Implementing Provider Driven Education to Decrease Antibiotic use for Suspicion of UTIs Among Older Adults in a Long-Term Care Facility: A Quality Improvement Project

Authors

• Karen DeCato

Document Type

DNP Project

Publication Date

2026

Degree Name

Doctor of Nursing Practice

Faculty Advisor

Dr. Chrystyne Olivieri, DNP, FNP-BC, CDCES

Practice Mentor

Debra Tyler, MSN, FNP-BC

Abstract

Background

Inappropriate antibiotic prescribing for asymptomatic bacteriuria (AB) in long-term care facilities increases the risk of adverse effects including multidrug resistant organisms and Clostridioides difficile (CDI) infections. Despite this high prevalence of over-treatment with antibiotics for AB, there is a gap in the literature to support an evidenced-based change. This project will utilize the McGeer Criteria for Infections Surveillance (HIQI, 2024) to address the diagnostic accuracy gap through healthcare provider focused education.

Project Goals:

1. Reduce unnecessary urine testing which will decrease antibiotics prescribed for UTIs in older adults in long-term care facilities. A goal to have reduction of prescribed antibiotics for AB by 5-10% that is tracked over 60 days.
2. Education to providers and nursing staff on the appropriate signs and symptoms of UTI that align with the McGeer criteria to be used with every suspicion of a UTI and then document that the McGeer criteria was used in the EMR.

Methods

This quality improvement project utilized a pre-and post-intervention design over a 60-day period. The interventions consisted of education given to healthcare providers and nursing staff on symptomatic UTI indicators and integrating the McGeer’s criteria into all suspicions of UTIs with a goal to reduce unnecessary urine testing and empirical pretreatment with antibiotics.

Results

Data revealed a 39.5% reduction in antibiotic pretreatment from 57.7% to 18.2% after the intervention. Diagnostic accuracy improved by 25.5%. Post-intervention also was successful with a 100% negative culture and empirical treatment after the McGeer criteria stewardship was used. While the p-value (0.223) was not clinically significant due to a small sample size (n=11), it did demonstrate a 90% return on investment.

Conclusion

The standardized use of the McGeer’s criteria for Infection Surveillance in the long-term facility shifted the mindset of healthcare providers to an evidence-based stewardship. Recommendations to integrate this criterion permanently into electronic health record of this long-term-care

Comments

A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

Creative Commons License

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Recommended Citation

DeCato, K. (2026). Implementing provider driven education to decrease antibiotic use for suspicion of utis among older adults in a long-term care facility: A quality improvement project [Unpublished DNP project]. Sacred Heart University.