RN UTI Management: Primary Care Registered Nurse Evaluation and Management of Suspected Urinary Tract Infection (UTI)

Purpose: To improve efficiency and standardize evidenced-based recommendations to manage patients reporting suspected urinary tract infections by registered nurses utilizing approved NMG protocol in primary care

Problem and significance in nursing: Per Brusch (2020), “approximately 25-40% of women in the United States aged 20-40 years have had a UTI. UTIs account for over 6 million patient visits to physicians per year in the United States. Approximately 20% of those visits are to EDs.” Currently, primary care physicians at NMG primary and specialty care treat patients reporting symptoms of dysuria either by evaluation or referral to immediate care/another internal medicine provider or treat empirically with antibiotics. Appointment availability inhibits patient access to care, as well as delays in evaluation and treatment. Current practices also increase the risk of inappropriate prescription ordering, increasing the risk of antimicrobial resistance. The general public lack sufficient education regarding safe management, treatment, and prevention of urinary tract infections as well as other risks associated with their self-reported symptoms.

Currently, every patient reported symptom related to dysuria/urinary tract infection, primary care nurse clinicians fully triage at Northwestern Medical Group. Within scope, the nurses provide recommendations and await the physician evaluation, standardized recommendations, and treatment plans. Since 2011, there has been a standard for evaluation and treatment plan for patients with uncomplicated acute cystitis. With an approved standardized workflow, based from this recommendation, nurses are working at the top of their license, providing more efficient, safer care for patients and supporting physicians evaluating the patients and providing care more efficiently.

Design: Level IV – quality improvement
Transforming evidence and creating clinical policy to standardize safe management of patient reported urinary tract infections by registered nurses

Methods: Participants include primary care triage nurse clinicians within Northwestern Medical Group. With approval, education, and training on standardized policy, triage nurses will create nurse visits for clinical triage, approve diagnostic testing, and provide subjective and objective data for physician consultation. Physicians will create treatment plans related to patients reporting dysuria or self empirically diagnosed urinary tract infection, and nurses will be able to evaluate and expedite care coordination.

Planned analysis: Data will compare management of patient encounters in the electronic medical record from June 2019 to June 2021 to July 2021 to present related to dysuria:
• Occurrences aligned in care with standardized practice recommendations
•    Number of touchpoints per patient encounter in the electronic medical record
•    Measured time from patient report to evaluation and MD treatment
•    Revenue lost related to care provided

Expected findings
•    Standardized management of UTIs based on evidence-based recommendations
•    Quicker response time to patients and symptom evaluation of suspected urinary tract infection
•    Decreased empiric antibiotic ordering rates
•    Lower risk of public antimicrobial resistance
•    Positive impact on physician, nursing, and patient satisfaction
•    Increased revenue and charge capture for physicians and NM system