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  • March 21, 2019
  • Walters, Elizabeth
    • Affiliation: School of Nursing
  • Antibiotic resistance, an increasing threat in healthcare, is driven by the misuse of antibiotics. It is critical to follow clinical practice guidelines for diagnosis and management of infections, so that antibiotics are used only when appropriate. Urinary tract infection (UTI) is one of the most common pediatric infections and effective management requires appropriate diagnostic methods and treatment. The literature suggests that there is variation in practice with specimen collection for pediatric emergency department patients when UTI is suspected. Furthermore, there is a wide variation in treatment with broad and narrow spectrum antibiotics (Copp, Yiee, Smith, Hanley, & Saigal, 2013; Coutinho, Stensland, Akhavan, Jaydevan, & Stock, 2014; Selekman, Allen, & Copp, 2016; Percival et al., 2015). The pediatric emergency department at UNC Hospitals did not have a standard protocol for the diagnostic testing or treatment of uncomplicated UTI. There was an opportunity to improve practice at the pediatric emergency department by standardizing uncomplicated UTI diagnostic testing and treatment according to local bacterial resistance patterns. Using quality improvement methodologies and the Lewin Change Theory, an evidence-based standardized clinical decision support algorithm for the diagnosis and treatment of uncomplicated pediatric UTI was implemented at UNC Hospitals Pediatric Emergency Department for patients ages 3 months to 12 years with suspected UTI. During the QI project, 458 children were assessed for UTI and 75 children diagnosed with UTI. The QI project resulted in sustained improvements in provider adherence to: correctly ordered specimens, correct management of positive urinalysis results and use of recommended antibiotics. Balancing measures showed no significant differences between pre- and post-intervention periods.This project has shown that the implementation of a simple, low-cost evidence-based algorithm, can be effective for improving provider adherence to antibiotic stewardship efforts, especially when tailored to a specific department or unit’s workflow. This is the first QI project to both address standardization of specimen collection and treatment for pediatric UTI in the emergency department setting and our findings suggest this can be done with no adverse outcomes.
Date of publication
Resource type
  • Willis, Zachary
  • Waters, Hugh
  • D'Auria, Jennifer
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018

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