Toolkit 1. Suspected UTI SBAR Toolkit

Toolkit Effectiveness

A study in 12 nursing homes in Texas found that using the Suspected UTI SBAR form reduced antibiotic prescriptions for asymptomatic bacteriuria by about one-third.¹

Overview of the Toolkit

Why Should a Nursing Home Use the Suspected UTI SBAR Toolkit?

Urinary tract infections (UTIs) are one of the most commonly diagnosed infections in nursing homes.² However, it can be difficult to differentiate between a UTI that requires an antibiotic prescription and asymptomatic bacteriuria, which does not require antibiotics and should not be treated. As such, the Suspected Urinary Tract Infection (UTI) Situation, Background, Assessment, and Request (SBAR) toolkit aims to help prescribing clinicians make this differentiation.

What is the Suspected UTI SBAR Toolkit?

The Suspected UTI SBAR toolkit helps nursing home staff and prescribing clinicians communicate about suspected UTIs and facilitates appropriate antibiotic prescribing. The primary tool in this toolkit is the Suspected UTI SBAR form. This form consists of questions that help nurses collect the most relevant information about a resident with a suspected UTI for the prescribing clinician, who then uses the information to assess the need for an antibiotic prescription.

The toolkit includes the following tools:

• Suspected UTI SBAR form (tool 1) (PDF) also available in a simplified, one-page format (Word) that can be edited
• A Clinician Letter: A template for a letter to prescribing clinicians explaining the form and its rationale (tool 2) (PDF | Word)
• Not All “Infections” Need Antibiotics: A handout for nurses describing the form (tool 3) (PDF)
• Urinalysis and UTIs: Improving Care provides training modules about the form for nursing staff (tool 4) (PDF | Word)

How Do I Implement the Suspected UTI SBAR Toolkit?

Implementing the toolkit involves three steps.

1. Introduce the Suspected UTI SBAR form to prescribing clinicians. Successful implementation relies on prescribing clinicians. This includes clinicians for the nursing home, residents' personal doctors, and clinicians at hospitals that may treat or refer residents. Once prescribing clinicians become familiar with the Suspected UTI SBAR form and its value, they will be more inclined to follow the guidelines outlined in the tool and expect nurses to use it. Prescribing clinicians should be sent the letter (tool 2) describing the new protocol and the Suspected UTI SBAR form (tool 1).
    
2. Introduce the tools to nurses. Successful implementation also relies on support from users—the nurses. Present the Suspected UTI SBAR form to the nursing staff who will use it to communicate with prescribing clinicians when a suspected UTI case arises. Tool 4 provides sample training modules that can be used to introduce nursing staff to the Suspected UTI SBAR form. The presentation should also include copies of the Suspected UTI SBAR form, a discussion about the rationale for using the form, and a discussion about available technical support. Evidence from the scientific or best practices literature should be made available. A periodic refresher training is also helpful as a reminder to staff and to make sure new staff understand how to use the tool.
    
3. Incorporate tools into daily practice. Champions or other staff should provide copies of the Suspected UTI SBAR form to the nursing staff, re-emphasize the rationale for using the tool, and communicate expectations for use. A periodic review of charts and prescription trends can validate whether the Suspected UTI SBAR form is always being used. The handout Not All “Infections” Need Antibiotics (tool 3) also should be given to nurses.

¹American Institutes for Research, the Texas A & M University School of Rural Public Health, and TMF Health Quality Institute. Standardizing antibiotic use in long-term care settings (SAUL study). Final Report prepared for Agency for Healthcare Research and Quality, Contract 2902006000191, Task Order 8; 2012.

²Centers for Disease Control and Prevention. Urinary tract infection (UTI) events for long-term care facilities (PDF).

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