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  • Implementation of an Educational Intervention in a Rural, Critical Access Health System to Improve Urinalysis Collection and Urinary Tract Infection Treatment in the Emergency Department And Ambulatory Care Settings

by Madison C. Barabas, PharmD, Jennifer R. Larson, PharmD, BCPS, Karlee A. Dulak, PharmD

​Objective: The objective of this project was to improve urinary tract infection treatment through optimization of urinalysis collection and antibiotic prescribing practices in the emergency department and ambulatory care clinics in a rural, critical-access health system through a pharmacist-led educational intervention.
Methods: An educational presentation and post-education reference materials were created to guide appropriate urinalysis collection and antimicrobial regimen selection by providers for emergency department and ambulatory care patients. Pre- and post-education retrospective chart reviews were performed on all adult patients in these settings who had provided a sample for a urinalysis during their visit between September 2022 and April 2023. The intention was to evaluate the effectiveness of staff education and reference materials on improving the following urinary tract infection (UTI)-focused antimicrobial stewardship outcomes: appropriateness of urinalysis collection, treatment regimen including evaluation of fluoroquinolone usage, and duration of therapy.
Results: A total of 1,644 retrospective chart reviews were assessed (868 pre-education and 776 post-education). Overall, there was a decrease in inappropriate urinalysis collection and suboptimal or inappropriate antimicrobial regimens (18.89% vs. 10.95%) following an educational intervention. There was a decrease in inappropriate urinalysis collection (7.72% vs. 4.12%); suboptimal use of first-line agents (2.65% vs.1.80%), which included unnecessary use of fluoroquinolones (2.07% vs. 1.55%); and suboptimal dosing or duration of therapy (7.60% vs. 4.90%).
Conclusions: The implementation of an antimicrobial stewardship educational intervention is an effective strategy to decrease rates of unnecessary urinalysis collection and inappropriate or suboptimal treatment of urinary tract infections.


Keywords: Adult, Fluoroquinolones, Anti-Bacterial Agents, Pharmacists, Retrospective Studies, Intention, Urinary Tract Infections, Anti-Infective Agents, Urinalysis​
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2023 September/October Table of Contents 

The Journal of the Pharmacy Society of Wisconsin (ISSN 2837-8229)


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  • Home
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  • For Authors and Reviewers
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