Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Stacy Pearson


Dr. Nancy Magnuson

Dr. Natalie Murphy

Dr. Janine Kampelman


Problem: Urinary tract infection (UTI) is one of the most complex and challenging medical diagnoses to make in the long-term care (LTC) population. The unnecessary treatment of a UTI can increase cost of care and the likelihood of multi-drug resistant organisms.

Methods: The McGeer criteria which focuses on UTI in the LTC population was utilized to complete a quality improvement initiative. A descriptive cohort project utilizing retrospective and prospective data was completed to determine if an implemented McGeer criteria protocol improved the avoidable treatment of asymptomatic bacteriuria (ASB).

Results: Before implementation of the protocol, 62.5% of residents were unnecessarily treated for UTI in the presence of asymptomatic bacteriuria. Upon institution of the McGeer criteria protocol, the number of residents inappropriately treated with antibiotics dropped to 6.25%. The results determined that use of a specific protocol increased accuracy of UTI diagnosis.

Implications: Antibiotics were prescribed 100% of the time before and after implementation of the McGeer criteria. This indicates that while behaviors changed for nurses in relation to charting, healthcare providers did not change prescribing practices to align with the criteria. These providers need targeted education about the McGeer criteria and appropriate prescribing practices related to treatment of UTI.