Diagnosis and Treatment of UTI at Gateway Internal Medicine

Author

Kathra Wickam, The University of Texas at El Paso

Date of Award

5-2020

Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)

Department

Nursing

Chair

H. R. Morales

Abstract

The project is a quality improvement (QI) initiative with a target population concentrated on adult women, between 18 and 99 years of age, presenting with symptoms of urinary tract infection (UTI). The symptoms are often nonspecific, and dipstick urinalysis lacks adequate specificity; empiric treatment leads to substantial antibiotic exposure that ultimately proves unnecessary. The completion of this QI project came about after a ten-day reflective practice, during which I identified a UTI diagnosis and treatment problem in women at Gateway Internal Medicine in El Paso, Texas. The QI project is aimed at reducing inappropriate outpatient antibiotic use and UTI recurrence by using diagnostics like urine culture before the initial treatment. The project is an evidence‐based Practice QI with the use of PDSA methodology to ensure proper diagnosis and treatment as well as antibiotic stewardship to decrease long-term complications. The project was carried out at Gateway Internal Medicine (GIMA) from January 21, 2020, to March 11, 2020. Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a team of four employees was created to spearhead the project. Patients with symptoms of UTI were asked to give a urine sample for culture and sensitivity. There was a telephone encounter follow-up two to three days after the initial visit to update the patient on the results, and a two-week follow-up after treatment. Out of the eighteen patients, fourteen urine cultures were positive with high sensitivity to Nitrofurantoin. Seventeen of the eighteen patients came in for follow-up. The team reviewed current guidelines and ordered sets related to specimen collection, storage, and transportation. The implementation of a standard protocol for urine culture follow-up and the discontinuation of unnecessary antibiotics were effective and safe for all eighteen patients that participated in the project. The antibiotic prescription rate decreased by 36% compared to the previous year.

Recommended Citation

Wickam, Kathra, "Diagnosis and Treatment of UTI at Gateway Internal Medicine" (2020). Cohort VIII. 8.
https://scholarworks.utep.edu/cohort_8/8