Abstract
Background: Current guidelines stated that urinalysis should no longer be used to confirm a urinary tract infection (UTI) diagnosis in nursing home (NH) residents, urine dipstick tests are still frequently used by nursing staff in response to a broad array of – often non-UTI related – S&S. This study gain insight into factors associated with guideline non-accordant urine dipstick test use in NHs, and explore the current processes and perceptions regarding urine dipstick test use among nursing staff.
Methods: Mixed-methods study in Dutch NHs.
Participants: NH residents with a suspected UTI and nursing staff members.
Measurements: In an existing dataset of 294 cases of suspected UTI, we compared patient characteristics between guideline-accordant and non-accordant urine dipstick test use. We additionally explored processes and perceptions regarding urine dipstick test use, using data from previously conducted interviews with 9 nursing staff members complemented with 2 newly conducted focus groups with 14 nursing staff members.
Results: A urine dipstick test was performed in 13.7% of 51 residents with an indwelling urinary catheter. A urine dipstick test was performed in 61.3% of 243 suspected cases without an indwelling catheter, 45% of which was not guideline-accordant. Renal or urinary tract abnormalities [OR 0.29, 95% CI 0.09─0.96] and mental status change other than delirium (OR 0.34, 95% CI 0.15─0.77) were associated with more guideline non-accordant dipstick use. Having cloudy urine, urine color change and/or urine odor change (OR 2.47, 95% CI 1.06─5.73) was associated with more guideline-accordant urine dipstick test use. The qualitative findings provided in-depth insight into current work processes regarding the urine dipstick test, knowledge and perceptions, and points for improvement.
Conclusions: Guideline non-accordant urine dipstick test use is common in NHs. Improved knowledge and skills of nursing staff is needed, as well as clear work processes. As the urine dipstick test is very much embedded in everyday practice, the change process requires sufficient time, clear and repeated communication, and involvement of nursing staff. Throughout the change process, the perceptions of nursing staff identified in this study are important to consider and address.