1. Evaluation & Treatment of UTI in the Elderly Review of Tools And Strategies
Susanne Salem-Schatz
MA Coalition for the Prevention of Medical Errors
HealthCare Quality Initiatives

2. Simplified URL for web tools www.macoalition.org/uti-elderly-tools

3. Clinician Education Sheet
References to AGS and
AMDA Choosing Wisely Recommendations

4. http://www. americangeriatrics

6. UTI /ASB Insert for Residents and Families
Reference to AMDA recommendation

7. Another tool for resident/family education
Consumer reports teams with AGS, ABIM
Coming later this year- integrated document with AMDA recommendations

9. Other Tools

10. ABCs for diagnosing UTI in long term care
Evidence based guidance for urine testing in the elderly
Research conducted in long term care, but applicable to other settings

11. When do you need an antibiotic?
To educate residents and families about the importance of prudent use of antibiotics
Additional brochure available developed for emergency departments
If interest, will adapt for LTAC and non-ED hospital units

12. Connecting UTI evaluation to the bigger picture

14. Key Implementation Strategies
Persuasive Education
Theories of change
Front line engagement
Small tests of change

15. Putting Theory to work: Start with willing volunteers
Stage 1 Innovation
Stage 2 Diffusion
Stage 3 Adoption
Experiment
Mainstream
Tipping Point
Innovators
Early Adopters
Early Majority
Late Majority
Laggards
Rogers’ Stages of Diffusion of Innovation

16. Putting theory to work: Use strategies and tools to
Front line engagement
Persuasive education
Measurement
Tools, systems supports
Knowledge
Persuasion
Decision
Implementation
Confirmation
Feedback, conversation

17. Lessons From Adult Learning Theory
Persuasive communication strategies
Establish credibility
Promote active learner involvement
Repetition and reinforcement
Brief graphic printed materials
Offer practical alternatives

18. Frame your change to encourage adoption (more from Rogers)
Relative advantage over current practice
Compatibility with practices and values
Less Complexity - what makes it simple?
Trialability – how could this be tested on a small scale?
Observability – can the practice and results be easily seen?
Discuss how you can bestow these features that encourage adoption on the changes you are trying to make.
What could you say?
What could you do?

19. The Model for Improvement
Study Do
Plan
Act
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?
Setting Aims
Establishing Measures
Selecting Changes
W. Edwards Deming
*2001 Associates in Process Improvement

20. Model for Improvement in Action
Study Do
Plan
Act
100% of residents with treated UTI will meet criteria for urine testing
Proportion of reviewed UTI cases that meet program criteria
Rates of urine culture, UTI, CDI
Aim
Measures
Changes
Educate all staff and engage them in identifying and testing practice change solutions.
Use decision support tools
Review cases daily; share results monthly
*2001 Associates in Process Improvement

21. PDSA: Small Tests of Change
Study Do
Plan
Act
PDSA: Small Tests of Change
Plan:
1 small change to test
Predict what will happen
Decide on what data to
evaluate test
Do:
Run the test
Document problems and
observations
Organize your data
Study
Analyze your data
Compare results t your predictions
Summarize what you have learned
Act
Decide what to do next
More testing?
Try something else?
Finalize the change?

22. Some Tips For Testing Small tests of change Rule of 1
1 patient/resident – 1 staff person – 1 day
Test over a short period of time
If they say weeks, think days
If they say days, think hours \
PDSA Worksheet to plan your test
Call for help!

23. Planning your Changes (in your handouts)

24. CEU Credits Link to CEU credit survey: