Date of Award

5-6-2016

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Tom Blodgett

Abstract

For many years the number of Clostridium difficile infections (CDI) has steadily risen. This common cause of antibiotic-associated diarrhea can have variable clinical presentations ranging from mild diarrhea to severe cases complicated by the development of pseudomembranous colitis, electrolyte abnormalities, dehydration, sepsis, and even death. The resistant nature of the spores produced by the bacteria and the emergence of hypervirulent strains have made treatment challenging. Previous studies have demonstrated clinician non-adherence to CDI clinical treatment guidelines may result in poor patient outcomes. This evidence-based practice project was implemented at a 311 bed academic medical center in the Midwest. The project development, implementation, and evaluation was guided by the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care. Pre-post analysis was used to determine the effect of clinician utilization of an evidence-based CDI treatment order set on clinical cure rate (resolution of diarrhea and no longer requiring treatment for CDI), 30-day disease recurrence, and 30-day readmission rates for CDI. Treatment guideline adherence was 35% in pre-implementation group and 48.9% in post-implementation group (p= 0.113). Guideline adherence did not have a statistically significant effect on recurrence rates (12.3% vs 14.8%, p = 0.425) or clinical cure rates (15.8% vs 23.9%, p = 0.241). The rate of 30-day readmission was higher among the guideline treatment adherent group (7% vs 1.1%, p = 0.078). However, this finding was not statistically significant. Clinician order set utilization increased the rate of guideline adherence versus clinicians that did not use the order set in the post-implementation group (83.3% vs 43.6%, p = 0.096). Although this is a promising result, the small sample size was not adequate enough to demonstrate statistical significance. Further studies are needed to determine the impact of clinician treatment guideline adherence on patient outcomes.

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