Question

1. Effective Interprofessional Communication

Dr. Killbug: Did you see Mrs. Mullins’ urine? That looks pretty bad to me. I wish you had let me know about that urine sooner. Last thing we need is for her to get a UTI and end up back in the hospital again.

Marizze: Actually, I was hoping to talk to you. I noticed that when she was transferred back from the hospital. She now has an indwelling urinary catheter in place. While her urine is cloudy, she is still doing well without any symptoms of an UTI. She does want the catheter out, as it is tugging on her leg. (SITUATION)

Dr. Killbug: Yeah, but she’s probably pretty weak now. Yes, but I’d still like to send a urine culture. Who knows what’s in her urine now? I’m going to put her on Bactrim, once you get that culture.

Marizze: I believe she had an allergic reaction to Bactrim in the past—yep, says here in her chart, “rash.”

Dr. Killbug: Okay, I’ll use Cipro then.

Marizze: I see, but getting back to the catheter, there is no indication provided for it. She has never needed a catheter previously. We are participating in the Long-term care- research /UTI project, and one of the key steps to preventing an UTI is to remove urinary catheters unless they are medically indicated.

Dr. Killbug: Yes, that is a good point you are making. But, how do you think she is doing today?

Marizze: On my assessment, Mrs. Mullins does not meet any of the indications for a catheter, as per the documentation from the hospital, nor does she need further testing of her urine; however, she might be a little dehydrated today, which might account for her cloudy urine.

Dr. Killbug: Great, do you think we should take the catheter out?  

Marizze: Yes, I’d like to remove it and give her a voiding trial. If that’s okay with you, I’ll take it out and let you know how that goes. And let’s hold off on the urine culture and antibiotics. I’ll keep a close eye on her this shift. If anything seems out of the ordinary with her recovery, I’ll call you.

Dr. Killbug: That sounds like a good plan. Where can I get more info about this UTI Long-term care research project?

The practical nurse used SBAR to improve communication with Dr. Killbug. Identify the SBAR elements of Nurse Marizze’s communication using the following prompts. Provide examples of Nurse Marizze’s dialogue:

Answer 1

The components of SBAR are as follows, according to the Joint Commission:

Situation: Clearly and briefly describe the current situation.

Background: Provide clear, relevant background information on the patient.

Assessment: State your professional conclusion, based on the situation and background.

Situation - The doctor and nurse were discussing about the patient who has an urinary problem

Background -  Nurse noticed that when she was transferred back from the hospital. She now has an indwelling urinary catheter in place. While her urine is cloudy, she is still doing well without any symptoms of an UTI.

Assessment - Its better to remove the catheter out and hold off on the urine culture and antibiotics. And have an clear observation on the patient.

Complications of a UTI may include: Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year. Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.

Several practices, often implemented in bundles, appear to reduce UTI or CAUTI in nursing home residents such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions.

The best antibiotics for a UTI Include:

• Ampicillin.
• Ceftriaxone (Rocephin)
• Cephalexin (Keflex)
• Ciprofloxacin (Cipro)
• Fosfomycin (Monurol)
• Levofloxacin (Levaquin)
• Nitrofurantoin (Macrodantin, Macrobid)
• Trimethoprim/sulfamethoxazole (Bactrim, Septra)

If you have two UTIs in a three month period, or more than three UTIs in a single year, you officially have a recurrent UTI (RUTI). But the reasons for developing a lingering one isn't the same for everyone. And not all of them are the result of impervious bacteria.

This article gives us some tools to reduce UTIs in our patients:

1. Increase fluid intake.
2. Provide good perineal care.
3. Remove indwelling catheters if possible.
4. Apply the McGeer criteria.