Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse |
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| Authors: | Anna Song Beeber Christine E Kistler Sheryl Zimmerman Cassandra Dictus Kimberly Ward Claire Farel Keith Chrzan Christopher J Wretman Marcella Boyton-Hansen Michael Pignone Philip D Sloane |
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| Institution: | 1. School of Nursing, University of North Carolina, Chapel Hill, NC, USA;2. The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA;3. Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA;4. School of Social Work, University of North Carolina, Chapel Hill, NC, USA;5. Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA;6. Sawtooth Analytics, Chesterton, IN, USA;7. School of Public Health, University of North Carolina, Chapel Hill, NC, USA;8. School of Medicine, University of Texas, Austin, TX, USA |
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| Abstract: | ObjectivesTo determine what information is most important to registered nurses' (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents.DesignWeb-based discrete choice experiment with 19 clinical scenarios.Setting and ParticipantsOnline survey with a convenience sample of RNs (N = 881) recruited from a health care research panel.MethodsClinical scenarios used information from 10 categories of resident characteristics: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical examination, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions (self-paced, n = 437 and forced deliberation, n = 444). The degree to which evidence- and non–evidence-based information was important to decision-making was estimated using unconditional multinomial logistic regression.ResultsFor all nurses (22.8%) and the self-paced group (24.1%), lower urinary tract status had the highest importance scores for the decision to call a clinician about a suspected UTI. For the forced-deliberation group, body temperature was most important (23.7%), and lower urinary tract status was less important (21%, P = .001). The information associated with the highest odds of an RN calling about a suspected UTI was painful or difficult urination odds ratio (OR) 4.85, 95% confidence interval (CI) 4.16–5.65], obvious blood in urine (OR 4.66, 95% CI 3.99–5.44), and temperature at 101.5° (OR 3.80, 95% CI 3.28–4.42). For the self-paced group, painful or difficult urination (OR 5.65, 95% CI 4.53–7.04) had the highest odds, whereas obvious blood in urine (OR 4.39, 95% CI 3.53–5.47) had highest odds for the forced-deliberation group.Conclusions and ImplicationsThis study highlighted the importance of specific resident characteristics in nurse decision-making about suspected UTIs. Future antimicrobial stewardship efforts should aim to not only improve the previously studied overprescribing practices of clinicians, but to improve nurses' assessment of signs and symptoms of potential infections and how they weigh resident information. |
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| Keywords: | Nursing care discrete choice experiment urinary tract infection nursing home decision-making |
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