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Antibiotic Starts and Urine Culture Tracking Sheet Instructions for UsePurpose: The antibiotic tracking sheet is designed to help you compile all necessary information including start dates, days of therapy, antibiotic name and indication, lab results, symptoms, and surveillance definitions for urinary tract infections (revised McGeer criteria), etc. Data needed to fill out the tracking sheet can be obtained from infection control logs, 24-hour report, pharmacy and lab data, and medical records. Use of the tracking sheet should be integrated into your normal workflow process and a designated staff person should be responsible for filling out the sheet. Summary graphs and data tables will be generated from the information you enter; allowing you to track your progress over time and easily share results with clinical and nursing staff, quality and administration. What data should be collected and entered on the spreadsheet? Collect and enter data on all antibiotic starts for presumed UTI, regardless of whether a urine culture was done.Collect and enter data on any urine culture done, regardless of whether an antibiotic was started. Your facility should collect and enter data for one month at the beginning of the project year and one month at the end of the project year (May 2017 and March 2018). If you do not have 10 antibiotic starts in one month, continue until you get to 10, or stop after 2 months.1. Line List Tab:Find the “Line List” tab in the Excel spreadsheet. Use this worksheet to enter all relevant information related to a resident’s culture and antibiotic treatment. If a resident was treated with multiple antibiotics for the same infection, enter each antibiotic on a new line. Variable NameColumnInstructions/ExplanationAntibiotic start dateAEnter the date (mm/dd/yyyy) the antibiotic was started. Please do not leave this blank.Days of Therapy (DOT)BEnter the number of days of therapy. Please do not leave this blank.Resident codeCCreate a unique code for each resident. Use the same code per each entry for the resident. Do not list resident names.Unit/FloorDEnter the unit/floor number where the resident is located at the time of the antibiotic start or the time of collection of the urine culture. The drop-down menu contains the example “2 North”, but you can list your own.Prescriber codeECreate a unique code for the clinician that prescribed the resident’s antibiotics. Use the same code per entry for the prescriber. Do not list prescriber names. This will allow you to follow up with the prescriber if necessary.Antibiotic nameFSelect the name of the prescribed antibiotic from the drop-down list. If the prescribed antibiotic is not contained in the list, type it into the cell.IndicationGType the indication for the antibiotic prescription FeverHSelect “Y” from the drop-down list if the resident had a fever at the time of culture collection. Fever is defined as a temperature greater than or equal to 100? F, OR repeated temperatures greater than 99? F, OR a temperature greater than 2? F above the resident’s baseline. Select “N” if the resident did not have a fever based on the above criteria. Please do not leave this blank.Leukocytosis ((14 x 109 cells/L) or left shift > (6% or 1.5 x109 bands/L))ISelect “Y” from the drop-down list if the resident meets the definition for leukocytosis. Select “N” if the resident did not meet the criteria. Please do not leave this blank.Other symptoms (rigors, new onset hypotension…etc.)J-USelect “Y” from the drop-down list if the resident had this symptom. Select “N” if the resident did not have this symptom. Please do not leave this blank.Indwelling catheterVSelect “Y” from the drop-down menu if the resident had an indwelling catheter (i.e., Foley catheter) at the time of urine culture collection. Select “N” if the resident did not have an indwelling catheter at the time of culture collection. Please do not leave this blank.WBC (109 cells/L) count within 48 hours of symptomsWEnter the resident’s WBC count at the time of culture collection (WBC must be collected within 48 hours of symptom onset). Please do not leave this blank.Date of urine cultureXEnter the date (mm/dd/yyyy) of the urine culture. Please do not leave this blank.Urine culture sourceYSelect the source of the urine culture from the drop-down menu. Please do not leave this blank.Culture result #1ZEnter the type of micro-organism(s) into the cell. If the culture result was negative or mixed flora, type these results into the cell. Please do not leave this blank.Colony counts (CFU/mL #1)AAEnter the culture colony counts into the cell. Please do not leave this blank.Culture result #2ABEnter the type of micro-organism(s) into the cell. If the culture result was negative or mixed flora, type these results into the cell. Please do not leave this blank.Colony Counts (CFU/mL #2)ACEnter the culture colony counts into the cell. Please do not leave this blank.Re-assessment within 48-72 hours of antibiotic start (Y/N) ADSelect “Y” from the drop-down list if there is documentation in the medical record that the resident and the antibiotic prescription was reevaluated by a clinician within 48-72 hours of the antibiotic start date. Select “N” if there is no evidence that the resident was reevaluated. Please do not leave this blank.Meets microbiologic culture criteriaAEThis field will auto-fill based on the information entered in the tracking sheet. Do not enter anything in this field.Meets revised criteria A (no catheter)AHThis field will auto-fill based on the information entered in the tracking sheet. Do not enter anything in this field.Meets revised criteria B (has catheter)AIThis field will auto-fill based on the information entered in the tracking sheet. Do not enter anything in this field.Meets revised McGeer CriteriaAJThis field will auto-fill based on the information entered in the tracking sheet. Do not enter anything in this field.2. Summary Tab:?Enter your total resident days for each month of data collection at the start of the project (May 2017) and the end of the project (March 2018). Total resident days can be obtained from the MDS or another billing source and should be entered in column C (yellow colored cell). Do not enter any other values in cells D-M (green colored cells), as they will be automatically generated after you enter your total resident days for the month. The Project Outcomes graphs will automatically be generated after you enter your total resident days for the month.3. Formats Page:This page describes in detail the drop-down choices that are used in the line list page of the Excel worksheet. Information on how to add additional items to the drop-down lists are included on this page. If your version of Excel does not include the option to view the drop-down lists, please refer to the Formats tab of the worksheet and type in your answers exactly as they appear in the Formats section. For example, for a cell that asks for “Yes” or “No”, you would enter “Y” for yes and “N” for no. For the urine culture source (column Y) on the line list tab, your options are limited to “clean catch”, “in/out straight catheter”, or “indwelling”. Do not write “Foley” for indwelling, or “void” for a clean catch specimen. You must enter the information on the line list exactly as it appears in the Formats section for the worksheet to accept your answers and appropriately categorize the infection per the surveillance definitions. Urinary Tract Infection (UTI) AssessmentUTIs are the most common infection in most nursing homes. Assessing the appropriateness of testing and treatment is a relatively easy way to increase the robustness of your antibiotic stewardship program. Only complete the UTI fields for residents that were treated with an antibiotic for the indication of UTI. The revised McGeer surveillance criteria can be used to determine whether the patient had a true “UTI” or asymptomatic bacteriuria. Application of the McGeer criteria is based on a combination of clinical signs/symptoms and laboratory results. Criteria differ based on whether the resident had an indwelling urinary catheter at the time of urine culture. This assessment is not intended to drive clinical decision making but rather to help you identify areas for improvement in your nursing home.McGeer Criteria for UTI AssessmentSymptom CriteriaMicrobiologic Culture CriteriaCriteria A: For residents without indwelling catheter:Criteria B: For residents with indwelling catheter:Acute dysuria or acute pain, swelling or tenderness of the testes, epididymis or prostate ORFever (defined above) or leukocytosis (14,000 μL) and at least one of the following (new or increased):Acute costovertebral (CVA) pain or tendernessSuprapubic painGross hematuriaUrinary incontinenceUrgencyFrequency ORNo fever and least two of the following symptoms (new or increased):UrgencyFrequencySuprapubic painGross hematuriaUrinary incontinenceAt least one of the symptoms listed below:Fever, rigors or new-onset hypotension, with no alternate site of infectionAcute change in mental status or acute functional decline, with no alternate diagnosis AND leukocytosisNew-onset suprapubic pain or CVA pain or tendernessPurulent discharge from around the catheter or acute pain, swelling or tenderness of the testes, epididymis, or prostateSpecimen collected from clean catch voided urine and positive culture with no more than 2 species of microorganisms, at least 1 of which is a bacterium of ≥105 CFU/m ORSpecimen collected from in/out straight catheter and positive culture with any number of micro-organism, at least 1 of which is a bacterium of ≥102 CFU/m ORSpecimen collected from an indwelling catheter* and positive culture with ≥105 CFU/mL of any microorganism.*If catheter has been in place for >2 weeks, change catheter before obtaining urine sample ................
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