Abstract
Objectives
To determine what information is most important to registered nurses' (RNs) decisions
to call clinicians about suspected urinary tract infections (UTIs) in nursing home
residents.
Design
Web-based discrete choice experiment with 19 clinical scenarios.
Setting and Participants
Online survey with a convenience sample of RNs (N = 881) recruited from a health care
research panel.
Methods
Clinical 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.
Results
For 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 Implications
This 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.
Keywords
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Article info
Publication history
Published online: August 21, 2020
Footnotes
The authors declare no conflicts of interest.
This work was supported by the Agency for Healthcare Research and Quality (grant 11921828, 1R01HS024519-01). The sponsor had no role in the design, methods, subject recruitment, data collections, analysis and preparation of paper.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
