147 Improving Urine Specimen Collection in Elderly Medical Inpatients—A Quality Improvement Project

The National Institute for Health Research reported in 2012 that urinary tract infections are a significant cause of mortality especially among the elderly population with 4,835 deaths in England and Wales. During an elderly care rotation, it was noted that a number of elderly inpatients were being treated for UTIs without urine samples for culture and sensitivity being collected. They were treated with antibiotics largely on the basis of positive urine dipsticks and/or clinical signs and symptoms. Despite local policy reflecting current national guidance on the diagnosis of UTIs in the elderly population, compliance remained poor. Method A quality improvement project using both quantitative and qualitative methodology was designed to determine the number of elderly medical inpatients (≥ 65 years) who have had urine sampling done within 48 hours of presentation as well as to seek to improve this aspect of patient care by determining limiting factors which could prove a hindrance to urine sampling in this age cohort. Quality improvement methods were used to improve and optimise urine sampling rates. Results The percentage of elderly medical inpatients having a urine sample taken on admission during the project period increased from 35% to just under 100%. Quality improvement methods have successfully identified and improved this aspect of the elderly care service leading to better patient care. Conclusion It was identified that lack of awareness and communication from both sides of the medical and care teams contributed to untimely urine sampling at our hospital. Education and personal discussion represents a sustainable intervention which could easily be replicated in other Trusts. Further work is underway with the development of a teaching session to support nurses and clinical support workers obtaining urine samples from incontinent patients undertaken by one of our community continence clinical nurse specialists.