Browsing "Urinary Tract Infections"

Urinary Tract Infections – Entry 2

Dear Diary:

Well, it’s been a struggle keeping Hattie out of the hospital. She had a fever for two days and clearly wasn’t feeling well. A urine culture was sent and everyone was encouraging her to drink fluids. Her urine looked clearer and lighter in color with the extra fluids, but she wasn’t feeling any better. Carol, her daughter, suggested sending Hattie to the hospital. Anna, Hattie’s nurse, was feeling the pressure related to Hattie’s change in condition, Carol’s desire to have her mother admitted, and knowing our nursing home’s goal to reduce hospitalizations. Anna called a staff huddle to discuss Hattie and invited me to attend .

First, we checked with the lab to see if there were any preliminary results from the urine culture but it wasn’t ready yet. Anna reported that Hattie seemed more confused. Sherry, the nursing assistant, checked her temperature and it was 0.5 degrees higher than earlier. We discussed what we could do and went into action. Anna called Hattie’s doctor and used the SBAR communication form to give him an update. Anna recommended trying an IV antibiotic and keeping her at River View. Anna told me the doctor didn’t seem to know, or remember, that we could administer IVs. The doctor ordered IV Gentamycin for 24 hours and asked that we call him with the lab results. He wants to switch her to an oral antibiotic as soon as he can. He also asked to be notified if Hattie’s temperature got any higher, she complained of nausea, or any other changes. Sherry went to assist Hattie with her lunch, encouraging her to eat and drink. I called Carol and informed her of the plan. She seemed relieved.

Hattie started to improve after the IV was started. Within several hours her temperature went down slightly, she was less confused, and she even asked for some ice cream. The lab results are back and Anna is going to call her doctor to get the antibiotic changed to an oral med. So luckily, we kept her out of the hospital. That said, we still have some system issues related to changes in condition.

Where do I start to look at how we can change our processes to prevent unnecessary hospitalizations ?

Signed, Donna

Share your nursing home perspective on this quality improvement issue.

Urinary Tract Infections – Entry 1

Dear Diary:

Hattie has made some progress with her mobility since her hip fracture. She’s transferring better, sitting up in the chair more often and starting to increase her walking distance in therapy. Anna, the charge nurse, removed her indwelling catheter a few days ago. I was hoping they would have removed it sooner, so we’ve really got to talk about some protocols for removing every catheter we can.

In our huddle today, I heard that Hattie seemed listless, was running a temperature, and the nursing assistant reported her urine looked “red-tinged”. Anna is planning to get a urine sample by straight cathing her and will send the sample to the lab as soon as possible. I also learned that the nursing assistant may have noticed the red-tinged urine prior to the catheter being removed but hadn’t reported it. This is another good example of why we have to use the “Stop and Watch” form. Until the urine culture comes back, the nursing staff is going to keep a close eye on Hattie, monitor her temperature, and encourage her to drink fluids. Anna called her doctor and he wants us to watch her closely rather than start her on an antibiotic before the culture comes back. I’m hoping we can start her on an antibiotic soon and not have to send her back to the hospital. I think that would be really hard on Hattie and her daughter Carol.

How can we do a better job in preventing UTIs?

Signed, Donna


  • When completing the Hospital Preadmission assessment, verify if catheter in place and ask that it be removed if indicated before D/C to TCU. Verify that voiding occured after removed and discharged to TCU.

  • We are putting together an inservice for all NARs regarding urinary catheters and infection control. Ihave had several NARs demonstrate the procedure for emptying cath bags as well as changing from bed bag to leg bag. There were serious red flags (i.e. allowing the tubing from bag to touch the inside of dirty urinals, improper cleaning and storage of bag being removed when applying another).

  • I would do cross analysis and see how many pt. on her hall also have a uti? if there is a significant increase in utis on her unit then start your root cause analysis. is there staff turnover? are there hydration stations available? are staff performing correct handwashing techniques? has there been a new soap intoriduced? are there new soap dispensers? Is the soap hard to get out of the dispenser? I would do staff education on handwashing, pericare, hydration, nutrition, toileting frequently.

Share your nursing home perspective on this quality improvement issue.