Date of Conferral

8-6-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Donna Bailey

Abstract

This quality improvement (QI) project addressed delays in diagnosing urinary tract infections (UTIs) at a skilled nursing facility (SNF), where reliance on urine culture testing and patient monitoring resulted in an average diagnostic period of 72 hours. A high UTI incidence and UTI-involved hospitalization rate are both nurse-sensitive indicators that are important to address in the nursing practice context because they portend negatively for nursing quality and safety. This quality improvement (QI) project addressed the practice-focused question: among long term care (LTC) residents with suspected UTIs in a nursing home (NH), how does reducing the diagnostic period from 72 hours to 24 hours impact UTI-involved hospitalizations? The purpose was to successfully implement a knowledge translation and evidence-based practice (EBP) process. Following a rigorous knowledge-to-action (KTA) analytical method, I implemented a UTI diagnostic reference guide with a minimum-criteria diagnosis decision algorithm to change from usual practice to a new 24-hour UTI diagnostic standard. Post-implementation, resolved, suspected UTI cases increased from 18% to 77%; the UTI incidence rate reduced from 11.7% to 7.5%; and the UTI-involved hospitalization rate declined from 2.6 per 1,000 resident days to 1.2. The practice change was deemed successful in ways that are translatable to strengthening the quality of LTC in comparable settings within a contemporary context of increasing societal demand for SNF in an aging society. It is recommended that the clinical site continue monitoring the outcomes to sustain the change. The gains from this initiative can also address longstanding disparities in UTI incidence and consequences for vulnerable LTC demographics, thereby strengthening healthcare equity.

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