Quality statement 1: Diagnosing urinary tract infections in adults aged 65 years and over

Quality statement

Adults aged 65 years and over have a full clinical assessment before a diagnosis of urinary tract infection is made.

Rationale

The accuracy of dipstick testing in adults aged 65 years and over can vary. It is therefore important that factors other than the results of dipstick testing are taken into consideration when diagnosing urinary tract infections in older people to ensure appropriate management and avoid unnecessary use of antibiotics.

Quality measures

Structure

Evidence of local arrangements to ensure a full clinical assessment is undertaken before a diagnosis of urinary tract infection is made in adults aged 65 years and over.

Data source: Local data collection.

Process

Proportion of adults aged 65 years and over who received a full clinical assessment before being diagnosed with a urinary tract infection.

Numerator – the number in the denominator diagnosed with a urinary tract infection based on a full clinical assessment.

Denominator – the number of adults aged 65 years and over diagnosed with a urinary tract infection.

Data source: Local data collection.

Outcome

Antibiotic prescription rates for urinary tract infections.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as hospitals, community services and GPs) ensure that adults aged 65 years and over receive a full clinical assessment before being diagnosed with a urinary tract infection.

Healthcare professionals ensure they perform a full clinical assessment before diagnosing urinary tract infections in adults aged 65 years and over.

Commissioners (such as clinical commissioning groups and NHS England area teams) ensure that all providers are aware that adults aged 65 years and over with a suspected urinary tract infection are diagnosed based on a full clinical assessment. NHS England area teams should be aware that achieving this quality statement could be incorporated into GP surgeries 'Avoiding Unplanned Admissions' Enhanced Service, as per local arrangements.

What the quality statement means for patients, service users and carers

Adults aged 65 years and over who have symptoms that are typical of a urinary tract infection have a full clinical assessment before a diagnosis of a urinary tract infection is made.

Source guidance

Definitions of terms used in this quality statement

Symptoms of urinary tract infection

These include dysuria, increased frequency of urination, suprapubic tenderness, urgency and polyuria (Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network [2012]).

Clinical assessment

A full clinical assessment should be a face‑to‑face review of the person's medical history, physical examination, assessment of pulse, blood pressure, temperature and recording of symptoms (Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network [2012]).