Tool Inventory

Family Education Brochure This single-sided brochure can be used to educate residents and family members/representatives about the facility's approach to managing suspected UTIs. The brochure highlights the importance of correct antibiotic use, describes steps taken by staff when a resident shows signs of a possible UTI and offers an explanation of active monitoring.

Family Education Letter This template may be customized with the facility logo and included in a resident welcome folder to provide background information on the facility's approach to managing suspected UTIs.

Family Education Video This video targets residents and family members/representatives education. Through a role-play telephone conversation between a family member and provider, it demonstrates an example of communication about a resident's change in condition, related to a suspected UTI.

Staff & Provider Infographic This two-page infographic describes the use of antibiotics in nursing homes, potential harms of antibiotic use, common myths and facts about suspected urinary tract infections (UTIs) and when & when not to test urine.

Collection of Urine Specimens for Culture This document provides guidance about the proper techniques for collection of urine specimens.

UTI Stoplight This document provides a reference using the stoplight colors – red, yellow, green – to assess suspected UTI.

When to Test Nursing Tool This tool provides a flowchart to assist in identification of next steps and management of a suspected UTI.

Communication Script Template This form may be used to assist in gathering information related to suspected UTI for use in contacting the medical provider.

Active Monitoring Tracking Form This form provides across-shift tracking of active monitoring for residents who have isolated non-localizing signs/symptoms.

Provider Prescribing Brochure This brochure is for providers and outlines treatment details for uncomplicated urinary tract infection (cystitis) and complicated cystitis/pyelonephritis, describes active monitoring and reviews antibiotic time-out.

Sample CPA Agreement This sample Collaborative Practice Agreement provides a framework for a facility working towards establishing agreement between a physician and consulting pharmacist. The agreement may define patient clinical services that can be delegated to the pharmacist by the physician (Wisconsin Act 294).

Sample CPA Policy This sample policy defines facility process to enable the consulting pharmacist to perform physician delegated patient services to optimize antimicrobial stewardship through a collaborative practice agreement which will help improve management of uncomplicated urinary tract infections.

Sample CPA Cover Letter The sample cover letter provides an overview of a Consulting Pharmacist/Physician Collaborative Practice Agreement and related policy.