Do: Randomly collect and submit urine cultures for analysis. Examine reflex to culture criteria (urine) from lab.

Investigate lab reflex to culture criteria:

• Less than 10 squamous epithelial cells per high power field.
• Positive Leukocyte esterase (1+ or greater)

• With present of >10WBC on microscopic examination

• Positive Nitrate
• Bacteria > 3+ (1+ for catheter samples) with few or none squamous epithelial cells
• Children 3 years and under are automatic culture if any of the following:

• Positive Leukocyte
• Positive Nitrite
• WBC seen in microscopic examination

Discovery: anytime a clinician orders urine culture despite lab micro findings, culture will be done.

Cerner issue that automatically drops 30-day (60 tabs) supply macrobid and will not allow prescriber to edit. Catrina (Pharm D) and Informatics nurse to fix.

• PharmD set order set for macrobid to 5 day duration with hard stop on hospital side.
• PharmD set order set for Bactrim to 3 day duration with hard stop on hospital side.

• Findings: on the out patient side (clinic, ER); there is no pharmacy oversite. Will continue to study this finding to see how this impacts prescribers. More investigation needed at this time. Unclear if there are order sets and who does those. Finding; there is remote pharmacy oversight for clinic prescribers.
• Summary, the good news; we discovered, compared to 9 other hospitals, that are prevalence rate of ASB is 22%. This finding is less than the majority of hospitals that are participating in the study. We also discovered 2 areas for improvement. Coulee’s treatment rate for ASB is 82% and antibiotic duration median is 7-10 days. We will focus on education with providers and nurses.

Smart Goal:#1

1. Reduce duration of antibiotic prescription for UTI to guideline by changing EMR order sentences to reflect guidelines.Cerner issue that automatically drops 30-day (60 tabs) supply macrobid and will not allow prescriber to edit. Catrina (Pharm D) and Informatics nurse to fix.                                                                                                                                  a. PharmD set order set for macrobid to 5 day duration with hard stop on hospital side.                                            b. PharmD set order set for Bactrim to 3 day duration with hard stop on hospital side.
2. Continue tracking and documenting duration for antibiotic prescriptions for UTI, Identify prescribers who may need one on one education and provide that education. (identify prescribing for ASB)
3. Update Medical Staff quarterly as needed to talk about UTI prescribing and anti-microbial stewardship goals for duration of prescribed antibiotics. Doctor Chaffee in May 2023 med staff presented AHRQ Safety Program for Improving Antibiotic use, titled ” Best Practices in the Diagnosis and Treatment of Asymptomatic Bacteriuria and Urinary Tract infections.
4. Provide Nursing education and revisit current UTI protocols to help distinguish between ASB and true UTI symptoms. (when to call the doctor).
5. Dr. Chaffee discusses antibiotic duration at clinic counsel meetings and med-staff meetings.
6. Provider Board made to include research and antibiotic pearls that address ABX duration.
7. Will continue to monitor closely over the next 6 months for improvements.
8. Will be joining ASB 201, where we will take a deeper dive.