Skip to main content Accessibility help
×
Home
Hostname: page-component-559fc8cf4f-dxfhg Total loading time: 4.51 Render date: 2021-03-03T03:46:58.647Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Implementation Strategies of a Quality Improvement Initiative for Hospital-Acquired Clostridioides difficile Infection Prevention

Published online by Cambridge University Press:  02 November 2020

Nicole Lamont
Affiliation:
University of Calgary
Lauren Bresee
Affiliation:
University of Calgary
Kathryn Bush
Affiliation:
Infection Prevention & Control, Alberta Health Services
Blanda Chow
Affiliation:
Infection Prevention & Control, Alberta Health Services
Bruce Dalton
Affiliation:
Pharmacy Services, Alberta Health Services
Cody Doolan
Affiliation:
University of Calgary
Peter Faris
Affiliation:
University of Calgary
Jared Fletcher
Affiliation:
Mount Royal University
Sara Hartman
Affiliation:
University of Calgary
Jaime Kaufman
Affiliation:
University of Calgary
Maida Khan
Affiliation:
University of Calgary
Joseph Kim
Affiliation:
Alberta Health Services/University of Calgary
Maitreyi Kothandaraman
Affiliation:
Alberta Health Services/University of Calgary
Scott Kraft
Affiliation:
Alberta Health Services/University of Calgary
Oscar Larios
Affiliation:
Alberta Health Services/University of Calgary
Jenine Leal
Affiliation:
Alberta Health Services/University of Calgary
Braden Manns
Affiliation:
Alberta Health Services/University of Calgary
Bayan Missaghi
Affiliation:
Alberta Health Services/University of Calgary
Wrechelle Ocampo
Affiliation:
University of Calgary
Dylan Pillai
Affiliation:
University of Calgary
Paule Poulin
Affiliation:
Alberta Health Services
Deana Sabuda
Affiliation:
Pharmacy Services, Alberta Health Services
Ye Shen
Affiliation:
Infection Prevention & Control, Alberta Health Services
Thomas Louie
Affiliation:
Alberta Health Services/University of Calgary
Jayna Holroyd-Leduc
Affiliation:
Alberta Health Services/University of Calgary
John Conly
Affiliation:
Alberta Health Services/University of Calgary
Rights & Permissions[Opens in a new window]

Abstract

Background: Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea in hospitalized patients. Probiotics have been studied as a measure to prevent CDI. Timely probiotic administration to at-risk patients receiving systemic antimicrobials presents significant challenges. We sought to determine optimal implementation methods to administer probiotics to all adult inpatients aged 55 years receiving a course of systemic antimicrobials across an entire health region. Methods: Using a randomized stepped-wedge design across 4 acute-care hospitals (n = 2,490 beds), the probiotic Bio-K+ was prescribed daily to patients receiving systemic antimicrobials and was continued for 5 days after antimicrobial discontinuation. Focus groups and interviews were conducted to identify barriers, and the implementation strategy was adapted to address the key identified barriers. The implementation strategy included clinical decision support involving a linked flag on antibiotic ordering and a 1-click order entry within the electronic medical record (EMR), provider and patient education (written/videos/in-person), and local site champions. Protocol adherence was measured by tracking the number of patients on therapeutic antimicrobials that received BioK+ based on the bedside nursing EMR medication administration records. Adherence rates were sorted by hospital and unit in 48- and 72-hour intervals with recording of percentile distribution of time (days) to receipt of the first antimicrobial. Results: In total, 340 education sessions with >1,800 key stakeholders occurred before and during implementation across the 4 involved hospitals. The overall adherence of probiotic ordering for wards with antimicrobial orders was 78% and 80% at 48 and 72 hours, respectively over 72 patient months. Individual hospital adherence rates varied between 77% and 80% at 48 hours and between 79% and 83% at 72 hours. Of 246,144 scheduled probiotic orders, 94% were administered at the bedside within a median of 0.61 days (75th percentile, 0.88), 0.47 days (75th percentile, 0.86), 0.71 days (75th percentile, 0.92) and 0.67 days (75th percentile, 0.93), respectively, at the 4 sites after receipt of first antimicrobial. The key themes from the focus groups emphasized the usefulness of the linked flag alert for probiotics on antibiotic ordering, the ease of the EMR 1-click order entry, and the importance of the education sessions. Conclusions: Electronic clinical decision support, education, and local champion support achieved a high implementation rate consistent across all sites. Use of a 1-click order entry in the EMR was considered a key component of the success of the implementation and should be considered for any implementation strategy for a stewardship initiative. Achieving high prescribing adherence allows more precision in evaluating the effectiveness of the probiotic strategy.

Funding: Partnerships for Research and Innovation in the Health System, Alberta Innovates/Health Solutions Funding: Award

Disclosures: None

Type
Poster Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 37 *
View data table for this chart

* Views captured on Cambridge Core between 02nd November 2020 - 3rd March 2021. This data will be updated every 24 hours.

Access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Implementation Strategies of a Quality Improvement Initiative for Hospital-Acquired Clostridioides difficile Infection Prevention
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Implementation Strategies of a Quality Improvement Initiative for Hospital-Acquired Clostridioides difficile Infection Prevention
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Implementation Strategies of a Quality Improvement Initiative for Hospital-Acquired Clostridioides difficile Infection Prevention
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *