Feasibility of Algorithm-Based Clinical Decision Support for Suspected Urinary Tract Infections in Nursing Home...

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Clinical Decision Support

Background:

• Urinary tract infections (UTIs) are frequently diagnosed in nursing home residents, often leading to antibiotic prescriptions.
• Non-specific symptoms in this population complicate accurate UTI diagnosis and management.
• There is a need for improved diagnostic and treatment strategies for UTIs in nursing home settings.

Purpose of the Study:

• To pilot test a paper-based clinical algorithm for the diagnosis and management of suspected UTIs in nursing home residents.
• To evaluate the acceptability and utility of the algorithm among advanced practice providers (APPs).
• To assess the algorithm's impact on APP confidence and workload related to UTI care.

Main Methods:

• A paper-based clinical algorithm, including antimicrobial stewardship and treatment recommendations, was developed and piloted.
• Ten advanced practice providers in southern U.S. nursing homes participated in the pilot test.
• The algorithm was modified based on APP feedback and clinical care needs.

Main Results:

• Advanced practice providers found the UTI antimicrobial stewardship and clinical decision support algorithm acceptable.
• Educational sessions and the algorithm enhanced APP confidence in diagnosing and treating UTIs.
• Participants perceived the algorithm as useful and reported no negative impact on their workload.

Conclusions:

• The pilot test suggests that a paper-based clinical algorithm can be a valuable tool for improving UTI diagnosis and management in nursing homes.
• The algorithm demonstrates potential for enhancing antimicrobial stewardship and clinical decision-making.
• Further evaluation is planned to assess the algorithm's impact on prescribing outcomes.