Presbyterian Support Southland (NZ) Discovers Early Benefits of Benchmarking - reducing urinary tract infections

Presbyterian Support Southland (PSS) is a Charitable Trust that has been working in the Southland and Wakatipu communities in Southern New Zealand for over 80 years. Currently the organisation operates five certificated Residential Aged Care Facilities which accommodate a total of nearly 340 aged care residents. The organisation also services 115 residents who live in independent living accommodation and provide community care services to clients who remain living in their own homes.

PSS began benchmarking performance outcomes with QPS benchmarking in September 2008. Since joining the program, benchmarking has helped to raise awareness and drive continuous quality improvement changes throughout the PSS Residential Aged Care Facilities. PSS has been submitting data on a variety of key clinical indicators including falls (general), skin tears (general) and urinary tract infections (UTI).

Each Residential Aged Care Facility Manager is responsible for the analysis of trends and the implementation of local strategies. This is done monthly during collation of QPS results and on an ongoing basis during review of incident forms.

After two successive quarters of benchmarking, the Manager of the Wakatipu Home in Queenstown (35 bed - low care), found that a comparative analysis of their QPS data showed that they had a high number of urinary tract infections. The Manager and her staff identified several possible factors that may have contributed to their high numbers of UTI. These included;

• Shared toilets and use of commodes (no en-suites).
• Poor resident hygiene practices, e.g. female residents wiping back to front and/or poor hand hygiene (urine cultures identified Escherichia Coli).
• Poor staff practice, e.g. poor hand hygiene between residents and/or wiping back to front.
• Residents drinking fewer fluids over the winter months.
• Commodes not being cleaned effectively after use.
• Diligent staff. Wakitipu Home is a small rest home and staff observe changes in behaviour very quickly and subsequently carry out a dipstick urinalysis. If they obtain a positive dipstick urinalysis, then a urine specimen is sent to the laboratory for culture and sensitivity. The General Practitioner will decide if treatment with antibiotics is warranted, generally if the resident is symptomatic.

To improve outcomes, the Facility Manager, together with the Quality Improvement team identified and introduced interventions to reduce the number of UTI incidences in the July - September quarter. Interventions included;

• Staff infection control education, focusing on hand hygiene and wiping from front to back.
• Resident education, focusing on the importance of hand washing and wiping from front to back.
• Installation of more hand gel/spray dispensers around the facility and education on how to use them.
• The General Practitioner commenced two residents on long term prophylactic antibiotics.
• Encouragement of fluid intake. Larger capacity cups and glasses have been purchased in order to encourage residents to drink more.
• Ensuring that the commodes are cleansed well after use.

Results from the July to September quarter have clearly shown improvement in the number of UTIs, and if this trend continues, then Wakatipu Home can expect to see sustained improvement to their UTI rates in the upcoming summer months.

Facility Manager, Janeen Holmes comments that "this has been an interesting exercise with positive results". Janeen feels that without QPS Benchmarking the problems may not have been identified.

The lessons learned at Wakitipu Home have been shared with other facility managers and the overall trends in UTI rates have been improving for the entire Presbyterian Support Southland organisation.

Overall UTI Rates, Presbyterian South showing continual improvement