Good Practice Examples – Improving UTI management/ Reducing Unnecessary Antibiotic Prescribing (31/10/16)

Name – Joan MacLeod

Job Title – Lead Pharmacist

Location - Aberdeen Health & Social Care Partnership

Briefly describe the initiative

In April 2016 letters and additional information were sent to both GP practices (n=30) and care homes (n=33) in Aberdeen to highlight best practice in managing suspected UTIs in older people in care homes. The information in the letter was as a result of collaborative working between the Department of Medicine for the Elderly, NHSG Bowel and Bladder Specialist service and HSCP Leads (medical and pharmacy). The work was begun after identifying the inappropriate use of dip stick urine testing in most care homes.Following on from the letter, the practice-attached pharmacists arranged to meet with senior staff in their attached care home(s) and deliver a short training session. The use of specially designed reporting forms was advocated.

Why did you undertake this initiative?

To improve the management of suspected UTIs of older people in care homes with suspected UTIs. We wanted to reduce the inappropriate prescribing of antibiotics to these patients.

What impact did the initiative have?

In addition to a reduction in numbers of trimethoprim and nitrofurantoinprescriptions there has been an improvement in communication between many of the practices and care homes and a better (and more holistic) view of how to manage UTIs.

What factors contributed to the impact of the initiative?

  • Multidisciplinary approach involving pharmacy, medical and nursing colleagues
  • Involvement of all practices and homes at the same time
  • Providing solutions (reporting forms) rather than just highlighting the problems
  • Meeting face-to-face with senior staff in care homes to discuss the project and explain the rationale

What lessons have you learnt as a result of this initiative?

  • Adopting a multidisciplinary approach takes more time but results in better solutions and more buy-in
  • Tackling one specific area at a time is easier and makes more impact than just a general approach to reducing antibiotic prescriptions
  • The vast majority of care homes were happy to change practice but the turnover of staff is a challenge (regarding consistent implementation)

What would you do differently next time?

  • Although it took a lot of time to design and implement the project it was worth it
  • Ideally we would have liked to have audited the holistic management of UTIs before and after the intervention within the practice (i.e. make the project more robust) but we didn’t have the manpower. It is acknowledged that measuring only trimethoprimnitrofurantoin Rx was a cruder means of testing the impact of the intervention.

Appendix 1 – Documentation Used