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Bradley Langford
Pharmacist, Antimicrobial Stewardship
Asked a question last month

Expert advice needed! One of the hospitals I am working with is performing a specific test (urine cultures) too much. This is leading to over-diagnosis and over-treatment with antibiotics (which can cause unnecessary harm to patients). The main barriers are lack of knowledge from doctors and nurses on the criteria to perform the test, fear of under-treatment or missing a diagnosis, overconfidence that treatment will solve the patients problems, inertia in that once the test is ordered, it is difficult to ignore the result (even if they or their colleague shouldn't have ordered it in the first place). The steps are 1) nurse or doctor suspects patient may have a problem, 2) doctor orders urine test on paper order sheet (sometimes this step is skipped), 3) nurse takes culture bottle from storage room and collects patient's urine, 4) urine is sent to laboratory with a form to test the sample, 5) if test is positive (which is common) doctor orders a course of (often unnecessary) antibiotics. In addition to education, what nudges or boosts can we implement to help address this problem? Any similar examples from other fields?

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