Strategies were developed and implemented in a 250 bed LTC facility to help identify true UTI symptoms that require further investigation.  Instead of notifying the primary care provider (PCP) when 1 vague symptom occurred, the resident was place on a 3 day UTI prevention protocol where the symptom was monitored every shift for 3 days as well as instituting specific nursing interventions to promote hydration, proper peri-care, and toileting. If 3 symptoms occurred any time during the protocol, the PCP was notified and a catheterized UA and culture were sent. The criteria to be met for a symptomatic UTI to be suspected mirrored the Centers for Medicare & Medicaid Services 2006 F-315 TAG and the American Medical Directors Associations clinical practice guideline on urinary incontinence.

Prior to implementing the protocol, PCP and residents’ families were notified of the protocol. All nursing and assistive staff were educated specifically on the policy & procedure of the protocol including symptom identification, execution of the protocol from initial symptom, specific nursing interventions, documentation requirements to outcome evaluation. A 2-month pilot study was initiated on 2 units to troubleshoot any problems with the protocol and then initiated on the remaining units. Out come measures comparing past and present quarterly UTI rates and Urinalysis utilization will be monitored as well as resident/staff/PCP response to the UTI prevention program.