Author ORCID Identifier
Semester
Summer
Date of Graduation
2024
Document Type
Problem/Project Report
Degree Type
DNP
College
School of Nursing
Committee Chair
Billie S. Vance
Committee Co-Chair
Ashley Barber
Committee Member
Carrie Cozart
Committee Member
Aaron M. Ostrowski
Abstract
ABSTRACT
Background: Clostridium difficile infection (CDI) is a prevalent infection often contracted in hospitals. CDI is also increasingly originating from community settings. In addition to the health risks associated with CDI, diagnosis of a hospital-acquired CDI can have a significant financial impact on hospital systems. When hospital acquired, hospital systems are no longer reimbursed by payers. Secondary to the increasing prevalence of community-acquired CDI, mechanisms for early detection and isolation are warranted.
Local Problem: J.W. Ruby Memorial Hospital has an integrated Clostridium difficile (C. difficile) electronic health record (EHR) screening questionnaire that requires updating to align with current guidelines.
Purpose: The purpose of the project was to improve early recognition of community-acquired CDI.
Methods: The Iowa Model Revised was used to guide the development, implementation, and evaluation of an evidence-based change project on three hospital units.
Intervention: Utilizing the existing screening questionnaire, a nurse driven screening protocol that required screening on Day 1, 2, and 3 following admission was implemented. In addition to the screening protocol, a clinical decision guide was developed to support nurse decision making about specimen collection and isolation.
Results: Despite implementation strategies, only 21% of patients were screened on all three days following admission. A specimen was ordered and collected on all patients who screened positive. Five out of the seven specimens tested positive for C. difficile, indicating a 71% positivity rate and identifying five cases of community-acquired CDI.
Conclusion: The nurse-driven screening protocol increased detection of community-acquired C. difficile cases. Policy changes allowing nurses to independently place orders for specimen collection, integration of the clinical decision guide into the EHR, and the addition of best practice advisories to prompt daily screening would increase sustainability.
Recommended Citation
Magnuson, Sandrela, "Implementing a Nurse-Driven Clostridium Difficile Screening Protocol" (2024). Graduate Theses, Dissertations, and Problem Reports. 12564.
https://researchrepository.wvu.edu/etd/12564
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