difference

SMART goal: Submit 10 cases per month. Natasha finds cases and send to Chelsea and Ryan to input.