Modification of nursing-initiated standing order sets results in a nonsignificant decline in inappropriate urinalyses in an adult emergency department.

Abstract

Background: Inappropriate treatment of asymptomatic bacteriuria with antimicrobials is widespread in health care facilities and promotes antibiotic resistance. We assessed the degree urinalysis is ordered in absence of urinary symptoms.

Methods: We randomly sampled 97 unique patients with urinalyses (UAs) obtained in the Emergency Department in 2022 and reviewed their charts to determine if UAs were ordered according to society guideline-based indications. To identify risk factors for inappropriate ordering, we performed simple logistic regression between patients with inappropriately versus appropriately obtained urinalysis by various demographic factors. Following an intervention where nursing order sets were modified to reflect appropriate urinalysis usage, we reassessed the appropriateness of UAs in a sample of 95 unique patients within 6months postintervention.

Results: Preintervention, 65% (95% CI, 54.1%-74.5%) of patients had inappropriately ordered UAs. Postintervention, we noted a nonsignificant decrease to 52% (42.0%-62.4%; χ² = 2.8, P = .095) of inappropriately ordered UAs. Postintervention, Hispanic ethnicity was negatively associated with inappropriately obtained UAs (OR 0.30; 0.12-0.71).

Conclusions: Most UAs remained inappropriately ordered despite a change in nursing order sets. Our results suggest provider-patient interactions are the major driver of inappropriately obtained UAs. The negative association with inappropriately obtained UAs in Hispanics suggests acuity of disease may influence this interaction.