Category: Federal Forum Posters
Purpose: Asymptomatic bacteriuria (ASB) continues to be an area that contributes to the overutilization of antimicrobials in the ambulatory care setting. This is in part due to ordering of urinalyses and urine cultures by primary care providers without clear indication. ASB is commonly misdiagnosed as a urinary tract infection (UTI), resulting in unnecessary antibiotic treatment. Increased exposure to antimicrobials result in multi-drug resistance, increased healthcare costs, and adverse events including Clostridium difficile infection. The purpose of this quality improvement (QI) project is to develop a clinical decision support tool, improve provider awareness, and reduce unnecessary screenings and antibiotic use in ASB.
Methods: The institutional review board (IRB) evaluated the project and determined it as a non-research QI project. Retrospective chart reviews will be conducted randomly for veterans who had urinalyses with positive urine cultures and received antibiotic prescriptions in the ambulatory care setting between May 1, 2018 and July 31, 2018. Veterans with ASB will be identified as having an elevated number of bacteria in the urine without symptoms of a UTI. Retrospective chart reviews will gather baseline data for urinalysis and urine culture findings, presence or absence of symptoms, name and class of antibiotics used, duration of therapy, side effects, incidence of hospitalizations from Clostridium difficile infection, and cost associated with unnecessary use of antibiotics. A computer decision support tool will be implemented to improve antibiotic order sets and offer treatment recommendations based on differential diagnosis of UTIs. One-hour provider education sessions and pocket cards will be provided to increase awareness on curbing overuse of antibiotics for ASB. Post implementation data will be collected and compared with the baseline data. Descriptive statistics, including mean, median, and standard deviation will be used to analyze data.
Results: Not applicable
Conclusion: Not applicable
My-Hanh Nguyen– PGY1 Pharmacy Resident, VA Sierra Nevada Health Care System, Reno, NV