Dianne Adkins

Innovating to create precedent

Dianne Adkins, RN, BSN
Hale Anuenue Restorative Care Center
Hilo, Hawaii

While overall infection rates were low at the 120-bed Hale Anuenue Restorative Care Center, Dianne Adkins noted that urinary tract infections (UTIs) comprised one-third of the long-term care facility’s total. The majority of these UTIs were among women, some with mild-to-moderate dementia. 

Adkins hit upon the idea of reducing UTI incidence by creating an education program for Hale Anuenue’s female residents. Unfortunately, she could not find a precedent for teaching infection prevention self-care to residents in a long-term care setting, particularly those with cognitive challenges.

“Just because there isn’t a model doesn’t mean it’s not worth doing,” said Adkins, who decided to create the model herself.

She went first to Hale Anuenue’s nurse’s aides, reviewing techniques of peri-care and gathering feedback about problem areas. Based on aides’ input, standards of care, and standards for educating individuals with dementia, Adkins developed a culturally-sensitive education program. The plan involved a multidisciplinary team – a social worker, activities staff, and food service to ensure residents’ comfort and generate excitement. During the sessions, Adkins explained that too many residents were becoming ill due to UTIs and requested residents’ help to address the problem. She then used a mannequin to demonstrate peri-care technique. 

Prior to the program, Hale Anuenue recorded 26 E.coli-associated UTIs in one year. The year following the educational sessions, this number dropped to eight. 

Just as important from Adkins’ perspective, the program empowered and enlivened facility residents. “It really went far beyond self-care instruction,” she said. “Residents were honored to be included in our goals. One stopped me to say, ‘Thank you for finding me worthy of education.’”

Hale Anuenue’s 2013 infection prevention plan includes one educational session per quarter; the residents can’t wait. “They constantly ask me how we are doing with UTIs and ‘When is the next session?’” said Adkins. “This goes to show: Don’t ever sell your ideas short.”