A Nurse-Led Algorithm for Diagnosing Urinary Tract Infection in Homebound Older Adults.

PURPOSE: We designed a nurse-led algorithm to standardize urinary tract infection (UTI) diagnosis for older adults receiving home-based medical care. Aims of this pilot quality improvement study were to reduce the frequency of empiric antibiotic therapy initiated without a urinalysis and urine culture (UA/UC) first being obtained, reduce antibiotic use without a concomitant increase in emergency department (ED) visits or hospital admissions, and ensure stakeholders' satisfaction with algorithm use. METHOD: A nurse-led diagnostic algorithm was designed and pilot-tested to address challenges and standardize diagnosis of UTI in a population of homebound older adults. RESULTS: In pre/post data analysis, algorithm implementation was associated with improved frequency of obtaining UA/UC before empiric antibiotic therapy was initiated, but the overall rate of antibiotic use for UTI did not decrease. No increase in ED or hospital admissions was identified. CONCLUSION: Use of a diagnostic algorithm for UTI among homebound older adults was associated with reduced frequency of empiric antibiotic initiation for suspected UTI without a UA/UC first being obtained. More rigorous study is needed to confirm and expand on these findings. [Research in Gerontological Nursing, 17(2), 92-97.].

Expansion of a House Calls Program for Patients With Dementia During COVID-19.

Homebound older adults with dementia have increased health care use, hospitalization rates, and mortality risk, which are associated with considerable health care costs. A large, unmet need for individuals with dementia is home-based medical care. Although our institution has had a primary care program for homebound patients since 2019, we did not have an analogous program for patients with dementia before the coronavirus disease 2019 (COVID-19) pandemic. However, with increased health risks and challenges associated with the pandemic, we rapidly expanded the program to include facility-based older adults with dementia. We incorporated telemedicine and home-based visits to effectively provide patient-centered care that was aligned with their goals and preferences, and we describe a program example of how we provided care during a COVID-19 outbreak in a large facility. Further research is needed to capture potential cost savings and hospitalization rates for persons with dementia who receive home-based medical care. [Journal of Gerontological Nursing, 48(10), 21-25.].