Nurse-led initiative cuts unnecessary urine cultures at Johns Hopkins Hospital: 4 things to know

An antibiotic stewardship intervention program led by nurses at Johns Hopkins Hospital in Baltimore led to a reduction of inappropriate urinary cultures for adult patients, according to a pilot study published in the November issue of The Joint Commission Journal on Quality and Patient Safety.

Four things to know: 

1. The before-and-after study involved 37 nurses and rotating providers from a group of 27 hospitalists staffed at a 24-bed adult medicine unit at Johns Hopkins. The study included patients with and without urinary catheters. 

2. The intervention led to a decrease in the mean urine culture rate per 100 patient-days from 2.30 to 1.52, compared to a 2.17 to 3.10 increase for the control group. The rate of inappropriate urine cultures also fell from 0.83 to 0.71, according to the study. 

3. The intervention included: education on principles of diagnostics stewardship, identification of a nurse champion to serve as a liaison between nursing staff and the antibiotic stewardship program, the implementation of an algorithm to guide discussions with hospitals about situations when urinary cultures may not be needed. 

4. The intervention was an effort to engage nursing staff in antibiotic and testing stewardship and improve patient outcomes related to the overtreatment of asymptomatic bacteriuria. 

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