SIGN Guidance advises not to use dipstick test in elderly in the diagnosis of UTI What’s the problem with dipsticks? Dipsticks are cheap, widely available and everyone can do them Prevalence of asymptomatic bacteriuria in elderly care home is high (~50% women, ~40% men) The positive predictive value of dipstick for UTI in elderly patient is therefore low ~50% Dipsticks are commonly misinterpreted by healthcare staff especially in elderly patients, leading to unnecessary antibiotic use Number needed to harm from treating asymptomatic bacteriuria = 3

Summary of baseline data test-run One GP practice’s prescribing to 6 care homes Does not include OOH prescribing 148 prescriptions to 51 residents in 12 months Sample of prescriptions for UTI reviewed by Clinical Pharmacist: “Task from reception” in all but one case Phoned call from care home  reception create task for GP  Prescription issued Clinical Assessment 2/3rds of episodes had no clinical details recorded at all in patient record. Urine Dipstick All 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 NPV Only information recorded in patient record was positive dipstick in a significant proportion of patients Church Walk data

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 prescriptions 56% 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 UTI

ENHCCG Project Outline