Bedside Nurses Help Expediate Process of C. Difficile Testing When Independently Ordering Tests

Allowing nurses who work bedside to independently order testing for Clostridium difficile infection (CDI) can significantly decrease the amount of time to receive test results when compared to requiring a physician’s approval, according to the results of a study published in the American Journal of Infection Control.

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The results also suggested that the testing policy change could decrease the risk of additional infections and the corresponding economic burden on the hospital.

“Given the implications of CDI on both a hospital and patient level, incentives exist for improving approaches to the prevention and spread of this infection in the clinical environment,” lead study author Ashley Bartlett, MD, of the Fargo Veterans Affairs Healthcare System, in Fargo, North Dakota, said in a press release. “Our findings suggest that allowing bedside nurses with appropriate training to order C. difficile testing based on patient symptomology could be a valid strategy to help healthcare systems achieve this goal.”

CDI is one of the most common health care-associated infections. The study authors noted that early detection, isolation, contact precautions, environmental cleaning, and appropriate antibiotic treatment can decrease the spread of the infection and lower the rate of morbidity and mortality.

At a single site, the infectious disease and nursing staff developed a policy change that allowed nurses to order stool samples for new patients that displayed symptoms of CDI. Normally, the policy requires a physician’s electronic signature.

The study authors evaluated the effectiveness of the new policy, which included comparing the frequency of tests that were ordered, the time to obtain test results, the number of positive and negative tests, and the time to initiate treatment for positive CDI tests. Investigators measured data from 44 months before and 59 months after the policy change.

After the policy change, investigators found that approximately 51.1% of physicians and 48.9% of nurses were ordering the stool PCR tests. The percentage of positive and negative test results before and after were relatively unaffected at 13.9% and 11.5%, respectively. Investigators said that this shows that allowing nursing staff to order stool samples did not increase unnecessary laboratory resources or become a financial burden to the hospital.

The average difference in time to obtain the test results after the lab test order was statistically significant before compared to after the policy change at 2.1 hours to 1.3 hours. Furthermore, investigators reported that the difference in time to obtain the test results after the lab order between nurses and physicians was 1.2 hours and 1.3 hours, respectively.

There was no significant difference in time to initiate treatment before and after the policy change at 1.7 hours for both. Investigators suggested that this was due to the process of notifying physicians to initiate antibiotic treatment did not change. Nurses did not directly receive the test results, nor could they order the antibiotics.

Reference

Study shows hospital policy allowing nurses to initiate C. difficile testing could reduce infection spread and associated morbidity. News release. EurekAlert. May 11, 2023. Accessed May 18, 2023. https://www.eurekalert.org/news-releases/988510