Nursing education and a clinical tool to enhance discussions on the necessity of urine cultures (UrCx) among nurses and hospitalists were associated with a reduction in UrCx, a study in the November issue of The Joint Commission Journal on Quality and Patient Safety suggests, according to a press release.
Working with nurses to reduce unnecessary UrCxs may improve the diagnosis of urinary tract infections (UTIs) and, indirectly, antibiotic use, particularly overtreatment of asymptomatic bacteriuria (ASB), which is a major driver of inappropriate antibiotic use in hospitals.
The nurse-driven stewardship intervention was carried out in a 24-bed adult medicine unit staffed by rotating providers from a group of 27 hospitalists and 37 nurses at the Johns Hopkins Hospital. The intervention included:
· Education on the principles of diagnostic stewardship.
· Identification of a nurse champion to serve as liaison between nursing staff and the antibiotic stewardship program.
· Implementation of an algorithm to guide discussions with hospitalists about situations when UrCx may not be needed.
With the intervention, the mean UrCx rate per 100 patient-days decreased from 2.30 to 1.52, while without intervention it increased from 2.17 to 3.10. In addition, with the intervention, the rate of inappropriate UrCx decreased from 0.83 to 0.71.
An accompanying editorial by Daniel J. Escobar, MD, and David A. Pegues, MD, noted: “Although this was a small, single-unit study, it demonstrated the impact of a multifaceted method to engage nursing staff in antibiotic and testing stewardship.”
