Antibiotic Stewardship: Case Study Facilitator Key

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI


  1. Divide into small groups of two to three people.
  2. Ask each group to work through each part of the case scenario, pausing for discussion before moving to the next section.

Useful Resources:

Case Study

Valerie Smith is an 80-year-old woman at Shady Oak Nursing Home. She has cognitive issues from a stroke she had 2 years ago. Valerie has a history of frequent urinary tract infections (UTI). Over the last year she has been admitted to the hospital twice for UTI and has had multiple courses of antibiotics. During her last course of antibiotics, Valerie developed a Clostridium difficile infection.

Johnny, Valerie's son, frequently visits his mom at Shady Oak, and is actively engaged in his mother's care. One morning during his visit, Johnny notices his mother is sleepier than normal and that her urine smells bad. Johnny thinks his mother might have another UTI and wants her started on antibiotics right away.

1. Should the attending physician prescribe antibiotics for Valerie? Explain why or why not.


Explanation: Valerie is not exhibiting signs or symptoms of a urinary tract infection (UTI).i Cloudy, smelly urine does not meet the UTI criteria. Remember, new-onset confusion and functional decline are only qualified symptoms of CAUTI, not UTI. And sleepiness alone is not sufficient for new onset confusion. Also, there has not been a urinalysis conducted to determine if bacteria is present in the urine.

2. How could the nurse respond to Johnny's request to start his mother on antibiotics? Using the TeamSTEPPS tool SBAR (Situation, Background, Assessment, Recommendation), develop a response to Johnny's concerns.


Have an example SBAR prepared to guide the conversation with staff members. Remember the SBAR mnemonic.

  • First, explain the Situation. What is the current state of Johnny's mother, Valerie, and the issue he is concerned about?
  • Next, share some Background information about Valerie and why it can be unsafe for her to receive unnecessary antibiotics.ii
  • Provide Johnny with your Assessment of the situation. What other factors might be influencing his mother's health, and what makes you think that this might not be a UTI?
  • Finally, share your alternative Recommendation for Valerie's care. It is helpful to emphasize that you are recommending this course of action out of your concern for Valerie's safety and that you will keep Johnny updated on what you are doing to care for his mother.

iCenters for Disease Control and Prevention. Urinary Tract Infection (UTI) Event for Long-term Care Facilities. 2012.
iiConsider providing residents and family members with information, such as the Centers for Disease Control and Prevention's What You Need to Know About Antibiotics in a Nursing Home handout.

Page last reviewed March 2017
Page originally created March 2017
Internet Citation: Antibiotic Stewardship: Case Study Facilitator Key. Content last reviewed March 2017. Agency for Healthcare Research and Quality, Rockville, MD.