Assesing the Management of Urinary Tract Infections at a Large, Urban Teaching Hospital
Recently, Grady Heath System (GHS) updated its urinary tract infection (UTI) management guidelines. Despite these guidelines, variability in the diagnosis and treatment of UTIs at GHS has been noted. Such deviation of clinical practice can have a tremendous impact on patient outcomes; therefore, we aimed to evaluate the preliminary efficacy of a pharmacist-driven educational pilot intervention in improving the management of UTIs.
From October 1, 2013 to March 31, 2014 a three-phase pilot study was conducted to identify patients 18 years or older with a urinalysis (UA) ordered for evaluation of a potential UTI. The initial phase involved retrospective chart review; UTIs were categorized as adherent or non-adherent based on whether their management was in line with GHS guidelines. The intervention phase involved the delivery of pharmacist-led education sessions focusing on recommendations for appropriate management of UTIs and the provision of informational pocket cards with diagnostic and treatment algorithms based on GHS guidelines. The final phase of the study consisted of a prospective chart review assessing UTI management similar to the initial phase. Lastly, a pharmacist provided real-time feedback to a physician member of the treatment team if non-guideline-based UTI management was identified.
Data for 100 patients was analyzed for the retrospective phase of the study. Of these, 86% were managed in compliance with guidelines. Data for 100 patients was analyzed for the prospective phase of the study. Of these, 90% were managed in compliance with guidelines, leaving 10% that were non-compliant requiring intervention. All UTIs evaluated were treated with guideline-compliant duration of therapy. Empiric antibiotic selection was in compliance with guidelines 66% of the time during the pre-intervention phase, compared to 76% during the post-intervention phase. Annualized cost savings based on antibiotic use avoidance resulting from pharmacist intervention were calculated as $5,000 for a 7-day course of antibiotics.
Pilot findings suggest that a simple, pharmacist-driven educational intervention can impact adherence to hospital UTI management guidelines, and thus result in improved antibiotic stewardship and substantial cost savings.
A. Kalokhe, None