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The U.S. Department of Veterans Affairs has honored the work of pharmacists who developed procedures to reduce the amount of urine cultures ordered by physicians.

Their work earned them the Network Star Award for the Veterans Integrated Service Network for the five-state, upper Midwest region. The team of clinical pharmacists and one infectious disease physician included Mike Lemon, Andrea Aylward and Kaitlyn Latour.

Lemon has worked with �ձ�av��Ƶ at the VA Black Hills in Sturgis since December 1997. Aylward and Latour are �ձ�av��Ƶ grads. Aylward works at VA Sioux Falls, while Latour is at the VA in St. Cloud, Minnesota.

The nine-member team had representatives from each state within its network — South Dakota, North Dakota, Nebraska, Iowa and Minnesota.

Lemon, who also precepts students in their final year of pharmacy school for rotations in internal medicine and psychiatry, said the new treatment plan came to be after the antimicrobial stewardship group at the Minneapolis VA noticed many inappropriate urine cultures that led to antibiotic use and infectious disease consults.

Lemon explained, “If a urine culture is ordered on a urine sample and the patient does not have symptoms, then the culture may show asymptomatic bacteriuria and the patient may be treated with unnecessary antibiotics.”

He said that antibiotic overuse can lead to “increased antibiotic resistance, adverse drug effects, and may increase the risk of diarrhea resulting from Clostridioides difficile (“C diff") infection following antibiotic treatment. 

Previously, a health care provider only had to enter a culture order without identifying an indicator to justify the culture. Now an indicator, such as fever without other identifiable cause or pelvic pain, is required.

Lemon noted a “significant” reduction of 26% in urine culture orders at the Minneapolis VA. He reported average cultures per month were 765 prior to the change and 564 afterward.

He said it can be a lengthy process to implement the change within the VA system, including antimicrobial stewardship committees working with clinical applications coordinators and then educating facility staff on the changes. In the case of the VA Black Hills, it took three months, Lemon said.

Robert McDivitt, executive director of the VA Midwest Healthcare Network, said 10 procedural changes in three categories were honored this summer. 

He noted, “These practices have been effectively implemented throughout VISN 23, delivering significant benefits to veterans, staff and communities. They exemplify the commitment to high reliability and continuous improvement.”