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Preventing, Recognizing and Treating Dehydration and Urinary Tract Infections in Nursing Homes

Social distancing is crucial when trying to contain COVID-19, especially in a long-term post-acute care (LTPAC) setting. However, this safety protocol can also lead to social isolation, which can impact both mental and physical health, including activities of daily living (ADL).

LTPAC residents are often prompted to eat and drink regularly in the shared facility dining rooms, either indirectly as other residents partake, or directly as staff encourage regular consumption. Without this vital social interaction, residents may forget to eat or drink, or lose their appetite entirely, which can lead to malnutrition, dehydration and ultimately, a urinary tract infection (UTI).

Let's look at this pandemic-induced issue using the Situation, Background, Assessment and Recommendation (SBAR) method.

(S) Situation: Because the coronavirus is highly contagious and can spread particularly fast in an LTPAC setting, it has become necessary to confine residents to their rooms. Staff have noticed many residents are experiencing painful urination, as well as poor skin turgor and increased incidents of orthostatic blood pressures.

(B) Background: Room confinement means staff may not realize the residents are not getting enough fluids. Dehydration can be especially dangerous in the elderly. One adverse outcome may be the inability for the body to adequately flush urine. If bacteria are introduced and grow in the urine, and the body is unable to flush that urine out, a UTI may occur.

(A) Assessment: Facility nurses perform complete assessments of the residents, looking for signs and symptoms to share with a provider, which can include:

  • Acute mental changes
  • Acute decline in ADL abilities
  • Inability to stand without severe dizziness or lightheadedness
  • Low urinary output

(R) Recommendations: Implement an interdisciplinary care conference to review the Care Path for Dehydration and the Care Path for Symptoms of Urinary Tract Infection (UTI), tools provided by the Interventions to Reduce Acute Care Transfers (INTERACT®) program. 

Refer to the Agency for Healthcare Research and Quality (AHRQ) Minimum Criteria for Antibiotics Tool, a decision support tool that can help providers determine the appropriate treatment for nursing home residents suspected of having a urinary tract infection, and Suspected UTI SBAR Toolkit, which helps nursing home staff and providers communicate effectively with each other.  

Finally, consult the Comagine Health Mobility Learning Guide, which has a section on assisting residents with their meals and fluid intake (pages 12-13).  Take time in the care conference to review this section to see how staff can use the information to encourage increased fluid intake and prevent urinary tract complications.

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