Description
GOAL: To optimize abx selection and duration for UTI. Will focus on clinics because they have more UTIs and focus on abx choice and duration of treatment. Duration and choice is variable. Focus on Urgent Care Primary Care
Project Resources
Whidbey final ASB Report 8.22.23
Core Elements
Education
Educating clinicians about resistance and optimal prescribing.
PDSA Cycles
Progress on PDSA Cycle 1
1. Collate data
2. Determine what is best treatment and duration
3. Develop education materials and rationale (Up to Date/Sanford Guide vs CSiM guide)
In December 2022, providers will attend TASP session when CSiM faculty reviews Whidbey case on ASB abx selection and duration.
Currently not collecting ER data due to low bandwidth (can do UTIs discharged from ED – do not need to be admitted)
12/14 update
In December 2022, providers attended TASP session and reviewed Whidbey case on ASB abx selection and duration. Updated the chiefs on TASP response. Continuing to develop education, and collect data.
Shared TASP summary and resources and info for follow-up with Whidbey clinical staff.
Check-in 2:
Discussed extended Macrobid duration with providers and saw large decrease in duration after discussion
Letters going out for getting urine when not needed and tracking who it is going to (mostly PAs)
Talking about antibiotics during new employee orientation
Lab will talk during AMS meeting in July to not use dipstick as replacement for UA and discuss reflexing – consider other options (dipstick –> micro –> UA)
12/14 collecting data in ambulatory collection form.
Check-in 2:
Has made graphs for Q4 for antibiotic choice
Letters going to mostly PAs – most reasons were “just in case”
Most data is clinic – primary care and urgent care walk-ins
Presented data to clinic quality meeting (frontline providers at all clinics) in March 2023 and represented data in May 2023.
Findings:
- ABX choice shows on track first line vs second line. 80% of time using first line ABX (bactrum, Macrobid) ; FQ use = 20%
- Duration – appropriate macrobid duration (5 days) dramatically increased in March to 100%
Next steps:
- Socialize the data!
- Pull out clinic and provider specific data (per their request for friendly competition)
- Educate on use of urine dip sticks vs urinalysis to trigger urine culture (collaborate with lab manager).