Evaluation & Treatment of UTI in the Elderly Review of Tools And Strategies

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

2. Tools 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.org/files/documents/Five_Things_Physicians_and_Patients_Should_Question.pdfhttp://www.americangeriatrics.org/files/documents/Five_Things_Physicians_and_Patients_Should_Question.pdf

5. https://www.amda.com/tools/ChoosingWisely_5Things.pdf

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 Rogers’ Stages of Diffusion of Innovation Stage 1Innovation Stage 2Diffusion Stage 3Adoption Mainstream Tipping Point Experiment Innovators Early Adopters Early Majority Late Majority Laggards

16. Putting theory to work: Use strategies and tools to Front line engagement Persuasive education Measurement Tools, systems supports 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?

19. The Model for Improvement 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? Act Plan Study Do Setting Aims Establishing Measures Selecting Changes W. EdwardsDeming *2001 Associates in Process Improvement

20. 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 Act Plan Study Do Model for Improvement in Action 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. Act Plan Study Do 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: https://www.surveymonkey.com/s/UTIRegionalWorkshops2014