SIGN Guidance advises not - PowerPoint Presentation

Slide1

SIGN Guidance advises

not

to use dipstick test in elderly in the diagnosis of UTI

Number needed to harm from treating asymptomatic bacteriuria = 3

Prevalence of asymptomatic bacteriuria in elderly care home is high (~50% women, ~40% men)

Dipsticks are cheap, widely available and everyone can do them

The positive predictive value of dipstick for UTI in elderly patient is therefore low ~50%

What’s the problem with dipsticks?

Dipsticks are commonly misinterpreted by healthcare staff especially in elderly patients, leading to unnecessary antibiotic useSlide2

Summary of baseline data test-runOne GP practice’s prescribing to 6 care homes

Does not include OOH prescribing148 prescriptions to 51 residents in 12 monthsSample of prescriptions for UTI reviewed by Clinical Pharmacist:“Task from reception” in all but one casePhoned call from care home

 reception create task for GP  Prescription issuedClinical Assessment

2/3rds of episodes had no clinical details recorded at all

in patient record.Urine DipstickAll patients had urine dipstick, poor recording of results

80% were positive. 20% were negative and treated as UTI anyway!

Incorrect interpretation of dipstick, as used for both PPV and not for NPVOnly information recorded in patient record was positive dipstick in a significant proportion of patientsSlide3

To Key messages from NHS BaNES Project ‘To Dip or Not To Dip’

Used an evidence-based algorithm based on SIGN guideline 88,

to diagnose UTI in care home residents

Educational intervention and resources focused on use of the guidance and good hydration / avoiding AKI

Results:67% relative reduction in the number of antibiotic prescriptions56

% relative reduction (24% absolute reduction)

in the number of care home residents

prescribed antibiotics for

UTI 82%

relative reduction

in the number of residents prescribed

prophylactic antibiotics for UTI

Improved

appropriate management of

UTI according to SIGN

Reduction in unplanned admissions

for UTI,

urosepsis

and AKI

Reduced calls

to GP practices for inappropriately diagnosed UTISlide4

ENHCCG Project Outline