Dr Lyn-li Lim1, Dr Melanie Wroth1, A/ Prof Juanita Breen1,4, Ms Kate Williams1
1Aged Care Quality And Safety Commission, Melbourne, Australia
2Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute for Infection and Immunity, Melbourne, Australia
3Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
4University of Tasmania, Hobart, Australia
“To Dip or Not to Dip” (TDONTD) is a quality improvement initiative focussed on educating clinical staff in residential aged care facilities (RACFs) to better recognise urinary tract infections (UTI) and asymptomatic bacteriuria (ASB); discouraging urinalysis as a practice that contributes to antibiotic overuse. An evaluation of the feasibility, useability and effectiveness of TDONTD using a mixed-methods approach was undertaken.
Methods: Implementation of education and clinical pathway was led by RACF nurses (“Champions”), supported by Quality Use of Medicines (QUM) pharmacists. Twelve Champions and four pharmacists participated in baseline and 3-month post-implementation activities.
Results: In baseline audits, 85 of 1,074 residents (7.9%) were on an oral antibiotic. Of oral antibiotics prescribed, 37.6% (32/85) were for a urinary tract indication. In baseline surveys, 50% of Champions reported that their facility did not use a protocol when assessing residents for UTI. 92% always or sometimes performed urinalysis after resident completion of antibiotic treatment. 25% said that urinalysis was regularly performed in asymptomatic residents.
Nearly all RACFs experienced outbreaks and many had changes to Champion roles. Case-based education was delivered by pharmacists in 11 of 12 facilities. Over November 2021 to April 2022, the clinical pathway was implemented in 9 of 12. We will discuss 3-month survey, interview and audit results.
Conclusion: UTI is a common reason for antibiotic prescribing in RACFs. TDONTD is a nurse-led AMS implementation activity to improve UTI recognition in RACFs. We will describe the feasibility, useability and effectiveness of TDONTD delivered by AMS Champions supported by QUM Pharmacists.
Biography: Lyn-li Lim is an Infectious Diseases physician at VICNISS, Doherty Institute and a consultant at the Aged Care Quality and Safety Commission with an interest in healthcare-associated infections and antimicrobial stewardship. She is involved in the research, development of clinical guidelines and educational information in the areas of infection prevention and control and infections. She has a special interest in AMS in Australian aged care facilities with a focus on promoting quality use of antimicrobials and implementation of evidence-based practice.