Research ArticleResearchMedication SafetyInfection Control

Asymptomatic-bacteriuria antibiotic use fell from 20% to 3% after a nurse-led UTI decision tool

Antimicrobial Stewardship & Healthcare Epidemiology (PubMed)Jul 6, 2026

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Brief summary

At one family-medicine practice, an EHR-integrated nurse-led UTI triage tool was associated with more symptom documentation, fewer urine cultures without microscopy, and a decline in asymptomatic-bacteriuria antibiotics from 20% to 3%, with no observed increase in pyelonephritis.

What NurseJet pulled from the source

Researchers used workflow mapping and interviews with 11 nurses to build an EHR-integrated UTI symptom score and triage algorithm for an urban academic family-medicine practice. A 15-month pre-post interrupted time-series evaluation examined adoption, documentation, urine testing, antibiotic prescribing, and 30-day pyelonephritis. All nurses adopted the tool, fidelity was 77.8%, and usability was rated highly. Documentation of at least two UTI-specific symptoms increased at implementation and continued improving by 2.4 percentage points per month (95% CI 0.1 to 4.7). Urine cultures ordered without microscopy had a slope of -5.5 percentage points per month (95% CI -7.9 to -3.2). Antibiotic prescribing for asymptomatic bacteriuria fell from 20% to 3% (P=.003), with no observed increase in 30-day pyelonephritis. The findings support a nurse-led stewardship workflow, but the single-practice pre-post design cannot by itself prove that the tool caused each change.

Why this matters for nurses

Urinary complaints can trigger reflex testing and antibiotics even when defining symptoms are absent. This study matters for nurses because it places structured symptom assessment inside the triage workflow and links better documentation with fewer low-value cultures and less treatment of asymptomatic bacteriuria.

Bedside takeaway

Be aware that after a nurse-led UTI triage tool was introduced, symptom documentation increased and asymptomatic-bacteriuria antibiotic use fell from 20% to 3%, with no observed rise in 30-day pyelonephritis.

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Key takeaways

The mixed-methods study developed an EHR-integrated symptom score and triage algorithm with 11 family-medicine nurses.
All nurses adopted the tool, with 77.8% fidelity and high reported usability.
Symptom documentation increased while urine cultures ordered without microscopy declined over the 15-month evaluation.
Antibiotic treatment of asymptomatic bacteriuria fell from 20% to 3%, with no observed increase in 30-day pyelonephritis.

Practice implications

Outpatient triage teams can use this study when evaluating locally approved EHR prompts that require symptom documentation before urine testing. Any tool should preserve assessment and escalation for suspected upper-tract infection and should not replace local diagnostic, prescribing, or scope-of-practice rules.

Limitations & cautions

The study involved one urban academic family-medicine practice and only 11 nurses. Its pre-post design cannot exclude secular trends or prove causation, and results may not transfer to inpatient, emergency, long-term-care, or differently configured EHR settings without local evaluation.
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Citations

Exact source links

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Antimicrobial Stewardship & Healthcare Epidemiology (PubMed)

Antimicrobial Stewardship & Healthcare Epidemiology (PubMed). Development and implementation of a nurse-led clinical decision support tool for urinary tract infection.

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https://pubmed.ncbi.nlm.nih.gov/42422871/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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European Journal of Clinical Pharmacology (PubMed)Jul 10, 2026Systematic Review

Across 12 studies, pooled hemoglobin and ferritin were higher with intravenous ferric carboxymaltose than oral iron during pregnancy, with the clearest hemoglobin difference before delivery, but substantial between-study heterogeneity limits certainty.

L&D / OB Med-SurgAI summaryReview source

Systematic ReviewResearchMedication SafetyPatient EducationAI summary · original source linked below

This systematic review and meta-analysis pooled eight randomized trials and four observational cohorts comparing intravenous ferric carboxymaltose with oral iron for anemia during pregnancy. In the hemoglobin analysis, seven trials and four cohorts included 6,495 patients. Intravenous treatment was associated with hemoglobin that was 0.91 g/dL higher (95% CI 0.30 to 1.51) and ferritin that was 63.8 ng/mL higher (95% CI 37.3 to 90.4). The hemoglobin difference was clearest before delivery, at 1.22 g/dL across eight studies with 1,575 patients, but was not significant postpartum. In smaller safety analyses, intravenous ferric carboxymaltose was associated with fewer drug-related adverse events (RR 0.42) and less nausea (RR 0.27) than oral iron. The authors judged it more effective for hematologic indices and favorably tolerated, while cautioning that substantial heterogeneity across studies limits confidence and does not define the best route for every patient.

Key takeaways

The review included 12 studies: eight randomized trials and four observational cohorts of pregnant patients with anemia.
Pooled hemoglobin was 0.91 g/dL higher with intravenous ferric carboxymaltose than with oral iron.
The predelivery hemoglobin difference was 1.22 g/dL, while the postpartum difference was not statistically significant.
Smaller safety analyses found fewer drug-related adverse events and less nausea, but heterogeneity remained substantial.

Why this matters on shift

Anemia treatment during pregnancy often requires balancing time to delivery, response to oral therapy, infusion logistics, and medication tolerance. This review matters for obstetric nurses because it quantifies the hematologic difference between routes while making clear that pooled evidence does not determine treatment for an individual patient.

Bedside takeaway

Be aware that pooled predelivery hemoglobin was higher with IV ferric carboxymaltose than oral iron, but heterogeneity and limited safety subsets mean route selection remains individualized.

Nursing implications

For obstetric nurses, the findings support awareness that prescribed intravenous iron was associated with higher predelivery hemoglobin while requiring infusion-specific screening, administration, and observation under local policy. They do not establish that intravenous treatment is appropriate for every patient or replace prescriber-directed selection and follow-up.

Limitations & cautions

The review combined randomized trials with observational cohorts, and substantial heterogeneity existed across studies. Safety estimates came from smaller subsets, the postpartum hemoglobin difference was not significant, and the abstract does not establish comparative effects on transfusion, birth outcomes, maternal symptoms, or longer-term infant outcomes.
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Citations · exact source links

European Journal of Clinical Pharmacology (PubMed). Efficacy and safety of intravenous ferric carboxymaltose versus oral iron in pregnant women with anemia: a systematic review and meta-analysis.

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Journal of the American Geriatrics Society (PubMed)Jul 11, 2026Research Article

In Medicare data for 79,417 older surgical patients discharged through skilled nursing before going home, 4% received a new gabapentinoid prescription and 38% of those new users had prolonged use.

Med-Surg GeriatricsAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Researchers linked Medicare hospital, outpatient, clinician, and Part D data from 2013 through 2020 to examine gabapentinoid use after 14 common operations in adults aged 66 or older who moved from the hospital to a skilled nursing facility and then home. Among 79,417 patients, the median skilled-nursing stay was 15 days. A total of 3,182 patients (4%) received a new gabapentinoid prescription, and 1,219 of those new users (38%) met the study definition of prolonged use. Female sex, gabapentinoid days' supply, emergency surgery, nonorthopedic and nonvascular surgery, and greater area deprivation were associated with prolonged use in adjusted analysis. The authors found that prolonged use was more common than previously reported among patients discharged directly home and called for more work on medication continuation after skilled-nursing discharge. The claims-based design did not determine whether an individual patient's prolonged use was clinically appropriate.

Key takeaways

The cohort included 79,417 Medicare patients aged 66 or older who underwent one of 14 operations and transitioned through skilled nursing before returning home.
New gabapentinoid use occurred in 3,182 patients, or 4% of the full cohort.
Among those newly prescribed a gabapentinoid, 1,219 patients, or 38%, had prolonged use.
The study describes prescribing persistence and associated factors but does not establish that prolonged use was inappropriate.

Why this matters on shift

A medication started around surgery can follow a patient across hospital, skilled-nursing, and home settings, making its original purpose and intended duration easy to lose. This study matters for nurses because medication reconciliation and clear handoff documentation can make a new gabapentinoid visible for review at each transition.

Bedside takeaway

Be aware that 38% of the older surgical patients newly prescribed a gabapentinoid during a hospital-to-skilled-nursing-to-home transition had prolonged use, a persistence signal that warrants reconciliation without assuming inappropriateness.

Nursing implications

During medication reconciliation, nurses can clarify and document when a gabapentinoid was started, its current indication, and whether continued use remains intended, then route uncertainty through the prescriber or pharmacist. The study does not support labeling every prolonged prescription inappropriate or independently stopping a patient's medication.

Limitations & cautions

This retrospective claims analysis used 2013 to 2020 Medicare data and cannot establish why a prescription continued or whether continued use was appropriate. It may not generalize to younger patients or newer prescribing patterns, and associations with prolonged use do not establish that the identified factors caused it.
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Citations · exact source links

Journal of the American Geriatrics Society (PubMed). Prolonged Use of Postoperative Gabapentin After Discharge From a Skilled Nursing Facility.

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International Emergency Nursing (PubMed)Jun 29, 2026Systematic Review

A network meta-analysis of 24 randomized trials involving 8,014 adults with difficult IV access found that ultrasound guidance improved first-attempt and overall cannulation success versus standard practice, while local warming showed narrower benefits supported by less evidence.

Emergency Med-SurgAI summaryReview source

Systematic ReviewResearchWorkflowNew Grad FriendlyAI summary · original source linked below

Difficult intravenous access can lead to repeated attempts, treatment delays, pain, and added cost. This systematic review searched four databases through February 1, 2026 and used a network meta-analysis to compare 11 active interventions across 24 randomized trials with 8,014 adults. Compared with standard practice, ultrasound guidance improved first-attempt success (OR 5.58, 95% CI 2.74 to 11.36) and was the only intervention with a significant overall-success benefit (OR 4.12, 95% CI 2.07 to 8.19). Local warming also improved first-attempt success and reduced procedure time and pain, but rested on more limited evidence. Near-infrared devices reduced attempts and improved satisfaction, while long catheters were associated with more pain and longer procedures. The authors judged ultrasound the most consistently supported option but cautioned that a sparse evidence network and assumptions behind indirect comparisons temper certainty.

Key takeaways

The network meta-analysis included 24 randomized controlled trials, 8,014 adults, and 11 difficult-access interventions.
Ultrasound guidance improved both first-attempt and overall cannulation success compared with standard practice.
Local warming improved first-attempt success and reduced procedure time and pain, but its evidence base was more limited.
The sparse comparison network and its transitivity assumption limit certainty about intervention rankings.

Why this matters on shift

Obtaining vascular access is a frequent nursing task, and repeated failed attempts can delay treatment while increasing pain. This review matters for emergency and med-surg nurses because it compares common escalation options in one analysis and separates the most consistently supported approach from promising but less certain alternatives.

Bedside takeaway

Worth knowing that across 24 randomized trials, ultrasound guidance had the most consistent evidence for first-attempt and overall success in adults with difficult IV access, while local warming showed narrower benefits with less evidence.

Nursing implications

For nurses following an approved difficult-access pathway, the findings support timely escalation to an ultrasound-trained clinician when standard attempts are unlikely to succeed and consideration of local warming where protocol permits. The rankings should not replace patient assessment, local competency requirements, or the unit's vascular-access policy.

Limitations & cautions

The analysis combined trials of 11 interventions through direct and indirect comparisons, so rankings depend on the assumption that studies were sufficiently comparable. The network was sparse, evidence for some options was limited, and the abstract does not provide certainty ratings or enough setting detail to establish one universal pathway.
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Citations · exact source links

International Emergency Nursing (PubMed). Comparative effectiveness of interventions for difficult intravenous access in adults: A systematic review and network meta-analysis of randomized controlled trials.

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Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Predelivery hemoglobin was higher with IV ferric carboxymaltose than oral iron in a pregnancy anemia meta-analysis

Among older surgical patients with a new gabapentinoid prescription, 38% had prolonged use after skilled nursing

Ultrasound guidance had the strongest overall evidence for difficult IV access across 24 randomized trials