1. To Dip Or Not To Dip – Improving the management of Urinary Tract Infection in older people Improving Patient Safety & Care 6th Feb 2019 Continuous Learning, Measurement & Improvement
Elizabeth Beech National Project Lead Healthcare Acquired Infection and Antimicrobial Resistance NHS Patient Safety Team, NHS #ToDipOrNotToDip

2. UK ambitions to reduce antimicrobial resistant infections and provide safe and effective care
We will reduce inappropriate antibiotic prescribing by 50%
We will reduce healthcare associated Gram-negative bloodstream infections in England by 50%

3. There were 42,000 E.coli blood stream infections in the 12 months to November 2018
75% of these have a community onset, and half will have a urinary tract origin, with antibiotic resistant E.coli increasing risk of UTI treatment failure
ToDipOrNotToDip – Improving the management of UTI in older people

4. 33.25 million antibiotic items were prescribed in primary care in England in 2017/18 at a cost of £ million 7 million (21%) of were for antibiotics commonly prescribed in primary care to treat lower UTI at a cost of £45 million 2.75 million (40%) of these antibiotics were prescribed to people aged 70+ years
ToDipOrNotToDip – Improving the management of UTI in older people

5. 13,447 residents in 251 aged care homes in Australia which participated in a single day PPS during June-September
1,300 (9.7%) residents prescribed at least one antimicrobial (N=1,867)
ToDipOrNotToDip – Improving the management of UTI in older people

6. 16,000 care homes provide care for 459,000 residents in England
ToDipOrNotToDip – Improving the management of UTI in older people

7. 545,000 antibiotic prescriptions were dispensed for 341,536 residents in long term care facilities in UK in the 12 months Nov16 – Oct17 1 in 2 residents had a least one antibiotic, and 40% of these were for UTI
ToDipOrNotToDip – Improving the management of UTI in older people
NHS Improvement

8. #ToDipOrNotToDip A patient centred approach to improve the management of Urinary Tract Infection UTI in the Care Home environment in Bath and North East Somerset
This is an evidence based systematic approach to improve the diagnosis and management of UTIs in residents in all 23 Nursing Homes in Bath and North East Somerset
It was delivered by the CCG care home pharmacist service working during , aligned to the existing GP enhanced nursing home service, and funded by the CCG as a quality improvement project in <£10K
And continued as an quality improvement programme due to impact
Why did we do this? Local clinical audit in 2013 identified residents were frequently prescribed antibiotics for UTI; 19% - 48% of residents per care home based on diagnosis by urine dip stick testing - which guidelines do not support
ToDipOrNotToDip – Improving the management of UTI in older people

9. #ToDipOrNotToDip – Improving the management of UTI
Aim of the project
Improve awareness on preventing and diagnosing UTIs in care home staff
Reduce unnecessary dipstick testing of urine samples
Improve communication between care homes and GPs about residents with suspected UTI
Reduce unnecessary antibiotic use in residents
Appropriate sending of urine samples for culture and sensitivity test
How to achieve?
Education sessions and resources for care home staff
Stop using urine dipsticks to diagnose suspected UTI
Introduce a clinical assessment and communication tool for care home and GP use
GPs following local guidelines for treating UTIs
Use of red top bottles which contains boric acid for preserving the urine and increase sampling
ToDipOrNotToDip – Improving the management of UTI in older people

10. ToDipOrNotToDip – Improving the management of UTI in older people elizabeth.beech@nhs.net

11. #ToDipOrNotToDip Pilot results from 8 Nursing Homes in NHS Bath and North East Somerset
56% reduction in the proportion of residents who had an antibiotic for a UTI
143 / 690 residents had at least one antibiotic for a UTI in 6 month period Jul-Dec 2015 after implementation
67% reduction in the number of antibiotic prescriptions
153 fewer in 6 month period in 8 nursing homes with pre and post data
82% reduction in the number of residents prescribed antibiotic prophylaxis
13 / 690 residents had antibiotic prophylaxis in 6 month period Jul-Dec 2015 after implementation
Unplanned hospital admissions for UTI, urosepsis and AKI reduced in the nursing home population following implementation
ToDipOrNotToDip – Improving the management of UTI in older people

12. #ToDipOrNotToDip Improving the management of UTI in NHS Bath and North East Somerset
Jul-Sep spike in the number of residents treated for UTI in 2016 reduced in 2017 following re-education in Apr-Jun 2017
ToDipOrNotToDip – Improving the management of UTI in older people

13. #ToDipOrNotToDip Improving the management of UTI in NHS Bath and North East Somerset
No seasonal change in the number of residents with urinary catheter use but there has been a reduction in number of residents with CAUTI and the number of antibiotics prescribed
ToDipOrNotToDip – Improving the management of UTI in older people

14. #ToDipOrNotToDip – Spreading the improvement Community of interest hosted on Slack – 400+ clinicians from multiple countries Spread – Support – Adopt – Adapt – Improve
ToDipOrNotToDip – Improving the management of UTI in older people

15. #ToDipOrNotToDip Resources free to use
ToDipOrNotToDip – Improving the management of UTI in older people

16. Join the #ToDipOrNotToDip community of interest of 400+ people in Slack via elizabeth.beech@nhs.net
ToDipOrNotToDip – Improving the management of UTI in older people

17. #ToDipOrNotToDip – What Next?
New PHE UTI diagnostic guidance for people aged 65+ years
NICE publish UTI guidance x 4
NHS Improvement to publish an improvement toolkit
Tackling antimicrobial resistance The UK ‘s 5-year national action plan
Ambition 4: Provide safe and effective care for patients
Ambition 8: Demonstrate appropriate use of antimicrobials
NHS England AMR diagnostic collaborative priority work stream
NHS England CQUIN scheme for providers will focus on hospital improvement
NHS Long Term Plan provides opportunities to implement in community networks
NHS England Medicines Optimisation Care Homes programme
ToDipOrNotToDip – Improving the management of UTI in older people
NHS Improvement

18. To Dip Or Not To Dip – Improving the management of Urinary Tract Infection in older people Welcome to contact for details
Elizabeth Beech National Project Lead Healthcare Acquired Infection and Antimicrobial Resistance NHS Patient Safety Team, NHS #ToDipOrNotToDip
ToDipOrNotToDip – Improving the management of UTI in older people