Mercy Health was well-represented at the 2018 National PACE Association Annual Conference from October 21-24 in downtown Portland, OR. Pharmacy Residents Kelly Kieffer, PharmD, and Amanda Martin, PharmD, completed their residency in Muskegon, MI, in June 2018 and presented their residency research project findings to participants at the conference, along with their preceptor Shalyn Quigley, PharmD, BCGP, Clinical Pharmacist, Mercy Health Ambulatory Services.
“Amanda and Kelly worked on this project for about a year (September 2017-October 2018). Together, we provided education to the entire local LifeCircles PACE interdisciplinary team (providers, nursing, nursing assistants, administration, therapy, social work, etc.) on urinary tract infection (UTI) best practices,” said Quigley.
PACE (Program of All-Inclusive Care for the Elderly) is a federal Medicare and Medicaid benefit for people aged 55 and older and who are eligible to live in a nursing home. The goal of the program is to keep participants living at home while receiving quality care that improves their well-being. Focused on the geriatric population, PACE seeks to improve the safety of medication and reduce hospitalization of patients who participate. LifeCircles PACE, located in Muskegon and Holland, contracts with Mercy Health for their pharmacy services which led to the residents’ involvement in the project.
Sharing Key Findings
Twenty posters and 70 educational sessions were selected for the PACE conference. Approximately 25 clinicians attended the Mercy Health team’s educational session and there was a lot of thoughtful interaction and traffic at the Mercy Health poster display.
Ordering unnecessary urinalyses without true symptoms of UTI can lead to inappropriate antibiotic use to treat bacteria living in the urinary tract. As a result of the study, the LifeCircles PACE urinalysis order form was updated to include the McGeer Criteria. It no longer recommends ordering urinalyses for confusion or foul-smelling urine alone as they do not usually indicate a true UTI, whose symptoms typically include pain/burning during urination, urinary urgency/frequency, flank pain, blood in the urine, new onset incontinence, and fever.
Unnecessary antibiotic use can cause antibiotic resistance, as well as adverse drug reactions, such as tendon rupture, peripheral neuropathy, high potassium levels, kidney problems and others. “A treatment algorithm was created for the providers in order to guide appropriate antibiotic use and minimize the risk of antibiotic resistance and adverse effects,” stated Quigley. “We reviewed pre- and post-intervention results and provided weekly feedback during the post-intervention period.”
A key conclusion of the study was this: A criteria-based urinalysis order form and facility-based treatment recommendations can reduce the number of urinalyses and antibiotics ordered.
“By ordering urinalyses only when patients have true UTI symptoms, and ordering appropriate antibiotics for appropriate treatment duration, we can help to reduce the risks of resistance and adverse effects,” stated Martin. “Several conference attendees told us that they were going to take our research back to their respective PACE organizations. It is exciting to know that we not only impacted patient care locally but may also have a chance to improve the screening and treatment of UTIs at other PACE organizations nationwide,” Kieffer added.
Studies such as this one are just one of many ways that Mercy Health works to allow seniors to remain in their homes for as long as possible. Congratulations to Kelly Kieffer, PharmD, Amanda Martin, PharmD, and Shalyn Quigley, PharmD for sharing their best practices with an audience of approximately 750 people from 31 states.