Technological Tools in the Fight Against Clostridium Difficile
Handout (613.4 kB)
The Stop Clostridium Difficile (C Diff) Project is an innovative quality improvement effort that strives to eliminate the transmission of C Diff. Electronic Medical Record (EMR) tools were developed to integrate novel Stop C Diff Project interventions and nurse workflow.
Relevance/Significance:
The Stop C Diff Project screens patients for asymptomatic carriage of the C Diff bacteria, which is known to be transmissible. Subsequent clinician processes became challenging, such as performing C Diff risk assessment and collecting C Diff swab specimens at admission, transfer, and discharge. Current nurse workflows served as a reference in the development of EMR-based Best Practice Advisory (BPA) notification as well as workflow modifications.
Strategy and Implementation:
To ensure the efficacy of EMR tools, an enriching exchange of ideas between Stop C Diff Project members and bedside nurses continuously occurred. At admission patients are asked 4 C Diff Risk Assessment Questions. The expectation is that this is to be done within 24 hours. Initially compliance was low. Discovered barriers to the C Diff Risk Assessment Questions included their partial completion and unfamiliar workflow. A BPA reminder system with a direct link to the risk assessment was designed to trigger if the workflow was not fully completed. Though nurses often completed the C Diff admission swab, the discharge swab was frequently forgotten. Staff stated this was a workflow issue due to the busy discharge process. Unit-based interventions were trialed. More notably nurses requested an EMR reminder system within the pre-existing discharge checklist. A soft stop reminder was implemented, designed to remind yet not delay the discharge process.
Evaluation:
Prior to the implementation of the EMR-based C Diff Risk Assessment BPA weekly hospital-wide compliance ranged from 73%–88%, afterwards it increased to 92%-95%. Similarly, prior to the introduction of the EMR-based C Diff discharge swab checklist prompt weekly hospital-wide compliance ranged from 48%-78%, afterwards it increased to 69%-92%. The developed EMR tools were successful.
Implications for Practice:
Specific implications for nursing practice include the valuing of current nurse workflows, empowering and engaging bedside nurses, leveraging EMR capabilities, encouraging contextual technological creativity, and strengthening the bond between practicing clinicians and health informatics experts.