# Development of a Stewardship Intervention for CLC Pharmacists to Improve UTI Treatments

> **NIH VA IK2** · PROVIDENCE VA  MEDICAL CENTER · 2020 · —

## Abstract

In the long-term care (LTC) setting, 70% of residents receive at least one course of antibiotics each year and
up to 75% of this use is reported to be inappropriate or unnecessary. The harms of antibiotic misuse in frail
older LTC residents are significant, including Clostridium difficile infection, adverse drug events and drug
interactions, and colonization and/or infection with resistant bacteria. This crisis has prompted the President of
the United States to formally recognize antibiotic misuse and resistance as a global public health crisis and a
key national security threat. In response, the Centers for Disease Control (CDC) recently outlined Core
Elements to improve antibiotic use in long-term care facilities (LTCFs) and mandate that at least one Core
Element be implemented immediately. While these Core Elements are timely, they are based on data
extrapolated from acute care hospitals, an environment that differs substantially from LTC. Effective and
financially resourceful antibiotic stewardship interventions to improve patient safety in LTCFs remain unknown
and absent, particularly within the VA. As such, there is a critical need for the development of tailored antibiotic
stewardship interventions to improve the care of the 50,000+ Veterans who reside in VA LTCFs (known as
community living centers or CLCs) annually.
Treatment of suspected urinary tract infection (UTI) is the largest contributor to antibiotic use in LTCFs. Much
of this use is unnecessary and/or inappropriate. My recent work showed that over 50% of initial antibiotic
selection for suspected UTI was inappropriate at two VA CLCs. There is a vast amount of literature targeting
providers and nurses evaluating interventions designed to improve the appropriate diagnosis of UTI. However,
focused on diagnosis, these studies have failed to correct inappropriate treatment selection when antibiotics
are truly indicated. This is extremely concerning as true UTIs are the most common cause of hospitalization in
LTC residents and the number one cause of bacteremia. Clinical pharmacists are drug therapy experts and are
ideally suited to correct inappropriate UTI antibiotic therapy. Therefore, I hypothesize that an educational
program targeting CLC pharmacists will lead to improved antibiotic use for UTIs. My long-term goal is to
improve the quality of care of residents nationally through reduction of inappropriate antibiotic use. Accordingly,
the work proposed, creates, implements, and tests a feasible “real world” model for antibiotic stewardship in
VA CLCs. This model places the pharmacist in a prominent antibiotic stewardship role by taking advantage of
a pharmacist’s expertise in guiding appropriate antibiotic use, while using the pharmacist as a consistent
presence for many CLCs. This model was specifically designed with the ability to disseminate this work to VA
CLCs nationally. To improve the utility of this model, interventions will be based off facility-specific antibiotic
use rat...

## Key facts

- **NIH application ID:** 10201719
- **Project number:** 5IK2HX002247-03
- **Recipient organization:** PROVIDENCE VA  MEDICAL CENTER
- **Principal Investigator:** Haley J Appaneal
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10201719

## Citation

> US National Institutes of Health, RePORTER application 10201719, Development of a Stewardship Intervention for CLC Pharmacists to Improve UTI Treatments (5IK2HX002247-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10201719. Licensed CC0.

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