Urinary Tract Infection Program

What do we need to change and are we ready to make those changes?

During this phase, long term care homes (LTCHs) look at the practice changes and assess both their need for the program and what they should focus on in addition to making sure they are ready to get started. At the end of this phase, LTCHs will have a good understanding of whether they are ready to move forward with implementing the Program.

Use the two worksheets below to help assess for need and fit of the program, and whether your LTCH is ready to implement. Once you have confirmed your readiness, you will then move on to establishing the implementation team that will support the implementation of the program.

Complete Practice Change Questionnaire

This questionnaire asks LTCHs to identify their current practices related to UTI management and treatment. These questions help to establish your readiness for the program and identify the objectives you will need to include in your implementation plan.

Go to Questionnaire

Review the Considerations for Readiness

These tips will help you reflect on the context within which your LTCH will implement the UTI Program and assess whether now is the right time to start.

Go to Questions

Get the Implementation Team Together

This resource identifies considerations for who should be on your implementation team and how the team will function to support implementing the UTI Program in your LTCH.

Go to Implementation Team Checklist

In the Plan phase, you will examine existing barriers to practice change and plan to address them using several implementation strategies. All activities, implementation steps, and implementation strategies are listed and linked below. More detailed information can be found in the implementation guide.

Examine Barriers to Practice Change

This tool lists barriers to practice change for UTI management and treatment that have been identified by LTCHs across Ontario and asks you to indicate whether it is a barrier in your LTCH.

Go to the Worksheet

Review Core Strategies

This is a checklist of the core implementation strategies included in the program. More information about each of these strategies is listed below.

Go to the Checklist

Create action plan

This worksheet includes questions related to each of the UTI Program’s strategies. The worksheet will help to document the implementation team’s decisions and the plans for implementing the program within your LTCH.

Go to the Worksheet

Strategies to address barriers and implement new practices

Increase buy-in and support

There are four strategies to help you increase buy-in for the UTI Program and the practice changes you will be making in your LTCH.

Strategy A: Involve local influencers

• Local influencers are well-respected and trustworthy individuals that can support practice change by sharing information about the program or helping to deliver education to staff.

Strategy B: Generate buy-in 

• Involving staff in discussions about the problem of antibiotic-related harms can increase acceptance and adoption of the key practice changes and engagement in the program overall.

Strategy C: Align policy and procedures to reflect practice changes

• This strategy ensures that the policies and procedures within your LTCH will support the key practice changes in the UTI Program.
• Resources:
  • Guidance for the Development of a Policy and Procedure for the Management of UTIs in Non-catheterized Residents
  • Sample Policy and Procedure for Assessment and Management of UTIs in Non-catheterized Residents

Strategy D: Review how resident symptoms are documented and communicated

• This strategy will help LTCHs understand how the LTCH is doing as the Program is implemented. By tracking information and monitoring for changes, LTCHs may identify areas that require further education/
  reminders or supports and create an action plan to improve practice.
• Resources:
  • Process Surveillance Form

Increase knowledge and develop skills

Changing key practices related to UTI management and treatment requires education for front-line staff, as well as residents and their families.

Strategy E: Deliver classroom education to staff

• Education can bring together staff to learn and discuss issues associated with the overuse of antibiotics, symptoms that indicate a UTI, and new organizational processes related to UTI assessment documentation.
• There are different ways to deliver education in your LTCH: classroom education, bullet rounds, online learning platforms, and orientation for new staff.
• Resources:
  • How to Interpret a Urine Culture Report and Methods for Specimen Collection
  • Frequently Asked Questions for Residents and Families
  • Resident and Family Update Form
  • Assessment Algorithm for UTIs in Medically Stable Non-catheterized Residents
  • Asymptomatic Bacteriuria
  • Causes of Mental Status Changes
  • When to Collect a Urine Specimen for Culture Susceptibility for Non-catheterized Residents
  • Evidence to Support Discontinuing the Use of Dipsticks to Diagnose UTI in Residents of Long Term Care Homes
  • Management of UTIs in Non-Catheterized Long Term Care Home Residents

Strategy F: Provide information and education to residents and families

• Residents and families may expect to receive antibiotics for non-specific symptoms and they may be concerned if they do not receive them.
• Resources:
  
  • Frequently Asked Questions for Residents and Families
  • Resident and Family Update Form
  • Communication for Family Newsletter

Strategy G: Use coaching to reinforce practices and support staff

• Coaches provide one-on-one education, supervision, assessment, feedback, and emotional support to front-line staff as they adopt the key practice changes in the UTI Program.
• Resources:
  
  • Coaching for Beliefs and Consequences

Monitor practice and give feedback to staff

Once your LTCH has adopted the key practice changes for UTI management and treatment, the UTI Program includes two strategies to support the integration of these practices into day-to-day activities and to ensure sustainability.

Strategy H: Keep track of how your home is doing and provide feedback to staff

• Once your LTCH has been monitoring for practice changes, it is important to share these results back with staff to demonstrate how well they are adhering to the practice changes. LTCHs can choose the way they prefer to share this type of feedback with their staff. Some ways that this has been accomplished include:
  • Via email
  • Sharing results at staff meetings
  • Huddles with staff
  • 1:1 feedback
  • Creating one-page reports or posters or memos
  • Share at meetings where this topic would be of interest, such as Professional Advisory Committees (PAC), IPAC Committee, or during Quality Improvement Planning (QIP).

Strategy I: Continue to remind staff of key practice changes

• Reminders are useful when staff and facilities are adopting practice changes.

After completing the Assess and Plan phases, you are ready to implement the UTI Program. Below is a listing of all the resources you need for the Program. The action plan you created (in the Plan phase) will help you move through each of the steps.

The UTI Program has been designed to support practice change to reduce the number of inappropriate urine culture submissions and inappropriate treatment of asymptomatic bacteriuria for residents in LTCHs. By participating in this program, LTCHs could potentially see:

• fewer total urine cultures being sent out for laboratory analysis
• reduced costs related to testing and treatment for asymptomatic bacteriuria
• reduced risk that residents will experience antibiotic harms

We have designed the UTI Program to be implemented by going through each of these three phases in order. If you have not yet completed the Assess and Plan phases, we recommend that you return to complete those steps.

If your organization is not able to take on the full program at this time, the resources below can also be used individually to support practice change as you see fit.

UTI Program Checklist

This checklist can be used to help your implementation team to monitor your progress and ensure that each step in the implementation guide has been addressed.

Go to Checklist

Increase Buy-in and Support

• Guidance for the Development of a Policy and Procedure for the Management of UTIs in Non-catheterized Residents
• Sample Policy and Procedure for Assessment and Management of UTIs in Non-Catheterized Residents

Educate and Develop Skills

Communication material

• Frequently Asked Questions for Residents and Families
• Resident and Family Update Form
• Communication for Family Newsletter

Fact Sheets

• Asymptomatic Bacteriuria
• Causes of Mental Status Changes
• When to Collect a Urine Specimen for Culture Susceptibility for Non-Catheterized Residents
• How to Collect Mid-Stream Urine Specimen
• How To Interpret a Urine Culture Report and Methods for Specimen Collection
• Process surveillance form

Infographic

• Antibiotic overuse in Ontario’s long term care homes

Poster

• Symptoms to Collect a Urine Sample

Presentation

• Management of UTIs in Non-Catheterized Long Term Care Home Residents
• Orientation to the Urinary Tract Infection Program for Long Term Care Homes

Reference material

• Assessment Algorithm for UTIs in Medically Stable Non-Catheterized Residents
• Coaching for Beliefs and Consequences
• Evidence to Support Discontinuing the Use of Dipsticks to Diagnose UTI in Residents of Long Term Care Homes