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Reducing Inappropriate Antibiotics for Urinary Tract Infections in Long-Term Care

A Replication Study

Cooper, Denise, DNP, RN, ANP-BC; McFarland, Marilyn, PhD, RN, FNP-BC, CTN-A; Petrilli, Francesca, DNP, RN, ANP-BC; Shells, Cherrell, DNP, RN, ANP-C

doi: 10.1097/NCQ.0000000000000343

Background: Nursing home providers face challenges in urinary tract infection assessment and treatment, often prescribing unnecessary antibiotics for asymptomatic bacteriuria, a practice that can result in adverse drug reactions, drug resistance, and an increase in antibiotic-associated diarrhea.

Purpose: The purpose of this project was to replicate the Cooper Urinary Tract Infection Program in another facility and measure its effectiveness.

Methods: Using a pre-post design, this project was implemented at a 120-bed, long-term care and rehabilitation facility located in the Midwest United States.

Interventions: This project used the multifaceted Cooper Urinary Tract Infection Program that includes the Cooper tool algorithm, didactic education for providers, and change champions.

Results: The results were significant improvements in nurse knowledge and reduced rates of urinary tract infections, inappropriate antibiotic treatments, and urinalyses.

Conclusions: These results add to the evidence for implementing the Cooper Urinary Tract Infection Program in long-term care facilities for effective reduction of inappropriate antibiotic usage for urinary tract infection.

School of Nursing, University of Michigan—Flint (Drs Cooper and McFarland); Impact Physician Group, Pontiac, Michigan (Dr Petrilli); and Michigan Health Specialists, Flint (Dr Shells).

Correspondence: Denise Cooper, DNP, RN, ANP-BC, School of Nursing, University of Michigan—Flint, 303 E Kearsley St, Flint, MI 48502 (

The authors acknowledge David J. Schwarz, SPT, LMT, BBA, for his significant contribution in editing the article.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for Publication: May 1, 2018

Published ahead of print: June 14, 2018

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