Stop Orders Research Articles

P-1749. Implementation of an Automatic 36-hour Stop Order on Empiric Meropenem Usage

Abstract Background Implementation of automatic stop orders (ASOs) for empiric antimicrobials have reduced antimicrobial use without negatively impacting patient outcomes. Given a recent increase in empiric meropenem use at our tertiary referral pediatric hospital, a 36-hour meropenem ASO option was implemented in the EMR for patients with sepsis requiring empiric antibiotics active against ESBL-producing organisms. We sought to evaluate the impact this initiative had on meropenem use and safety outcomes. Methods A 36-hour ASO for meropenem was implemented on October 12th, 2022. We conducted a single-center, retrospective pre/post evaluation of order set implementation of all patients admitted to Riley Hospital for Children and treated with meropenem between 9/01/2019–9/01/2021 (pre-intervention) and 10/13/2022–10/13/2023 (post-intervention). The primary outcome was meropenem utilization, as measured by the number of meropenem days and doses per admission. Secondary outcomes included total hospital and ICU mean length of stay (LOS), mortality within 30 days of meropenem exposure, and 30-day readmission rate. Results 309 admissions during which meropenem was administered were included. Demographics between pre-ASO (147 patients; n = 193 admissions) and post-ASO (88 patients; n = 116 admissions) groups were similar. There was no difference in the number of meropenem days (pre and post-ASO: median = 4; p = 0.88) or the number of meropenem doses (pre-ASO: 11 vs. post-ASO: 10; p = 0.63). Secondary safety outcomes including death within 30 days of meropenem administration (8.7% vs. 8.7%; p = 0.99), hospital LOS (18 vs 15.5 days; p = 0.42), ICU admission, and 30-day readmission rate were not significantly different. The new ASO was utilized in 23.3% of admissions in the post-implementation period. Conclusion Use of the new ASO was not widely adopted, making evaluation of impact difficult. No significant difference in meropenem use nor clinical outcomes were identified after implementation, which has informed the next Plan-Do-Study-Act (PDSA) cycle for quality improvement at our center, likely with a focus on EMR modifications and education. Disclosures Jack G. Schneider, MD, MiraVista Diagnostics: Advisor/Consultant

P-1727. Impact of Four-Day Automatic-Stop Orders on the Duration of Antibiotic Treatment

Abstract Background Implementation of automatic antibiotic stop orders is an antimicrobial stewardship intervention that encourages timely antibiotic order re-evaluation for potential discontinuation, spectrum de-escalation, transition to oral therapy, or spectrum escalation if warranted based on emerging diagnostic results. This pre-post study was designed to evaluate the impact of a four-day automatic-stop order on antibacterial orders for patients admitted at a single community hospital site. Methods A single-center, retrospective pre-post study was conducted to compare outcomes following the re-introduction of a four-day automatic-stop order on antibacterial orders. The primary outcomes were hospital length of stay and median duration of antibiotic therapy. Secondary outcomes included hospital readmission within 30 days and the occurrence of C. difficile infections within 30 days. Data was compared between 2 non-consecutive weeks in the pre-implementation of the automatic-stop order policy with data from 2 non-consecutive weeks in the post-implementation of the automatic-stop order policy to ensure prescriber variability and prescribing practices. Patients admitted for fewer than 4 days, or who had orders with indications for meningitis, bacteremia, prosthetic material infection, bone and joint infections, endocarditis, C. difficile treatment, prophylaxis, or documented uncontrolled source were excluded to align with exclusions in the policy. Results The study included 362 patients in total, 167 in the pre-implementation group and 195 in the post-implementation group. The median hospital length of stay was 8.2 days in the pre-implementation group and 7.1 days in the post-implementation group (p=0.536). The median total treatment duration of antibiotic therapy was 6.2 days in the pre-implementation group and 5 days in the post-implementation group (p=0.02). Incidence of c. difficile was 3% in the pre-implementation group, compared to 1% in the post-implementation group (p=0.256). Conclusion An antimicrobial automatic stop policy of four days was associated with decreased antimicrobial days of therapy per patient, without differences in hospital length of stay. There were no safety concerns identified with this intervention. Disclosures All Authors: No reported disclosures

Using the Failure Mode and Effect Analysis Tool to Improve the Automatic Stop Order Process.

Automatic stop orders (ASOs) in computerized prescription order entry (CPOE) systems predefine the length of treatment. This can improve resource use for select therapies (e.g., empirical antibiotics). However, root cause analysis of dose omission errors identified inappropriate ASO-directed termination of medications without prescriber notification. This quality improvement initiative aimed to identify potential failures of the medication ASO processes to develop a new workflow and anticipate issues that may arise after implementation. A failure mode and effect analysis (FMEA) was conducted following Institute of Healthcare Improvement guidance. A multidisciplinary ASO-FMEA team reviewed the existing workflow. Failure modes, risk priority numbers (RPNs), and interventions were identified and assessed. The RPNs calculated for the proposed new workflow (assuming all recommendations were implemented) were compared with those of the existing workflow. Eight failure modes, 17 effects, and 31 causes were identified in the five workflow steps (mean RPN 365.4; median 280). Specific, measurable, achievable, realistic, and time-bound interventions were proposed. Assuming successful implementation of all recommendations, the RPNs of the proposed workflow (mean 117.6; median 112) were significantly lower (p < 0.05). When modifying existing CPOE systems, FMEA may identify possible failures that can be addressed before the implementation of a new process. This may prevent errors, improving medication safety. Regardless, continuous audit and monitoring are required to ensure the effectiveness of implemented changes.

Optimization for Customized Bus Stop Planning, Order Schedule, and Routing Design in On-Demand Urban Mobility

Optimization for Customized Bus Stop Planning, Order Schedule, and Routing Design in On-Demand Urban Mobility

Refining patient care: Evaluating prescription practices of medical residents and interns in a teaching hospital through an audit.

Hospitals in India use the National Accreditation Board for Hospitals and Healthcare Providers guidelines as criteria to ensure safe prescribing practices. This audit was conducted to provide insight into in-patient prescription of drugs to (1) evaluate the quality of prescriptions (2) reduce prescription and medication errors (3) improve the quality of care in terms of prescriptions that the hospital provides to the patient. The cross-sectional study was conducted in an in-patient department of a tertiary care teaching hospital in Chennai where 153 paper-based prescriptions were continuously collected from the internal medicine department over 1 month. The prescriptions were evaluated on 13 parameters that is, patient details (including name, age, sex and Hospital unique ID), height and weight, allergies, capital letters, legibility, date and time of prescription, medicine prescribed by generic name, brand name or both, dosage, route of administration, frequency, relation with food, stop order and signature of the doctor. The data obtained was summarised and analysed using Google Sheets. A total of 153 prescriptions from the in-patient department of a tertiary care teaching hospital were audited. Out of the 153 prescriptions and 13 parameters assessed, patient details (including name, age, sex and Hospital unique ID), legibility, route of administration and frequency were found in all of the prescriptions. On further analysis, we found that only 12.26% of the prescriptions were compliant with the components of the stop order. The majority of the prescriptions (69.28%) contained both generic and trade names. Prescriptions are the most common areas of errors. This study shows the form of errors that can arise while prescribing medications. Doctors must be adequately trained to write prescriptions and follow the standards set by the National Accreditation Board for Hospitals and Healthcare Providers. Audits need to be conducted regularly to ensure and improve the quality of prescriptions.

The effect of Implementation of Automatic Stop Order program on the management of the request and the cost of frequent and costly tests in Shahid Rajaei Educational and medical center

The effect of Implementation of Automatic Stop Order program on the management of the request and the cost of frequent and costly tests in Shahid Rajaei Educational and medical center

Pharmacist insights into antimicrobial stewardship: A social marketing approach

BackgroundAntimicrobial resistance is a worldwide public health problem. Antimicrobial stewardship programs (ASPs) optimize antimicrobial use within hospitals. The social marketing framework has been used in analyzing systems and devising best practices. Objective(s): To use the social marketing framework to explore pharmacist experiences and perceptions of structural, behavioral and interventional strategies that support ASPs. MethodsA qualitative approach utilizing semi-structured individual interviews was utilized. A purposive sample of hospital pharmacists was invited to participate. An interview guide was constructed to describe participant experience and perceptions regarding ASPs in their institutions based on elements of social marketing: Behavioral goals; Customer Insight; Segmentation and Targeting; Competition; Exchange; and Marketing and Interventional mix. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was conducted using deductive methods. A combination of case-based and code-based approaches allowed individual and holistic analyses respectively. Codes were collated into themes and subthemes. ResultsSaturation of themes occurred with 25 interviews from 17 hospitals. ASP metrics included: consumption of antibiotics using days of therapy and defined daily dose, rates of C. difficile and multidrug resistant organisms, resistance patterns, and provider adherence to the ASP. Active stewardship tools such as preauthorization, and prospective feedback/audit were preferred over passive tools such as order sets and automatic stop orders. A physician champion and a clinical pharmacist with infectious disease training were core elements in the multidisciplinary team. Despite certain areas being considered key for stewardship, participants emphasized a hospital-wide approach including outpatient departments; discharge stewardship emerged as a primary theme. Leadership supported ASPs with finances, rapid and novel diagnostics, Clinical Decision Support Systems, mobile technology, and continuous staff training. ConclusionsThe social marketing framework has been used to explore pharmacist perceptions that inform successful qualities including metrics, restriction methods, personnel, benefits, barriers, training needs/modes, and promotional avenues that support ASPs in hospitals.

Decreasing Antibiotic Use in a Community Neonatal Intensive Care Unit: A Quality Improvement Initiative.

In view of the excessive use of antibiotics in our neonatal intensive care unit (NICU), we launched a 5-year multidisciplinary quality improvement (QI) initiative in our NICU in 2018. We had set our aim of decreasing the antibiotic use rate (AUR) from 22 to 17%. The QI initiative was conducted in our 53-bed level 3B NICU. We used the core elements of antibiotic stewardship and focused on improving gaps in knowledge by using updated standards of care and a multidisciplinary approach. Outcome measures included overall AUR in NICU. Statistical control chart (P chart) was used to plot the AUR data quarterly. The AUR demonstrated a decline at the onset, and at the end of the initiative the AUR demonstrated a sustained decline to 13.18%, a 40% decrease from the baseline AUR of 22%. The changes that were implemented included development of evidence-based guidelines for babies less than and greater than 35 weeks, daily antibiotic stewardship rounds, sepsis risk calculator, antibiotic stop orders (48-hour stop, 36-hour soft stop, and 36-hour hard stop), and periodic reviews. Our multidisciplinary approach using all the core elements of an antibiotic stewardship program significantly decreased AUR in our NICU. · Excessive use of antibiotics may cause harm to the infant's health.. · Indiscriminate use of antibiotics can lead to antibiotic resistance.. · Stewardship programs can significantly decrease AUR in NICUs..

Reducing catheter-associated urinary tract infections in the cardiac intensive care unit with a coordinated strategy and nursing staff empowerment

BackgroundCatheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. The use of urinary catheters is associated with several complications and increased mortality and morbidity. At the...

Introduction to Algorithmic Trading Strategies

In the past few decades, securities trading has experienced significant changes as more and more stages within the trading process have become automated by incorporating electronic systems. This Paper gives an overview of Algorithmic Trading and its benefits in the ever-advancing technology where industries are revolutionized by the automation and optimization of tedious manual processes. The trade management industry is no exception. The paper then talks about different commonly used Algorithmic Strategies used for Trading Execution illustrated with the help of examples. There are different market situations and trader’s requirements depending on which different Algorithmic Strategies are used, and this paper will try to uncover those areas. We specifically would cover Market Order, Limit Order, Iceberg Order, Stop Order, Trailing Stop Order, Market-Not Held Order, and Momentum Strategy

Automatic Stop Orders for Opioids

&#x0D; Automatic stop orders may reduce or have no significant effect on opioid-based prescriptions at the institutional level.&#x0D; We did not find any evidence regarding a range of clinical outcomes (e.g., rates of opioid dependence, misuse, and diversion; reduction in opioid dependence, health-related quality of life, and adverse events) associated with automatic stop orders.&#x0D; We did not find any evidence-based guidelines regarding the use of automatic stop orders for opioid prescriptions.&#x0D; Given the limited number and observational, nonrandomized design of the included studies, as well as the absence of any evidence-based guidelines regarding the use of automatic stop orders for opioid prescriptions, it was difficult to draw any firm conclusions about the clinical effectiveness of automatic stop orders for opioid prescriptions in the Canadian context.&#x0D;

Right to Roam? Nineteenth-Century Commons and Caroline Lesjak's The Afterlives of Enclosure

It is August 2022, and I am sitting in the British Library completing a shamefully late review (this one) when I see the headline: “Trespassers Demand Right to Roam Minister's 12,000 Acre Estate.” One hundred fifty protesters led by activist Nadia Shaikh and complete with a Morris dancing troupe walked into the Englefield estate of Richard Benyon, the UK government minister responsible for access to nature, as part of a campaign around public access to land. Benyon's ancestral estate contains sizeable areas of former common land enclosed by his ancestor, also Richard Benyon, in 1802. Nick Hayes, author of The Book of Trespass, who was at the protest, added: Over the next twenty years [Richard Benyon] moved an entire village out of sight of Englefield house to make way for his deer park. Then, in 1854, a stopping order was granted by his friends in parliament to close the public road that ran in front of his house. Today the Ramblers’ “Don't Lose Your Way” website reveals a former footpath running through the estate, identifiable on old Ordnance Survey maps, but which has since been extinguished.Like many other activists over the past three hundred years or more, Shaikh organized a walking—and singing and dancing—resistance to the legal fact of enclosure that leaves only 8 percent of English land with free access. As Raymond Williams reminded readers in The Country and the City (1973), the “mathematical grids of enclosure awards, with their straight hedges and straight roads, are contemporary with the natural curves and scattering of the park scenery.”

Determination of the Enablers and Challenges in the Implementation of Pharmacy-based Antimicrobial Stewardship (AMS) Program in a Level 3 Hospital in Manila.

Antimicrobial resistance (AMR) is a global public health threat that results from misuse and overuse of antimicrobials. The Department of Health (DOH) institutionalized the Antimicrobial Stewardship (AMS) Program in hospitals, based on the core elements (1) Leadership, (2) Policies, Guidelines, and Pathways, (3) Surveillance Antimicrobial Use (AMU) & AMR, (4) Action, (5) Education, and (6) Performance Evaluation to ensure rational use of antimicrobials and improve patient outcomes. The program implementation will require the involvement of the AMS clinical pharmacist to positively influence the success of the program's implementation. This study aims to identify the enablers and challenges as perceived by AMS clinical pharmacists in the implementation of an AMS program in a level 3 hospital in Manila. A quantitative descriptive study design was employed by administering an online 50-item survey questionnaire to AMS pharmacists, who have at least six (6) months of experience as an AMS pharmacist in the hospital. The survey questionnaire was validated by an expert consultant and underwent pre-testing (Cronbach α = 0.983) for acceptable internal consistency. Responses were collated, coded, and analyzed using median values and frequency distributions for each questionnaire item per Department of Health (DOH) Core Element. Items garnering a median of >3.50 up to 5 were considered as perceived enablers, while those ≤3.50 were identified as perceived challenges. Some perceived enablers by the AMS pharmacists include presence of a leader and/or clinician in the AMS team, Information Technology (IT) resource availability, clear roles of AMS pharmacists, readily available hospital AMS guidelines, engagement in AMR and AMU surveillance activities, regular performance of AMS interventions (e.g., IV-to-PO conversion, dose optimization, de-escalation of broad spectrum), regular monitoring and evaluating of prescriptions and prescribing behavior, and continuous education on infection, prevention, and control (IPC) and hygiene. On the other hand, some perceived challenges include insufficient funding, inadequate knowledge in interpreting antibiograms, lack of adequate and specialized training sessions, lack of coordination with medical and nursing staff to ensure timely drug administration and automatic stop order, prescribing of non-Philippine National Formulary (PNF) antimicrobials, lack of time to perform AMS activities, lack of qualified personnel, and lack of hospital management and information technology (IT) support. Empowering AMS clinical pharmacists is vital to addressing the perceived challenges and maximizing the perceived enablers to ensure the successful implementation of the AMS program in the hospital.

Decreased Antibiotic Exposure for Suspected Early-Onset Sepsis in the Neonatal Intensive Care Unit Through Implementation of an Antimicrobial Time-out.

Antimicrobials are among the most frequently prescribed drugs in the neonatal intensive care unit (NICU), although most neonates exposed lack a bacterial infection. Overuse of antimicrobials carries risk to the patient and fosters the development of resistant organisms. Strategic and systematic processes hold promise to limit the unnecessary use of these drugs in this population. This study reports a quality improvement initiative in which 2 antimicrobial stewardship strategies were implemented in a large, regional NICU setting: an automatic stop order and an antimicrobial time-out. Antimicrobial use was compared before and after implementation. These 2 simple strategies were associated with a nearly 30% reduction in antibiotic use (31 days per 1000 patient days).

Legal responsibility for illegal crossing of the state border: foreign experience of legal regulation

In the scientific article, the authors conducted a study of foreign experience in prosecuting for illegal crossing of the state border under the laws of neighboring countries and the European Union. Based on the study, the authors concluded that according to foreign legislation on liability for illegal crossing of the state border, such acts are mostly criminal liability (especially post-Soviet states, except Ukraine, Belarus, Estonia and Moldova; the United Kingdom of Great Britain and Northern Ireland; Poland; France; Germany). However, the legislation of many European Union countries, including the Czech Republic, Slovakia and Estonia, provides for criminal liability only if there are aggravating circumstances when crossing the state border, providing for administrative liability for crossing the state border in other cases. Such circumstances are: use of force or threat of imminent use of force when crossing the state border, violation of the air border, ignoring the stop signal or order issued by a border guard official, crossing the border by a group of persons or a vehicle in a place not intended to cross the border, repeated offense while crossing the border, causing serious damage to health or life of a border guard official. Similarly, the legal regulation of legal liability for illegal crossing of the state border in Ukraine is an administrative offense, but in the presence of qualifying circumstances (illegal crossing of the state border to harm the interests of the state, as well as illegal crossing of the state border by a person prohibited entry into the territory of Ukraine, or representatives of units of the armed forces or other law enforcement agencies of the aggressor state) – a crime. Belarusian law provides for administrative liability for illegal crossing of the state border for the first time, and criminal liability for repeated offenses. States such as the Republic of Slovenia and the Republic of Moldova, whose legislation does not provide for criminal liability for illegal entry and illegal stay in the country, consider illegal crossing of the state border exclusively as an administrative offense.

Generalization of affine feedback stock trading results to include stop-loss orders

The main question we would like to address in this paper is as follows: Given a geometric Brownian motion (GBM) as the underlying stock price model, what is the cumulative distribution function (CDF) for the trading profit or loss, call it g(t), when an affine feedback control strategy with stop-loss order is considered? Moreover, is it possible to obtain a closed-form characterization for the desired CDF for g(t) so that a theoretician or practical trader might be benefited from it? The answers to these questions are affirmative. In this paper, we provide a closed-form expression for the cumulative distribution function for the trading profit or loss. In addition, we show that the affine feedback controller with stop-loss order indeed generalizes the result without stop order in the sense of distribution function. Some simulations and illustrative examples are also provided as supporting evidence of the theory.

Impact of a computerized physician order entry (CPOE)-based antibiotic stewardship intervention on the treatment duration for pneumonia and COPD exacerbations

BackgroundIn hospitalized patients, the duration of antibiotic therapy for uncomplicated pneumonia is often longer than recommended in clinical guidelines. Consequences include increased risk of Clostridioides difficile infection and the emergence of antibiotic resistance. Reducing the duration of antibiotic therapy is an important goal of antibiotic stewardship (ABS) programs. ObjectiveTo evaluate the impact of a computerized physician order entry (CPOE)-based ABS intervention on treatment duration in respiratory infections and on antibiotic use. MethodsA new type of prescription tool featuring a “soft stop order” was introduced into the CPOE system in the Respiratory Medicine department of a Thorax Center. The effect of this intervention was evaluated after 24 weeks using a retrospective before-and-after study design. ResultsA total of 210 patients were evaluated (preintervention group n = 109, postintervention group n = 101). Mean antibiotic treatment duration decreased from 9.59 days to 7.25 days (p < 0.001). It was reduced from 9.93 to 7.21 days (p < 0.001) in community-acquired pneumonia, 10.21 to 7.81 days (p = 0.05) in hospital-acquired pneumonia and 7.81 to 6.83 days (p = 0.14) in COPD exacerbations. The proportion of patients treated according to clinical guidelines increased from 35.8% to 69.3% (p < 0.001). The mean quarterly antibiotic use density was 41.2 RDD/100 PD (recommended daily doses per 100 patient days) before the intervention and decreased to 34.03 RDD/100 PD after the intervention (p = 0.037). ConclusionOur study demonstrates the short-term effectiveness of a CPOE-based ABS intervention to reduce antibiotic treatment duration for uncomplicated pneumonia. This approach may be particularly suitable for hospitals with limited ABS resources.

Implementation of a multidisciplinary antimicrobial stewardship programme in a Philippine tertiary care hospital: an evaluation by repeated point prevalence surveys

Optimising antimicrobial prescribing in hospitals through antimicrobial stewardship (AMS) is essential in addressing the global threat of antimicrobial resistance. The objective of this study was to evaluate the impact of a hospital-wide programme, delivered by a multidisciplinary AMS team, on antimicrobial prescribing outcomes. The AMS programme consisted of a combination of persuasive, restrictive, and structural components and was implemented in two phases. We used data from the Global-PPS, collected every six months between September 2017 and December 2019, to measure the antimicrobial use prevalence and monitor selected antibiotic prescribing quality indicators. A significantly increasing trend (P < 0.001) was observed for the indicators related to documentation of prescribing, that is the reason for treatment and stop or review date. We observed a significantly decreasing trend (P < 0.001) in the number of prescriptions for surgical antibiotic prophylaxis (SAP) prescribed for more than 24 h; however, sample sizes for surgical patients were small. For these three indicators, a sudden and pronounced improvement was seen after the second set of interventions, which consisted of (i) an antibiotic documentation policy, (ii) a 24-h automatic stop order for SAP, and (iii) dissemination of new SAP guidelines. A significantly decreasing trend was also observed for hospital-wide antimicrobial use prevalence (P < 0.001). The implementation of a multidisciplinary antimicrobial stewardship programme positively influenced antibiotic prescribing practices. Further research should address long-term trends in antibiotic prescribing to establish whether these coordinated activities have led to a sustained behaviour change among prescribers, thereby also evaluating clinical outcomes and antimicrobial resistance rates.

Antibiotic stewardship in NICU: De-implementing routine CRP to reduce antibiotic usage in neonates at risk for early-onset sepsis.

Antibiotic overuse is common in the neonatal intensive care units (NICUs). We evaluated the change in antibiotic utilization rate (AUR) by eliminating routine CRP in the management of early-onset sepsis (EOS). Retrospective before-after cohort study in a Level 3B NICU. We made the following practice changes in the management of EOS: (1) stop routine CRP and (2) implement an automatic stop order (ASO) for antibiotics at 48 h. We compared the AUR, defined as any antibiotic use per 1000 patient days before and after practice change. There was an absolute reduction of 30% in AUR and a decrease in the proportion of neonates receiving antibiotics from the day of life 3-6 in postintervention period. We did not identify any case of partially treated EOS with change in practice. Elimination of routine CRP and ASO implementation for antibiotics in neonates at risk for EOS decreased AUR.

Current Practices in Infection Prevention: A 3-year Survey of Michigan Nursing Homes’ Urinary Tract Infection Prevention Strategies

Background Robust infection prevention and control (IPC) programs with evidence-based policies, audits, staff education and data-sharing are critical to safe nursing home (NH) resident environments. The purpose of this study was to identify outcome and process measure data in NHs to prevent both non-catheter and catheter-associated urinary tract infections (UTIs and CAUTIs). Methods Over a three-year period, 58 NHs participated in a 12-month program to reduce healthcare-associated infections by enhancing relationships between NHs and hospitals. A 36-question survey on IPC characteristics was distributed prior to the start of each cohort for years 2018-2020. All surveys were completed prior to March 2020 when the first case of COVID-19 was identified in Michigan. Surveys were completed by infection preventionists, directors of nursing, or NH administrators. Results 55 NHs (95%) completed the survey. Most were aware of their UTI and CAUTI rates (93%, 87%). Policies on catheter insertion, care and other UTI/CAUTI prevention practices were common, but frequency of staff training was inconsistent with some NHs providing education at hire (55%), annually (70%), “when needed” (60%) or never (4%). Less than half were aware of their hand hygiene rates (45%); 36% were aware of gown/glove use. 100% shared infection data with NH leadership, 70% with bedside nursing staff and 26% with residents and families. UTI/CAUTI prevention strategies included hydration practices (77%); nurse-initiated indwelling urinary catheter (IUC) discontinuation (59%); stop orders (45%); indwelling device rounds (28%); and electronic alerts (25%). 57% used cranberry juice/tablets to prevent UTI/CAUTI despite weak evidence of efficacy. Conclusions While awareness of UTI and CAUTI rates is high, process measures like hand hygiene rates and gown/glove use are not evaluated consistently. Hand hygiene and use of personal protective equipment have heightened priority during the current COVID pandemic. NHs have made significant progress operationalizing many evidence-based infection prevention practices but gaps exist.