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GPs collaborating to improve urinary tract (UTI) infection antimicrobial stewardship in nursing homes

20 February 2020

GPs collaborating to improve urinary tract (UTI) infection antimicrobial stewardship in nursing homes                          

Northern Ireland has the highest use of antimicrobials per person in United Kingdom. Major regional work is now underway to improve urinary tract (UTI) infection antimicrobial stewardship in nursing homes in the Northern Trust area. The work in this important sector of our healthcare system, is one of four Regional Scale and Spread areas of work underway in NI’s Health and Social Care Quality Improvement (HSCQI) network.

UTIs are one of the main sources of HCA gram negative infections. 45%* of all infections treated were UTIs. Staff in three care homes in the Northern Trust area are working alongside four Antrim GP practices with the aim of reducing the GP practices’ inappropriate antimicrobial prescribing by 10% for the care home residents. The use of a decision aid and checklist tools are helping to progress the improvements and the QI project is an excellent example of how all sectors can work together using quality improvement science methodology to make a real difference to a critically relevant issue.

Elizabeth Graham, Assistant Director of Person Centred Practice, Nursing Innovation and Development at Northern Trust and Dr Brian McCloskey, A Critical Care Consultant in the Belfast Trust are the joint project leads for this HSCQI work which is being facilitated by the Institute for Healthcare Improvement (IHI). Speaking at a recent project strategy meeting hosted in Massereene Manor Care Home, they spoke about the progress to date:

Elizabeth noted “This antimicrobial stewardship QI project with three of the Hutchison Group’s Care homes in the Antrim area is exemplary in providing a platform for multiple stakeholders working, from both the independent and public sectors, having the key aim of providing safe, effective care for our growing older population. We are currently working with Massereene Manor, Clonlee and Antrim Care Homes and four Antrim GPs Practices.  Nurses in the homes and their management have been amazing in embracing this work.

Brian added,” Alongside the care homes and the GP practices, we are collaborating with the Northern Trust, Public Health Agency (PHA), the Regulation and Quality Improvement Authority (RQIA) and Quality Improvement experts. Although based at present in the Northern Trust area, this work will in time benefit the long-term health of the NI population as HSCQI intend project spread across other NI care homes and GP Practices following outcomes based testing.

Dr Alan Lewis Vice Chair Antrim/ Ballymena GP federation and one of the participating GP Practices commented:

From my perspective I expect this project to streamline and standardise prescription requests for possible UTIs in nursing home patients giving GPs a more accurate clinical description of the patient to ensure appropriate prescribing in a timely manner.  I also expect that by giving nurses structure to their requests it will help them consider alternative diagnoses for the presenting symptoms and signs and may actually reduce requests for antibiotics for UTIs.  In the current antimicrobial crisis this would be an important step in the fight against antibiotic resistance.

Sharon Mc Cracken, the Manager of  Antrim Care Home who is taking part in the project commented:

“This is a fantastic opportunity for us in the private sector to work closely with the GP’s, PHA and Trust to reduce the use of antibiotic use to improve the quality of care for residents in Nursing Homes. “

Dr Jackie McCall, Clinical Lead for the HSCQI Improvement Hub who is working on the project commented:

“Media campaigns such as the recent ‘Antibiotic Guardian’ campaign have been reminding us all that antibiotic resistance is one of the biggest threats facing us today. This project continues to work towards safeguarding our antibiotics for future use. We want to keep antibiotics working.”

Click on where you can hear Brian and Elizabeth discuss the importance of this regional work.  You can also follow @HSCQI on Twitter to follow the #ScaleUpNi progress or see

This work is one of a series of four HSCQI Regional Scale and Spread areas of work which comprises of Sepsis, Antimicrobial Stewardship in Care Homes, Towards Zero Suicide Safety Planning and Safeguarding for Children in a social care setting. These regionally important  HSCQI projects are being facilitated by the Institute for Healthcare Improvement (IHI) and are endorsed by NI Health and Social Care senior leaders and
the Department of Health.

*HALT (NI) Report